Dr. Greene Answers Your Questions

To celebrate reaching the 1,000 fan mark, Dr. Greene answered three questions posed by our Facebook Fans. I’ll post each question and answer. First up, Harmony!

Harmony Wells: What can we do with out medication to help a really bad case of reflex?

Dr. Alan Greene

Dear Harmony,

Gastroesophageal reflux [http://www.drgreene.com/azguide/gastroesophageal-reflux] is no fun for babies or their parents, and, unfortunately kids — and especially kids under 18 months — can be susceptible to the problem. When we swallow, our food travels down the esophagus, passing through the lower esophageal sphincter that keeps the stomach acids out of the esophagus.

In many babies, the lower esophageal sphincter hasn’t developed enough to stay tightly closed. This is why little babies spit up, and for many, the regurgitation is no big deal. But some kids with a looser-than-average sphincter, a stomach that digests more slowly or a food allergy might have trouble gaining weight and can experience heartburn, irritability, bad breath, excessive cavities, wheezing, chronic cough, pain with eating or recurrent pneumonias. A doctor’s exam may diagnose gastroesophageal reflux disease, or GERD [http://www.drgreene.com/blog/2008/03/28/what-pediatric-gerd-and-how-can-you-treat-it ].

Although some may need medicine, and today’s prescriptions are often effective with few side effects, these can be strong medications that should be distributed with discretion. If your baby has acid reflux problems, you might consider the following before trying medication:

1) Try feeding your baby more frequently, decreasing the amount of milk or formula. And some have had success with adding a tablespoon of rice cereal per ounce of formula when feeding by bottle. Some studies say this may decrease both spitting up and crying in babies with reflux, though others have found no effect. And the extra calories might make it tougher for your baby to know when he is sated.

2) Because it’s easier for a baby to keep food out of the esophagus when he is upright, carry your baby upright when he is awake, or place him on his tummy. In the crib, you might elevate the head of the bed or use a Tucker Sling, a foam wedge developed just for this purpose.

3) Ask your pediatrician about food allergies. About 60% of the babies with reflux have a food allergy, perhaps to cow’s milk and soy proteins in formulas. Breastfeeding moms might avoid eating other common food allergy culprits, such as peanuts, cow’s milk, soy and eggs. And, although we haven’t seen studies on the effect of a breastfeeding mother’s consumption of tobacco, coffee or caffeine, I suspect that these may also worsen reflux in babies.


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