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