GERD: Beyond Spitting Up

Up to 85 percent of premature infants have GERD, a digestive disorder that makes the early months tough on parents. While GERD is one of the most common problems among preemies, most babies outgrow it. Until then, there are things parents can do to minimize its effects.

By Christina Elston

Here's a riddle: What could make a mom prefer walking her beat as a New York City cop to staying home with her baby? Answer: GERD.

Gastroesophageal reflux disease is an extreme form of something that happens to all babies - food traveling backward from the stomach to the esophagus, the tube between the mouth and stomach. GERD is "spitting up" that's persistent and accompanied by pain and crying, weight loss, or difficulty breathing. And for preemies, it's a common problem.

A Problem for Preemies

Because the systems in their bodies that coordinate digestion are still immature, premature babies are more likely than full-term infants to have reflux. It's estimated that 65 percent to 85 percent of premature babies reflux, according to Joseph Levy, M.D., director of the division of pediatric gastroenterology at New York University School of Medicine. This compares with just 10 percent to 20 percent of full-term babies.

Luckily, the condition can often be dealt with at home. One study of otherwise-healthy premature babies who could suck and swallow on their own found that while 60 percent had reflux, just 3 percent to 10 percent had reflux that required medical treatment, according to neonatologist Alice K. Gong, M.D., of University Health System in San Antonio. "Most babies will outgrow this just fine," she says.

But while full-term babies can outgrow reflux in as little as six weeks, for a preemie it might take as long as a year, according to Rula Harb, M.D., a pediatric gastroenterologist at Children's Hospital Los Angeles.

Reflux Clues

Some babies have reflux, but no associated problems. But the Children's Digestive Health and Nutrition Foundation suggests talking with your pediatrician if your baby has:

  • Vomiting that includes blood (bright red streaks or anything that looks like coffee grounds) or green or yellow fluids.

  • Poor weight gain.

  • Crying or arching away from the breast or bottle, or refusal to feed.

  • Choking, coughing or gagging during feeding.


  • Breathing difficulties.

    Joseph Levy, M.D., gastroenterologist at New York University School of Medicine, says that urinary tract infections, metabolic problems, severe diaper rash, food allergies, protein intolerance and lactose intolerance can also make babies spit up. If home care and medications for reflux aren't helping, other possible causes should be explored.

  • A Tough Time for Parents

    And that year won't be easy. Beth Anderson, founder and executive director of the Pediatric/Adolescent Gastroesophageal Reflux Association (PAGER), knows this firsthand. Her two children both began life with severe reflux, and one of her organization's members is that New York City police officer who found walking her beat easier than caring for her baby.

    Parents are rarely prepared for the challenge of caring for an infant with GERD, Anderson says. "A lot of these babies cry. They cry like babies with colic, but instead of lasting for weeks, it lasts for months."

    They also wake several times a night, are fussy for feedings, require twice as much holding and create twice as much laundry as other babies.

    Anderson recalls one day during her daughter's infancy when she came to the end of her rope. She was sleep deprived, her toddler was acting out, and her daughter - who was crying inconsolably - had just spilled her $300 bottle of medicine. Too exhausted to safely drive to the pharmacy and plead for a refill, Anderson handed her screaming infant off to a neighbor she had barely met. "I walked out the front door and gave my daughter away to the first person I saw," she says.

    That incident ended well. Anderson returned for her daughter a few hours later, and the two women eventually became best friends. But Anderson says that parents of babies with reflux often find that other parents don't "get it."

    Home Care for GERD

    With preemies, who generally spend extra time in the hospital, doctors and nurses have time to share home-care strategies with parents.

    "There's a lot of education that goes on in the nursery," says Philip Sunshine, M.D., a neonatologist at Lucille Packard Children's Hospital at Stanford University. "So when the mom goes home, she's really tuned in to what's going on."

    To start, babies with reflux do best with smaller, but more frequent, feedings. And parents of bottle-fed babies are often advised to thicken formula or breast milk with rice cereal. "It's a gravity issue," Harb explains. The cereal makes the formula heavier and helps keep it in the stomach.

    To further put gravity on the baby's side, Levy advises holding or carrying the baby upright for at least 30 to 45 minutes after feedings to give the stomach a chance to empty. Avoid putting a just-fed baby into a car seat, which compresses the stomach and makes reflux more likely.

    Because persistent reflux can cause damage to the esophagus, many doctors prescribe medications to reduce the acidity of the stomach juice. Some doctors also prescribe medications designed to help the stomach empty. Surgical treatment is generally used only in babies who have serious complications from reflux, and those with neurological impairments who are unable to eat normally.

    Additional Coping Strategies

    Back on the home front, Anderson says it is important to understand why your fussy GERD baby is crying. Babies with reflux, she stresses, cry because they are in pain, not because they are "bad" babies. Keep this in mind, and share it with anyone else who will care for your child.

    If you're struggling with breastfeeding - which experts agree is best for both premature infants and infants with reflux - a lactation consultant can help.

    It can also help to talk with other parents whose babies had reflux. There are local support groups available in some areas, and PAGER has 40 volunteers available to offer support by phone or online.

    Ask for help if you need it, and accept help when it's offered. But Anderson says that parents shouldn't farm out all other tasks in favor of caring for their high-needs baby. Let someone else care for the baby occasionally, she advises, and handle a couple of other small tasks or errands yourself. If you have other children, remember that they need some time with you as well.

    This, Too, Shall Pass

    Also remember that this won't last forever. Anderson notes that as babies are able to sit up, stand, and eat solid food, reflux symptoms start to subside.

    She also says that parents and children who have coped with reflux together often form a strong bond. "You become really, really good at reading your child," she says. "You have to notice those first squirms of pain and take care of them as quickly as possible. You become an advocate for that child."

    Levy says that while reflux is one of the most common problems relating to prematurity, most of these babies outgrow it. "Even if they're going to have a hard beginning," he says, "there is reason to be optimistic."

    Christina Elston is a writer specializing in health issues, and a senior editor for Dominion Parenting Media.

    Christina Elston is a writer specializing in health issues, and a senior editor for Dominion Parenting Media.


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