The current approach to reflux, and what this means for our babies
Reflux, again. It is such a prolific problem, so many of my friends, family and clients are suffering with this and there is so much conflicting information out there so I wanted to do more by learning more. I attended a seminar recently on the current approach to reflux, and why it is not working, hosted by the Baby Reflux Lady – Áine Homer – who has a diploma in Nutrition for Food Allergies and Intolerances and specialises in Newborn, Baby & Toddler Reflux.
Millions of babies - approximately 50% of babies – suffer from reflux in some way, and the medical system is not supporting these infants as well as it could be. The conventional approach to reflux, be it GOR or GORD, does not put baby centre of care, yet the long term health of an individual starts in infancy, so the risks to their long-term health are increased when babies continue to suffer throughout infancy - which is ultimately putting more pressure on an already heaving healthcare system.
Further, when babies suffer in pain their parents and families suffer too. Over 86% of mothers whose child suffers from reflux feel it negatively affects their mental health, there are increased rates of postnatal depression, reduced sleep (which in turn causes increased risk of cardiovascular disease, obesity, productivity etc), relationship breakdowns and negative effects on siblings and the wider family. The system is not doing enough right now and the longer it doesn’t the greater the effect on future generations. Parents are dismissed and told that it is ‘normal’ baby behaviour - we need to educate and empower parents to help their babies and restore joy to their family life.
It is important to acknowledge the importance of pain management – until 1987 it was believed that babies couldn’t actually feel pain, but since 2010 there has been significant research to suggest they do and it is actually felt more acutely than in adults. Parents are told ‘crying is normal’, ‘all babies cry’ and ‘reflux is normal’ but that means we are ignoring babies in pain, and this is not ok. Babies in NICU are being treated for pain, but outside of the hospital it isn’t given enough consideration despite the fact that we know that constant and excessive exposure to cortisal in the body has an impact. It is well documented that frequent and repetitive pain in infancy alters the development on the central nervous system, causes long-term changes to sensory processing, poorer cognitive and motor skills, and impairments of growth.
There is a lot of published evidence the medical community is ignoring, or at least not acting upon quick enough – it can actually take 17 years for medical research to make it into practise! Medications that are not proven safe for infants are being prescribed, medications that chemically alter how the body absorbs nutrients at a critical time in their development and without proper attention to the long-term risk. There are no gastric restriction medications that have been approved for infants under 1 month and only one form of omeprazole approved for infants 6-12 months. There is growing evidence that PPI medications (anything ending in a ‘prazole’) are not effective and may not be safe, but the rate of prescribing them is increasing – it has doubled in the 7 years to 2017 (last published stats) and 37% of preterm infants are prescribed PPI medications.
There is evidence that PPI medications cause: change in microbiota, c. difficile colitis, acute gastroenteritis, community-acquired pneumonia, bone fractures (any use of PPI (or H2RA – used in the US) medication in infancy leads to a 23% increase in childhood bone fractures – if a child was using both PPI and H2RA medications the risk went up to 32%), dementia (there is no research yet on what the effect is on babies brains, but PPI use in adults increases risk of dementia and Alzheimer), hypomagnesemia and b12 deficiency; nutritional deficiencies caused by PPI’s include calcium, magnesium, vitamin c, vitamin b12, iron, macro fat digestion and absorption. PPI effects how the stomach (and therefore digestion) works - the brain needs fats to be able to grow (the brain is 25% of adult size at birth and 95% of adult size at 5yrs old, it is the fastest growing organ in the first 2 years of life), fats are broken down in the stomach so if the way the stomach works is altered it will be unable to break down the fats. Infants with Oral Dysphagia prescribed PPI’s are twice as likely to be admitted to hospital.
You may have heard that reflux is to do with a weak lower esophageal valve, that it is physiological and babies will grow out of it. This is the most common explanation, and is what doctors are taught, but this is unproven. There is NO evidence that a weak lower esophageal valve causes reflux, no evidence that reflux is to do with the development of the body and no evidence that reflux is causes by an overproduction of stomach acid.
Reflux is a symptom, not a disease, and there are about 30 different causes for reflux. Therefore, something that works for one baby may not work for another so if you do not get to the bottom of what is causing the symptom then it is really about trial and error. We must look at each baby as an individual, to find out what those underlying causes are and what we can do to help these children be free from pain and be comfortable in their own bodies.
For more information, please also see my other blog post on Babies with Colic, Reflux and Infant Allegies.
As a postnatal doula, I can help ease some of the suffering by offering practical and emotional support. Please get in touch if you would like to discuss how I could help you.
Doula Bea x
