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Presentation by Jessica Tovey and Dr Naomi Farragher, with input from Belinda Salter, Glenda Blanch, Trudi Wynn, the Reflux Infants Support Association.

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Presentation on theme: "Presentation by Jessica Tovey and Dr Naomi Farragher, with input from Belinda Salter, Glenda Blanch, Trudi Wynn, the Reflux Infants Support Association."— Presentation transcript:

1 Presentation by Jessica Tovey and Dr Naomi Farragher, with input from Belinda Salter, Glenda Blanch, Trudi Wynn, the Reflux Infants Support Association Inc and members of the RISA Administration Team. Information primarily sourced from Reflux Reality: A Guide for Families, and seminar presented by A/Professor Peter Lewindon, Paediatric Gastroenterologist, Royal Childrens Hospital Brisbane (May 2010)

2 Mother of Cameron, 19 months GP Registrar at Lowood Medical Center Volunteer with RISA Inc 1 year Parent who survived a child with severe reflux and cows milk protein intolerance

3 Mother of Arabella, 4 years and Jordan, 11 months Currently employed by CCYPCG, and a Trainee Breastfeeding Counsellor with ABA Volunteer with RISA Inc for 4 years Parent to two refluxers

4 What is RISA? Support/information non-profit community group for those caring for babies and children diagnosed with GOR and GORD Australia-wide, operating since 1982 Parent forums, member library, newsletters, Facebook site, phone and email contacts, coffee meet-ups Advocacy

5 What is reflux? Stomach contents enter the oesophagus Vomiting or silent 50% infants < 3 months will reflux, 70% between 4 and 6 months, 5% at 12 months Can be very normal, but if it causes symptoms sufficient enough to interfere with normal life (NASPHGAN Guidelines), it becomes GORD Severity can depend on frequency and composition of the contents rising

6 Why do infants reflux more? Body position Feed composition Increased number of episodes of TLOSRs (transient lower oesophageal sphincter relaxation) Shorter oesophagus

7 Symptoms of reflux Irritability/crying/screaming Vomiting/regurgitating or posseting Appearing to be in pain Repeated hiccups and wind Hoarse voice (damaged vocal cords) Feeding problems: refusal to feed or only taking a small amount despite being hungry comfort feeding- feeding frequently pulling away and arching their back crying/screaming during or after feeds gagging/spluttering Tooth decay and bad breath Constipation or irregular movements Sleeping issues: catnapping during the day frequent night waking easily disturbed from sleep, or restless Respiratory issues: Choking Wheezing/coughing Recurrent chest infections Failure to thrive or overweight Recurrent ear, throat or sinus infections Congestion, snuffling or appearing to have a cold

8 Possible side effects of GORD Feeding problems such as feed refusal, difficulty with certain textures or gagging on feeds Weight loss Failure to thrive (tubes/tube dependence) Comfort feeding leading to weight gain Cyanosis (going blue), life threatening events Sleep disorders Breathing issues such as wheezing, stridor, aspiration Chronic cough Oesophagitis Behavioural issues Sleep disorders Irritability Constant vomiting/vomiting blood (fundoplication) Seizure-like posturing (Sandifers syndrome) Constipation (can worsen the reflux) Emotional aspects – relationship of carers, treatment of baby/child

9 Some causes of GORD Lower oesophageal sphincter (mal)functioning Delayed oesophageal clearance Delayed gastric emptying Genetic (reflux can be an inherited condition) Structural issues – e.g. hiatus hernia, pyloric stenosis Prematurity Neurological conditions – e.g. Cerebral Palsy Food allergy/intolerance Pain response (hypersensitivity) Tobacco smoke, some foods, certain medications

10 Myths about reflux 1.Reflux is just another name for colic 2.All babies have reflux – its no big deal 3.If the parent/baby are having problems, its because youre an inexperienced/first time parent 4.Children have to look sick and cry all the time to have reflux (But she looks so happy/healthy) 5.If an infant gains weight well, their reflux is not serious or worth treating 6.Your child will eat when they are hungry; no child will starve itself 7.Medications such as Omeprazole (e.g. Losec) must be crushed for a baby


12 Our advice to parents Trust your instincts Keep a symptoms diary, take photos or videos of baby crying, have a specific list of concerns GP first – find one who has experience with reflux and is supportive Seek diagnosis, based on symptoms – could be other issue with similar presentation (e.g. UTI, Pyloric Stenosis, neurological or metabolic disorder, etc.) Take a support person with you to appointments (baby usually happy at doctors) Try medications – communicate regularly with GP Get known at the local medical centre or specialists – be persistent for the sake of your child Parenting is instinctual. Even with zero child/baby experience it still comes naturally. If you know something isn't right, trust in that feeling and keep seeking help. Too many parents start doubting themselves on their reflux journey because they can constantly be undermined by people who just don't understand it. Nicki, RISA Mum

13 Referrals Paediatrician – be prepared to find one who has experience with GORD Paediatric Gastroenterologist – specialises in digestive system disorders Paediatric Allergist Feeding Therapy Clinicians (e.g. Speech Pathologist, Occupational Therapist) Specialist Dietitian Social Workers Counselling

14 Other management techniques Baby upright for 30 mins after feeds Use a baby sling Avoid slumping (e.g. baby capsules) that put pressure on the stomach Elevate the head whenever lying down Consider using a dummy Avoid vigorous movements Avoid tummy time after a feed Change nappy before a feed (roll baby to side) Avoid any tight clothing around the waist Avoid exposure to smoke or dust Rocking in a pram or rocker can be helpful Use distraction – go outside, put music on, etc Use a CD or white noise to prevent baby waking Contact a support organisation for emotional support Get out socially – find an understanding group Lower expectations of what you can achieve (e.g. household tasks)

15 Feeding a refluxer Keep baby upright as much as possible Avoid overfeeding - if the baby vomits, wait until the next feeding rather than feeding them again Experiment with feeding amounts and times Experiment with positioning and timing For a refuser, try feeding while just waking up or in a quiet, dark room. Try thickening the feed (Infant Gaviscon or Karicare thickener) after speaking to a medical professional Bottle-fed - try AR (anti-reflux) formula, or a hypoallergenic/soy one (after speaking to a medical professional)

16 Introducing solids early? Some professionals will recommend introducing solids at 3 months of age. The theory behind this is thicker foods will stay in the stomach easier and decrease the reflux Current research shows that the gut of a baby at 3 months of age is not mature enough to digest food and introducing at this early age can increase the risk of food allergies and intolerance Recommendations are between 4-6 months of age (6 months if breastfeeding), when the baby shows signs of being ready for food Many reflux parents have found that early introduction of solids worsens the reflux

17 Allergies and sensitivities A lot of refluxers have food intolerances Cows milk protein intolerance/allergy is one of the most common – approx. 40-50% of reflux babies/kids (note: NOT lactose intolerance) There is a cross reaction with soy for over 50% of babies with a cows milk protein intolerence/allergy. Introduction of solids can be difficult in sensitive children and may need help from health professionals Elimination diets for breastfeeding mothers may be required Having an infant with reflux and/or intolerances does not mean you have to stop breastfeeding

18 Feelings parents may experience This is not what I imagined it would be like (mourning the loss of their parenting dreams) I am a failure as a mother, I am not cut out for this (feeling like you are not coping but should be) Everyone else seems to like their baby more than I like mine (no matter how much you love your baby, not feeling happy around them is not uncommon) I just want to run away Everyone thinks I am a bad parent (the feeling of being judged by other parents, family members, friends and people in the medical profession) Everything is a blur (sleep deprivation may put a reflux parent into auto pilot) This will never end (feeling positive about the situation can be hard) My baby has been in pain everyday of his life (it is devastating to a parent to see their child in pain and feel helpless to do anything about it)

19 Thank you for your time Any questions? Reflux Reality: A Guide for Families can be purchased from Michelle Anderson Publishing, by emailing RISA on, or through various bookstores and online book

20 Thank you for your time Any questions?

21 Some stats currently given to doctors Prognosis of reflux in untreated infants - 60% symptom free by 18 months of age - 30% had troublesome symptoms into childhood - 5% developed oesophageal strictures - 5% died from pneumonia or inanition Prognosis in treated infants - 50% require no further therapy by 10 months of age - Another 30% improve by 18 months - 17% have ongoing symptoms which respond to anti reflux surgery - 2% have persisting symptoms beyond 24 months

22 MEDICATIONS TypeExamplesUsePreparationSpecial NotesSide Effects AntacidsMylanta Gastrogel Calcium Carbonate Short term relief of intermittent symptoms of reflux Liquid or chewable tablet Can interfere with the absorption of some medications Constipation or diarrhoea Thickening Agent Infant Gaviscon, KARICARE thickener Reduce regurgitation in infants; short term relief Powder sachetDo not use with other thickening agents or thickened formula Constipation or diarrhoea Can worsen symptoms Histamine- 2 Receptor Antagonist (H2RA) Ranitidine- Zantac Cimetidine- Tagamet Regular use; suppress acid production Syrup, effervescent tablet; or tablet Weight based medication Headache, nausea, diarrhoea Proton Pump Inhibitor (PPI) Omeprazole- Losec Lansoprazole- Zoton Esomeprazole- Nexium Regular use: stops acid production Tablet/capsule or suspension; injection Pellets are enteric coated; and must not be chewed or crushed (more effective than H2RAs) Constipation, diarrhoea, abdominal pain, nausea, vomiting, headache Prokinetic Agents Motility medication Domperidone Erythromycin Metocloprami d Motilium Regular use: help food move through the gastro-intestinal tract quicker Tablet, liquidBest administered 15- 30 minutes before a feed. Should not be given at the same time as other medications Nausea, vomiting, diarrhoea, abdominal pain, irritability

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