I think you should see a pediatric gastroenterologist. I really like Dr. Lee, Duffy, etc- in Fairfax.
Regular pediatricians prescribe the low doses of meds.
My kids had reflux severely. I would get into the pediatrician first, and ask for an additional med (combination therapy) because it can take up to 4 months to get into a pedi gastro doc.
ALSO - something you can do to help immediately is to burp her after every two ounces. It is a pain, but it helped me a lot!
feel free to contact me with any questions.
To all the other mommies on here that have spitters- I hope you find this article helpful. Untreated GERD can lead to esophageal ulcers - which are very painful and detectable by an endoscopy.
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FROM THE WALL STREET JOURNAL:
Baby Crying? Doctors Say It May Be Acid-Reflux Disease
July 22, 2008; Page D1
Olivia Manganello was 1 month old when she started screaming, usually right after she nursed. Her family tried switching to formula, then different formulas, but nothing helped. Finally a pediatric gastroenterologist diagnosed gastroesophageal reflux disease (GERD) and put Olivia on Pepcid. "In two days, she was a completely different baby," says her mother, Trina Chiara of Avon, Conn.
READING ON REFLUX
• Pediatric/Adolescent Gastroesophageal Reflux Assoc. information site: www.Reflux.org
• "The Reflux Book" by Beth Pulsifer-Anderson, 2007
• "Colic Solved" by Bryan Vartabedian, MD, 2007
• "Why Is My Baby Crying?" by Barry M. Lester, Ph.D., 2006
Years ago, babies like Olivia were dismissed as having colic. Sometimes Valium was prescribed for their moms. Now, infants are increasingly being treated for GERD, paralleling a rise in chronic heartburn in adults. Use of proton-pump inhibitors (PPIs), the strongest acid-blocking drugs, in infants soared 750% from 1999 to 2004, according to a study of four major health plans. Some experts worry that GERD is being overdiagnosed in infants; others say it isn't being taken seriously enough.
Even the terminology is confusing. Most babies have reflux -- spitting up some liquid, since the valve separating the stomach from the esophagus isn't fully closed. It usually doesn't hurt. Experts like to say these "happy spitters" are a laundry problem, not a medical problem, and no treatment is needed. Most babies outgrow this simple gastroesophageal reflux (or GER) by the time they're about 7 months old.
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• Join a discussion about colic, or reflux, in babies.
• Read more about Pager and the diagnosis of GERD.
GER becomes more-serious GERD if the infant won't eat and stops gaining weight, vomits blood and is extremely irritable. He may be highly sensitive to stomach acid -- "just like some adults get heartburn and call 911," says Beth Anderson, founder of the Pediatric/Adolescent Gastroesophageal Reflux Association (Pager), an information group for parents. GERD babies may also choke or aspirate liquid. Acid-reducing drugs -- which run the gamut from over-the-counter antacids to H2 acid suppressors to PPIs -- won't stop the reflux but can cut the acidity, and thus the irritability, if acid is causing the problem.
Most experts think colic is a separate issue, though it's still vaguely defined as at least three hours of crying at least three days a week for at least three weeks. Doctors theorize that it may be because of a milk allergy, gas or food not moving smoothly through immature intestines. Some 20% of babies get colic, and it's generally gone in three months -- but those can be miserable.
What's tricky is that colic and reflux can occur together. "Those babies are sometimes put on acid-reducing medications, but they don't get better," says Jeffrey S. Hyams, a pediatric gastroenterologist at Connecticut Children's Medical Center in Hartford, and Olivia Manganello's doctor. "There's no medicine for colic except time and Mother Nature."
Doctors can check for abnormal acid by putting a thin tube down a baby's nose, and rule out anatomical problems with a barium X-ray. But many simply put babies on acid-reducing drugs first to see if they improve.
Critics say that leads to overtreatment. "It's the 'get the mom off my back approach,'" says Vikram Khoshoo, a pediatric gastroenterologist at West Jefferson Medical Center in New Orleans. He says 80% of reflux babies get better with time and measures such as thickening formula with cereal, avoiding cigarette smoke and reassurance.
Bryan Vartabedian, a pediatric gastroenterologist at Texas Children's Hospital, had an epiphany when his own irritable baby improved dramatically when she was treated for reflux. He thinks about half of what's considered colic may actually be undiagnosed GERD. "We should be looking for signs of treatable conditions so babies aren't suffering needlessly," he says.
Is there any harm in putting a baby on drugs for GERD if it is just colic? None are specifically approved for infants. In older children, side effects are generally mild, like nausea and diarrhea; PPIs have been linked with a risk of bone fractures in adults. But few long-term studies have been done.
Left untreated, some babies outgrow GERD, but doctors worry if it prevents an infant from eating. "Babies need to gain weight," says Dr. Hyams. "If they don't, there's something wrong."
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When Beth Anderson organized a meeting of other parents of babies with acid reflux in Washington, D.C., in 1992, she thought she was starting a small support group, not a national organization. The Pediatric Adolescent Gastroesophageal Reflux Association (Pager), as it's now known, has mushroomed along with the diagnosis of GERD. The group's Web site, www.reflux.org, got 2.3 million hits in March, and has 61,000 searchable posts.
Pager fields inquiries from parents at both ends of the misery spectrum -- from parents worried about a little bit of crying to those whose infants have very severe symptoms. "We don't advocate medications," says Mrs. Anderson. "Our position is that if the parents think their child is in significant pain, they need to talk to their doctor." She advises parents to keep track of their baby's behavior and report objectively. "If you say, 'my baby cries all the time,' the doctor may not take you seriously. If you say, 'my baby cried six hours yesterday and six hours the day before,' then they know it's time to do something."
Some parents in Pager say it took awhile for doctors to take their concerns seriously. Melissa Willard of Easley, S.C., says her daughter, Maggie, started choking her first night in the hospital, and made strange nasal noises -- "like she was starting a car." But she was repeatedly told it was "normal baby stuff." The turning point came when Mrs. Willard's obstetrician heard Maggie sputtering and diagnosed reflux. A pH probe confirmed it. Maggie took Zantax for several months and no longer needs it.
Some parents who were told their babies were "just colicky" have seen them grow up to have fullblown GERD or food allergies. Erica Hale of Salt Lake City, Utah, says her son, Isaiah, sometimes cried "20 out of 24 hours" when he was an infant. Though he did outgrow it when he was 4 months old, the distress returned in elementary school. Now age 11, Isaiah is taking Prevacid and has been diagnosed with a gluten intolerance. "When we went over the symptoms with him, he said he'd had this for as long as he could remember," says Mrs. Hale. Meanwhile, she says, "I think we've all got post-traumatic stress from that four months of screaming and no sleep."
Indeed, months of crying and sleeplessness can take a huge toll on the family, whether it's due to reflux or colic or another cause. "You can talk to parents 25 years later and they'll remember it like it was yesterday," says Barry Lester, director the Colic Clinic at Brown University's Center for the Study of Children at Risk in Providence, R.I. The clinic treats entire families, not just the infant, including consultations with a psychologist or social worker.
"The big danger is in thinking the drug is a magic bullet," Dr. Lester says. "The crying may go away, but the damage to the family dynamic may not."
• Email ____@____.com a discussion on colic and reflux.