“I’m passed the point of utter despair from it. With no gp support it was horrendous. … I was petrified of the outcomes for her. She gained weight slowly but screamed constantly and still suffers from periods of it. Some professionals don’t see it as a burden but I certainly think it changed me”
Reflux and “silent reflux.”
I’m kind of surprised it took us so many months to get to this one, because this one is an important topic to myth-bust. What do I hope you can take away from this discussion this morning?
1. The misinformation and urban myth surrounding reflux in infants is everywhere; the advice given online or in mammy-groups can be unhealthy and/or dangerous.
2. The biggest risk in infant reflux/colic is not to the infant at all, it is to the mother’s health. Really. Just read the question above again.
Actually, 90% of the time, it’s just a normal part of being a baby.
Reflux is when the milk in the tummy moves back and up into the oesophagus, and sometimes out through the mouth (and nose). This is normal in infants. Docs also call them “happy spitters,” because they are not cranky and do not appear to be in a great deal of pain. They will naturally grow out of it. It starts at 2-3 weeks of age, gets worse until around 5 months, and then gradually improves around 12 months, but may take until age 18-24 months to fully settle.
When reflux causes symptoms or the child doesn’t grow out of it, then it is considered a disease.
**Today’s Take Away Message 1: You don’t need to treat your young infants “spitting up” if there is no other problem/concern. It is more than likely normal.
So, when is the reflux NOT normal?
● Refusal to feed
● Crying and/or arching the back DURING feeds
● Blood or greenish color in the spit-up
● Forceful spit-up
● Belly is swollen or feels hard
● Wheezing and coughing
● Baby isn’t gaining weight or is having fewer wet and dirty diapers
If your child has any of those symptoms, you need to ring your GP. Your GP will usually start first line treatments, and may often send your child to be seen by a consultant paediatrician or a paediatric gastroenterologist.
The average age of the onset of colic (excessive crying for no reason) is 3 weeks, and that is also the age of the onset of normal reflux. Many parents worry that reflux is the cause of their child’s excessive crying, irritability or difficulty sleeping. In 25 years of multiple dedicated studies, the actual number is only around 10% of infants with colic/crying symptoms have abnormal reflux. Irritability and difficulty sleeping are problems that can be related to a number of conditions.
**Today’s Take Away Message 2: Excessive crying, irritability, and poor sleep in an infant ages 3 weeks to 3 months may have many causes, not just reflux. The spitting up and excessive crying are both very common in this age.
14-28% of parents report infant crying as a problem.
Crying starts to increase at around 3 weeks of age to the peak at 6-8 weeks of age, when baby is crying 2.5 hours out of every 24 hours.
‘Colic’ (occurs in 9-12% babies!) is known to docs by rule of 3’s: crying more than 3 hours per day, for at least 3 days per week, over a three week period that resists soothing. Most babies are over-achievers here. This occurs between ages of 3 weeks to 3 months.
***Take Away Message 3: The cause(s) of true colic are unknown. It can’t be fixed. The baby does outgrow it. It is not harmful to your baby, but it is potentially harmful to mother’s mental and physical health. It only becomes harmful for infants as increasingly anger/frustration of parents can lead to Shaken Baby or ill-advised alternative therapies.
What isn’t colic? 30 years of studies have examined possible links to commonly blamed culprits: reflux, food intolerance or allergy. Despite lack of evidence, many breast-feeding mothers change their own diet (if breast feeding) or the infant’s formula. Others seek over the counter medications for reflux.
Problem crying is associated with early weaning from breast milk, frequent changes of formula (not a good idea) and parent depression symptoms. If the parent feels that their infant’s crying is a problem the doc needs to listen, regardless of whether the actual duration of crying meets criteria for ‘colic’. Many times the mother’s thought process, understandably, at breaking point is that there has to be something wrong, everyone has told her it was reflux/milk allergy, and if you fix that, the baby would just stop crying, and then maybe she would be okay. Many depressed mothers don’t realise that the feeling of being overwhelmed or at break point isn’t normal.
And parents are usually desperate. They feel that the GP’s assurances that it is “normal” or “will pass” inadequate, dismissive, or insufficient. The GP is usually correct, but this is no help to a mother at breaking point. Most feel that there must be “something wrong”, and parents usually explore every possible answer online or in parent groups at this point. Alternative practitioners often fill this gap. Alternative therapists have been shown in multiple, rigorous trials to have no impact on crying. [In particular, experts do not recommend chiropractic manipulation of any sort of a young infant.] Other medications/supplements are either ineffective, associated with serious side effects, or may be harmful to infants.
(Remember my rules about CAM: It should be safe, potentially effective, and not misleading/exploitative. In colic, unfortunately, many of alternative treatments are exploiting the desperation of parents at breaking point, are not effective, and some are potentially unsafe. In the next post, we will break that down some more.)
Mothers of babies with colic are more likely to suffer post-partum depression with all those associated problems: anxiety, sleep problems, isolation, trouble concentration, loss of joy, irritability. Infants of depressed mothers are also more likely to have sleep problems or irritability. Often, there is a bit of “chicken and the egg” problem there. Both mother and baby need attention to address the problem.
However, in a busy GP practice, the story often gets lost. It would be great if behind many of the mothers who presents worried about infant reflux or milk allergy, the GP could hear the real problem: the exhaustion and desperation to just stop the crying and for both mother and baby to sleep.
Take Away Message 4: Sometimes it’s reflux, but studies show that 90% of the time, it is something else.
More often than not, we don’t need to fix reflux/colic as much as we need to support Mammy. Both mother AND baby do better in the long run if we do (shown in multiple studies that followed mothers and babies for 5 years). If you are at breaking point, that is a problem in itself. Ask for help: your family, your friends, your midwife, your GP. It’s okay to tell the GP you just can’t cope. It’s a good starting point, and that honest conversation is often more helpful than changing formula.
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