GER occurs in infants with some regularity, especially right after
feeding. Nursery staff members have been known to cringe as they watched
the pediatrician examining a baby they'd just fed. Those who change
baby's outfits are most keenly aware of what happens when she isn't
handled extra-gently after a feeding. In Shakespeare's As You Like It,
babies are described as "puking in the nurse's arms," the reason being
reflux, methinks. Infants who spit up occasionally just need gentle
handling and small, frequent feeding with well-placed burps. If the
spitting continues, the baby can be kept upright for 20 to 30 minutes
after feeding. If this doesn't help, try keeping the baby in a vertical
position for a longer period and thickening her milk with cereal. If the
baby is healthy and thriving, you need do no more than this. Time
solves most reflux, particularly the common, mild variety.
For some reason, once the baby begins to walk, most reflux stops.
Reflux is talked about a lot these days, mainly because of its less
common but more serious aspects. A few children who have it vomit so
frequently that they lose weight. Another small percentage of re-fluxers
bring up the stomach contents only as far as the lower esophagus but
don't regurgitate at all. The latter often end up with their sensitive
membranes inflamed by the acids of the stomach, a risk of blood loss,
and sometimes scars that can narrow the esophagus significantly. Lung
infections and wheezing are two more rare complications that occur when
some of the refluxed material is inhaled into the baby's lungs. This is
more likely to happen when babies have nighttime GER. All of these more
serious manifestations of GER usually require more than just the passage
of time to be cured, so, in these cases, doctors want a clear picture
of just what's happening in the baby's esophagus. In the past, the only
way physicians could get a firsthand look at GER in action was X-ray
examination while the baby swallowed barium.
That test (the esophagram) presented Jots of problems. Since GER
doesn't occur continuously, the test often yielded normal results even
when the problem existed. Also, very enthusiastic examiners, using very
enthusiastic techniques, often got "positive" findings suggesting
problems even in normal subjects. Eventually doctors began to consider
minor degrees of reflux as normal, and only reflux that met certain
criteria was considered significant. The catch here was in deciding on
what was significant. Technology to the rescue, by the way of tiny
pressure transducers inside tubes that can be passed into the esophagus.
These new transducers reveal whether or not the pressure in the
baby's lower esophagus is too low to prevent GER. If your doctor wants
to see if your baby's esophagus is inflamed bythe stomach's acid, he can
have a very narrow, illuminated, flexible tube passed directly into the
gullet and see firsthand.
Scanning over the esophagus and lungs after
feeding the baby a radioactive compound is another space-age way of
detecting GER. These tests are wonderful, but luckily, most refluxers
never need them because their health and weight remain normal, and, as
for treatment, they respond to benign neglect
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