“What comes Up!” – The Guardian (Mar ’05)

“What comes Up!” – The Guardian (Mar ’05)

Reflux causes suffering in as many as one in five babies, but it’s a problem that often goes undiagnosed. Tobe Aleksander knows only too well how bad things can get…

Sam’s arrival was always going to be a challenge. We weren’t exactly in the first flush of our childbearing years, we already had two delightful but demanding young daughters, and we were living in a half-finished house with a dozen builders. Then Sam turned up a month early, small, scraggy and a little underdone. Nothing serious: a little jaundice, some weight-gain issues, a few problems with his rear end. Then there was his digestive system.
Sam, it seemed, was a bit of a “sicky baby”. “Not to worry,” said the midwives and health visitors, “some babies are just like that.” But this wasn’t the usual bit of posseting with an occasional full-on vomit. This was endless streams of regurgitated milk. Sam simply opened his mouth and out flowed whatever he had just taken in. There was no gagging or retching; only the slap of milky sick landing on the floorboards. We nicknamed him “Vomiting Vernon”.
 It was completely demoralising. Breastfeeding had never been my forte, and now Sam wanted to feed every two hours. He clearly found it comforting, and presumably all that throwing up made him hungry. The house was awash with sour milk-soaked muslins. My clothes were permanently sodden. We didn’t bother going out.
And then there was the crying. Endless hours of miserable mewling. Over the years we had done our fair share of pacing and pacifying, but Sam was inconsolable. He didn’t smile; he hardly opened his eyes. At the start we reached for the Infacol. But it made no difference. He began to arch his body and throw his head backwards with increasing violence. His screams pierced the builders’ drills. Yet nothing we did would comfort him. We concluded that we were too old and too haggard for this baby business. We had evidently “lost it”.
 A paediatrician friend watched our tribulations and began to mutter the word “reflux”. We mentioned it to the paediatrician looking after Sam and he concurred. An examination confirmed the diagnosis: Sam had gastro-oesophageal reflux.
 Reflux happens when the stomach contents retreat back up the oesophagus. Sometimes they come all the way up, causing the individual to vomit, and sometimes only part-way, resulting in heartburn or “silent” reflux. Reflux usually occurs because the oesophageal sphincter, the valve between stomach and oesophagus, is not working properly. Instead of closing after food or liquid enters the stomach, the valve remains relaxed. When the stomach contracts to force food out through the intestines, the relaxed valve allows the food, now mixed with stomach acid, back up the oesophagus, causing intense pain.
Even though there is growing awareness of the condition and more research is being conducted into its causes, child specialist Dr Ahmed Massoud, a consultant paediatrician at a major London hospital, believes it often goes unrecognised. ”Reflux presents itself in early infancy when there are lots of reasons why young babies cry, including colic. If the crying persists and there are other symptoms like arching of the back and vomiting, it makes diagnosis easier.”
 Most babies are born with some degree of reflux. It often affects premature babies. But by the time a baby is sitting up and walking, the oesophageal valve is generally working properly and the symptoms subside. While as many as 20% of babies may continue to suffer discomfort, in most cases, the reflux needs no medical intervention. Only in very rare cases is surgery necessary. Most of the problems relate to pain, vomiting and failure to thrive, although when regurgitated material enters the nose, windpipe or lungs it can cause respiratory complications. Despite the vomiting, many babies are content and thrive. Sam, while piling on weight, was definitely not a “happy chucker”. But while the vomit was a social liability, he probably suffered less than the silent refluxers.
Through trial and error, we established a drug regimen that would alleviate the pain and curb the vomiting. We started with infant Gaviscon and the acid suppressant Zantac (Ranitidine), a tried and tested approach. Mixed into baby milk, Infant Gaviscon reacts with the stomach contents to form a gel which acts like a plug between stomach and oesophagus. With a breastfed baby, giving Gaviscon is something of a challenge unless you express. Given our two-hourly timetable, expressing wasn’t an option. We moved Sam on to formula, partly because it meant we could administer the medication, but mostly because breastfeeding was now a Herculean task. Contorted with pain, Sam continually catapulted himself out of my arms.

However, the medication wasn’t as effective as we had hoped. We added an acid-blocking drug, but it didn’t make much difference. The business of dissolving the tablets in formula and administering the vile-tasting gritty liquid caused so much stress all round that we dropped it. We tried another drug instead. Finally into the cocktail went a different drug that acts as an anti-emetic. The drugs were all heavy hitters and there is debate about their use on young children. I sometimes wonder now whether it was right to give them to Sam, but then again, time plays tricks and you forget the realities. A friend wrote to me recently describing her own experience: the exhaustion, the noise, the baby who screamed too loud to take outside, the child no one wanted to hold. “Tell them reflux is hell,” she said.

Over time, the medication brought the pain and vomiting under control.
 Simple things like ensuring he didn’t slump when fed, keeping him upright generally, raising the head of his cot and treating him with kid gloves after a feed also paid dividends. We were wary when changing him. Lift his legs too high and the changing mat was swimming with regurgitated milk. Putting him in larger, looser nappies also helped. We were advised to start solids early, but that only produced the familiar agonies – so we waited. We succumbed to a dummy.

A year on and Sam is a strapping lad. With the pain gone, the “real” Sam emerged – sunny, smiley and with a great sense of humour. Aside from the Gaviscon, he has now been weaned off all medication. He loves his food, his sisters and dismantling door hinges. He sleeps like a log.

On reflection, I think we got off lightly. We were lucky to get an early diagnosis and the support of an experienced paediatrician. Dealing with a reflux baby can be soul-destroying. In the windy, gripey world of newborns, it is often misunderstood. In this context it is easy to understand why it can bring families to their knees and why reflux is implicated in child abuse and shaken-baby syndrome cases. Even in the most well-resourced families it can exact a heavy toll. A local mum I met on the reflux grapevine describes how one day, after hour upon hour of crying, she rang her mother in desperation, convinced she was going to hit her baby son. “I just sat in the hall, shaking. I kept asking myself, ‘When is it going to end, why doesn’t anyone understand?’ ” She wondered, when, if ever, she was going to enjoy her baby.
There is no miracle cure for reflux. Eventually the symptoms will pass. But a year to 18 months seems like an eternity when you are run ragged by an unsatisfied, crying baby. Simply understanding what is happening and getting some effective support can make a world of difference.
Tobe Aleksander
The Guardian – 04/2005
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