Mothering a baby with GERD
A journalist shares her experience caring for a three-month-old baby with GERD
By Alma Anonas-Carpio, Contributing Writer
Journalist Dulce Arguelles-Sanchez was ecstatic over her new baby, a miracle child she said, for she had been diagnosed with polycystic ovarian syndrome and told she may have difficulty conceiving. The day was August 31, 2006.
"My baby is beautiful," Sanchez said shortly after giving birth by caesaran section to baby Katherine Grace at the University of the Philippines-Philippine General Hospital. "She's tiny but she is perfect." Born three weeks shy of the full term and small at just four pounds, baby Katherine was nonetheless robust.
Sanchez couldn't breast-feed her baby because, at the time she gave birth, her congenital asthma had blossomed into a bad bout of bronchopneumonia and she was on intravenous antibiotics and bronchial dilators, so her baby had to make do with infant formula. This notwithstanding, mother and daughter went home five days later, with Katherine sleeping peacefully all the way to the family home in Laguna province.
On November 18, 2006, Sanchez was plagued with mother's panic over three-month-old Katherine's persistent colic, her instincts as an award-winning health journalist telling her there was something very wrong with her baby. "[Katherine] was throwing up all the time, and it was not the regular amount of
lungad (regurgitated infant formula or milk) that you would expect of a baby. I didn't think this was normal," Sanchez recalled.
Katherine had also developed severe skin rashes and went from being a quiet little angel into a shrieking, irritable infant who looked like a "patchwork baby," as Sanchez put it, and refused to be put down or even carried in a lying position. "She'll sleep while we carry her," Sanchez said, "but she'll wake up and start howling the moment she is put down."
The baby's pediatrician said at a routine well-baby checkup that she was too small for her age-the first sign that she was not getting properly nourished despite frequent feedings. Worse yet, Katherine did not want to feed.
Sanchez rushed her baby to Makati Medical Center (MMC) just days after Katherine's checkup. The infant was crying constantly by then, "howling in pain." Pediatric neonatologist Rita Dolendo had the infant admitted and promptly prescribed tests for GERD-including several blood tests, stool sample examination where blood was found in her feces, and a barium test that had Sanchez in tears of frustration.
Katherine's hospital stay lasted nearly a week and, by the time she was discharged, Sanchez had received a long list of verboten foods-including formula containing lactose-and a list of medications that included a strong antihistamine for the baby's allergies, a corticosteroid ointment for the infant's skin rashes, and medication to relieve the baby's acid reflux.
"I've got a baby on drugs," Sanchez lamented, adding that she had "no better choice but to make sure she gets the treatment, even if it breaks my back financially and it makes my baby look zombified."
The corticosteroid ointment made Katherine photosensitive, Sanchez said, adding that her baby's physicians had warned her of that side effect "so sunning her had to be done very early in the morning, just at sunrise, and just for a few minutes daily."
When Sanchez began feeding Katherine solid foods, she recalled having to "be very particular about what she [was fed]. Her dietary limitations precluded foods that were not organic, food that contained dairy products, and foods that might trigger allergies. I could not give her citrus juices or any acidic juices. I had to get creative to make sure she ate nutritious foods that would not trigger any more acid reflux or any allergic reactions."
"More than that, I had to keep Katherine happy and immediately soothe her if she began crying," Sanchez added. "The doctors had warned me that, because asthma runs in my family-I have it in a bad way-Katherine should not be left to cry because that could trigger the onset of bronchial asthma, which is also associated with GERD."
Sanchez also relied on her skills as a health journalist to empower her to care for her baby: "I read up on GERD and learned all I could about the disorder from doctors and by doing research."
As the months wore on, Sanchez worked hand in hand with Katherine's doctors on a dietary regimen that bordered on being strict vegetarian-her formula was soy-based, with vitamin supplements to provide the nutrients not in her soy formula. There was no meat, no dairy, nothing that would trigger more acid reflux in the little girl. Even chocolate was a banned substance. Sanchez also had to ensure that her baby was not allowed to tire herself out lest asthma take hold-so she resorted to reading to the infant and providing colorful hypoallergenic toys to keep her still yet engaged and entertained.
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"What I did was to keep her as happy as I could, keep her entertained with music, read to her to soothe her, give her toys to keep her mind engaged and just plain ban any foods that the baby could not eat from the house," Sanchez said. "I also made sure she had loose clothing to wear and I kept her diapers as loose as I could so her tummy would not get constricted and squeeze acid up her esophagus, as the doctors ordered."
"The good news was that Katherine, under the new dietary regimen, began to flourish," Sanchez said with a heartfelt laugh. "She gained weight with a vengeance and her appetite got so good I had to stop her from eating when her tummy pulled tight as a drum and she kept on trying to get at the food."
Three months after that emergency run to the hospital, Sanchez, with the approval of her daughter's pediatrician, began introducing tiny amounts of dairy foods into Katherine's diet, with the understanding that "at the slightest sign of reflux or allergy," the dairy goods would again be banned and the list of verboten foods would again be in effect.
According to Sanchez, the quick diagnosis, apt medical care, correct medication, correct dietary adjustment, and the correct information on GERD created the desired effect. As of Christmas 2007, Katherine was off the drugs and free to eat the full dietary range of foodstuffs she needs to grow optimally.
Katherine is now an active toddler, though Sanchez still makes sure the medications Katherine needed during her crisis are on standby and her doctors remain vigilant for even the slightest resurgence of GERD, allergies, and even the smallest sign that the toddler inherited her mother's asthma.
"It feels good to breathe again, now that I know she has a good shot at a normal life and that she is growing so fast. It is a big change over worrying that she was getting stunted because the GERD was starving her," Sanchez said.
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GERD in infants and children
Telling the difference between normal, physiologic reflux (gastroesophageal reflux or GER) and GERD in children is important-primarily because GERD will affect the infant's feeding habits and, if untreated, will lead to undernourishment.
Most infants with GER are healthy even if they frequently spit up or vomit, and babies usually outgrow GER by their first birthday. However, reflux that continues in a child one year or older may be GERD.
Studies show GERD is common and may be overlooked in infants and children-as it may often be written off as colic. GERD can manifest as repeated regurgitation, nausea, heartburn, coughing, laryngitis, or through respiratory problems like wheezing, asthma, or pneumonia.
Infants and young children with GERD may be irritable or frequently arch their backs- often while they are being fed or immediately after feedings. They may also refuse to feed and will, as a result, experience poor growth.
Parents who are concerned their children may have GERD should seek medical help, especially if reflux-related symptoms occur regularly and cause the child discomfort.
Simple strategies for avoiding reflux, such as burping the infant several times during feeding or keeping the infant in an upright position at least 30 minutes after feeding may be recommended by the pediatrician. If the child is older, the doctor may advise parents or caregivers to feed the child small, frequent meals instead of the usual three large meals daily, avoid feeding the child foods known to trigger GERD, and refrain from feeding the child three to four hours before bedtime.
The doctor may also recommend raising the head of that child's bed with wooden blocks under the bedposts to prevent reflux during sleep. If these changes are ineffective the doctor may prescribe medicine for the child. In rare pediatric GERD cases, the child may need surgery.
M Alma Anonas-Carpio
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