ECZEMA – part 2

Written by Dr Nické Theron, Pediatrician.

Eczema is a chronic disease and sadly it is not (yet) curable. It is however possible to control the symptoms. The aim is to get the acute inflammation of the skin under control (usually with topical steroids added to your normal regime), and then maintaining a healthy skin barrier by keeping the skin hydrated. It is thus very important that you understand the disease and what causes flare-ups in your child (see previous post) so that you can create the best management plan with your doctor.


…being strengthened with all power according to His glorious might so that you may have great endurance and patience…

Col 1:11

General Tips and Tricks:

• Avoid triggers as far as possible. Triggers differ for each child and can be as simple as: extreme cold or dry environments, sweating, emotional stress or anxiety or exposure to certain chemicals or cleaning solutions eg soaps, perfumes, cosmetics, wool, synthetic fibres.

• Keep the skin hydrated:
This is a very important part of the management plan. It is not necessary to buy the most expensive ointments; research show they do not necessarily work better than the ones you can buy in Dischem.

Your moisturizer needs to tick the following boxes:

  • It must be an emollient or ointment, lotions can worsen the dehydration of the skin.
  • Contain cetomacrogol (emulsifier), urea or glycerol (locks in moisture on the skin)
  • Contain NO colourants or fragrants. Be careful of any ointments containing “Sodium Lauryl Sulphate” as this can also break down the natural skin barrier.
  • E.g. in South Africa: Cetaphil, Epimax, Epiderm
    Best results when applied twice a day. Important to apply directly after bathing.

Bathtime talk: Lukewarm baths / showers soothe the skin but avoid long (10-15min) baths. Use a non-soap cleanser sparingly (you can use the same ointment that you apply after bathtime). In some cases a specialist may prescribe a “bleach bath” to decrease the amount of bacteria on the skin. Use a ¼ cup of bleach in a full bathtub (+- 150L) twice a week. (Discuss this with your doctor first.)

Medical treatment

Topical Steroids
Most children with eczema will use topical steroids at some point during the disease. The anti-inflammatory effect is very effective in the treatment of the itch and the inflammation of the skin and most mild and moderate cases of eczema respond quickly to these ointments.

There are many different types of topical steroids and they are classified according to their potency. Examples you may know is Hydrocortisone (Mylocort) which is a weak steroid, Methylprednisolone (Advantan) moderately strong, and Betamethasone (Repivate) one of the strongest steroids available to use on the skin. Your doctor will help you to weigh up the risks and benefits to decide which steroid cream to use.

When there is a flare-up of the eczema, use a stronger steroid cream once daily for 7-14 days, then switch to a weaker steroid until the lesions are gone

Steroids in general has a bad reputation because they have the potential to cause some nasty side effects. However, only 2% of the topical steroid is absorbed, and if you use it safely it can bring a lot of relief to your child. It is important to use the ointment sparingly (apply only a pea-size per affected area), apply only once a day, limit the duration of strong steroids to 14 days, use the weakest effective ointment, be careful in the face and skinfolds as these areas are more prone to side effects. Long term use of strong steroids may cause a steroid-crisis because the body stops making its own steroid-hormones that are vital in times of illness / surgery / injury.

Common side effects can be thinning of the skin (atrophy), small red / purple spider-veins (telangiectasia) or stretch marks may develop in the affected area or the steroid can irritate the skin causing a contact dermatitis.

Once you have control of the acute flare, it is important to maintain the control by using emollients consistently and in moderate / severe eczema you can also use intermittent topical steroids for 2 days in a week to minimise the side effects.

Sometimes it may be necessary to give a short course (3 days) of oral steroids to get control of a severe eczema flare, but this should be the last resort!

Topical calcineurin inhibitors
This is a relatively new class of treatments that are very expensive. Tacrolimus ointment (Protopic) / Pimecrolimus cream (Elidel) are effective to manage eczema and it has fewer side effects, but it does not work as quickly as steroids. It is better to use in sensitive areas such as the face and groin in children over 2yrs. There are still some concerns about long-term use (possible link to cancers later in life, this is still being investigated) and it is thus mostly used as a second line of therapy for children who does not respond to topical steroids.

Relieving itching
It is important to relieve itching as this is usually the most bothersome symptom and keeps children awake at night. Scratching also worsens the eczema lesions, so keep finger nails short!

Oral antihistamines such as Hydroxyzine (Atarax) may cause drowsiness which will improve sleep. Cetirizine (Zyrtec) can also be used.

Wet dressings/wraps (the topical steroid and emollient is applied under a wet gauze covered with a dry dressing) is very effective to soothe and hydrate the skin, loosen crusts, reduce itching and prevent scratching.

Alternative treatments:

  • Probiotics – research shows a small reduction in the symptoms which is not statistically significant. No serious side effects were noted so it may be worth it to test it in your child.
  • Melatonin – In two small randomized trials, melatonin supplementation reduced disease severity and improved sleep in children with eczema. Melatonin is a hormone and as such has its own risks and side effects. Please discuss with your doctor

Prevention of Eczema:

  • Use of emollient therapy from the first week of life has proven to reduce the risk of developing eczema before 1yr of age. This is a safe, cost-effective measure to use if you know your baby may be at risk.
  • Use of probiotics in the mother and the baby may prevent the development of eczema but more studies are necessary. This is also a relatively safe precaution to take.

Life with a child with eczema can be hard, but if you stay positive, build treatments into a fun routine and walk this road with your health care provider, there is light at the end of this tunnel.

Worry does not empty tomorrow of its sorrow. It empties today of its strength.

Corrie ten Boom

Pediatrics and Playdough & Medicine Mommy

Resources:

  • Miller DW, Koch SB, Yentzer BA, Clark AR, O’Neill JR, Fountain J, Weber TM, Fleischer AB Jr; “An over-the-counter moisturizer is as clinically effective as, and more cost-effective than, prescription barrier creams in the treatment of children with mild-to-moderate atopic dermatitis: a randomized, controlled trial.”; J Drugs Dermatol. 2011;10(5):531
  • Coondoo A, Chattopadhyay C; “Use and abuse of topical corticosteroids in children”; Indian J Dermatol. 2014 Sep-Oct; 59(5): 460–464.
  • Michail SK, Stolfi A, Johnson T, Onady GM ; ”Efficacy of probiotics in the treatment of pediatric atopic dermatitis: a meta-analysis of randomized controlled trials.”; Ann Allergy Asthma Immunol. 2008;101(5):508.
  • Chang YS, Lin MH, Lee JH, Lee PL, Dai YS, Chu KH, Sun C, Lin YT, Wang LC, Yu HH, Yang YH, Chen CA, Wan KS, Chiang BL; “Melatonin Supplementation for Children With Atopic Dermatitis and Sleep Disturbance: A Randomized Clinical Trial.” JAMA Pediatr. 2016;170(1):35
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ECZEMA – part 1

Written by Dr Nické Theron, Pediatrician

Red rashes… there are so many things that could look the same, and each child’s rash reacts a little differently. Even in the Bible many chapters in Leviticus was devoted to different skin lesions. There is only a small amount of treatments available…but oh so so soooooo many “boererate” and little ointments, potions and lotions that everybody swears worked for their child. Luckily eczema is one of the rashes we actually do have some answers for, so let me share what I do know:

What is Eczema?

Eczema (also called atopic dermatitis) is a chronic inflammatory skin disease that usually starts before the age of 5 years. It affects up to 1 in 5 children worldwide, and it seems as though it is becoming even more common in developed countries. You are not alone in your struggles!

Genetics play a strong role so there is usually a family history that one or both parents have atopy (this means they are prone to food-allergies, eczema, allergic rhinitis and asthma). An abnormality in the outer barrier of the skin, the epidermis, leaves the skin vulnerable. Environmental irritants (such as grass, dust, heat, cold), allergens and microbes (such as bacteria and fungi) can now pass through, and the skin loses more water. Some children also have an abnormal immunological response to foreign proteins, worsening the inflammation of the skin. This cycle is a little like the debate about who comes first, the chicken or the egg. It is still unsure whether eczema starts “inside-out”, or “outside-in” and although specific food or aero-allergens can make it worse, it is not always the cause of eczema.

There is evidence that the microbiome on the skin (the “normal” bacteria and fungi that live on your skin in harmony) is disrupted in a child with eczema. This causes an overgrowth of bacteria (usually Staphylococcus Aureus) which could worsen the inflammation of the eczema. It is thus not a cause of eczema, but it can make it worse.

Although tonsils play a part in the immune system of the body, I could not find any information suggesting that it could play a role in the development of eczema.

Symptoms:

Dry skin, intense itching, patches of red skin with small bumps and some flaking of the skin can be seen in children with eczema. There can also be some blistering and watery fluids leaking from the lesions, causing crusts on the skin. Itchiness is often worse at night. Scratching can worsen the inflammation and introduce infections. The skin can become thickened or darkened or even scarred from the constant inflammation and scratching.

Eczema usually start before one year of age, and the area of the body affected by the eczema can differ between children but can also change in the same child over time. Infants most commonly have patches on their arms and legs, their cheeks or scalp. Older children are more affected on their backs and the creases of their elbows and knees. Some children are only affected on their hands, or around their eyes or lips.

The Eczema Journey:

Most children will outgrow their eczema by late childhood (80% clears up by 8years of age). If your child has a mild eczema and was diagnosed before 2yrs of age, the chances are good that your child will be eczema free soon.

However, if the eczema started before 2yrs of age, your child has a higher risk of developing other allergies and asthma. We call it the “allergic march”, meaning that if your child’s immune system is prone to over-react to foreign proteins encountered via the skin as a baby (resulting in eczema), it will probably overreact to food proteins encountered via the gut (resulting in food allergies), pollen proteins encountered via the nose (resulting in allergic rhinitis) and proteins encountered via the lungs (resulting in asthma) as your child grows. This does not mean that every child will develop all of the above, but we need to keep our eyes open for the signs and symptoms.

Children and adolescents with eczema can also develop ADHD, depression or anxiety disorders. This is thought to be caused by the lack of sleep due to night-time itching, the psychological stress of having a chronic disease as well as the effect of chronic inflammation on the developing brain.

There is also an association between Autism Spectrum Disorders and eczema. Children diagnosed with eczema before the age of 2 has a slightly higher risk to be diagnosed with autism later in life. This relationship is still being investigated, but it is thought that the different inflammatory markers (especially the cytokines) may play a role.

Eczema can thus affect all areas of your child’s life and they need close follow-up and care.

“Cast all your anxiety on him because he cares for you.”

1 Peter 5:7

Making the Diagnosis:

Your GP can make the diagnosis by taking a good history and doing a quick examination of the skin. General practitioners should be able to treat mild cases, but if initial management does not work, it is better to follow up with a dermatologist and/or pediatrician to ensure good control of the disease.

Some diseases that could mimic eczema or that should be excluded are:

  • Allergic or Irritant Contact dermatitis: This is when the skin reacts to a known allergen (eg a piece of fish touches your child’s hand he will get a rash only on his hand) or an irritant (eg your child wears new shoes and the rash is only visible where the shoe touched the foot.)
  • Seborrheic dermatitis: mostly in infants. They develop a greasy red rash with scales on their scalp, eye brows and in their skin folds that is not itchy.
  • Psoriasis: chronic auto-immune skin disease with red skin patches with a silvery scale. Rare in children
  • Scabies: infection of the skin, very contagious, also very itchy. Usually there is a specific rash on the palms or in between the fingers.
  • Certain drug reactions
  • Primary immunodeficiency syndromes: here a lack of a certain part of the immune system may result in a rash on the skin.

Thank you for all your questions that helped me to write this post, I have also learned a thing or two while reading the latest research. I hope that you will feel more confident in understanding what eczema is and how it works and that this will empower you to tackle this journey with your child. Find a caregiver that you trust and will take alongside you on this journey. Treatment is available, and we will discuss it in tomorrow’s post.

“He who has a why to live can bear almost any how.”

Friedrich Nietzsche

Pediatrics and Playdough & Medicine Mommy SA

Resources:

  • Thorsteinsdottir S, Stokholm J, Thyssen JP, Nørgaard S, Thorsen J, Chawes BL, Bønnelykke K, Waage J, Bisgaard H; “Genetic, Clinical, and Environmental Factors Associated With Persistent Atopic Dermatitis in Childhood.”; JAMA Dermatol. 2019;155(1):50
  • Kim JP, Chao LX, Simpson EL, Silverberg JI; “Persistence of atopic dermatitis (AD): A systematic review and meta-analysis.”; J Am Acad Dermatol. 2016;75(4):681. Epub 2016 Aug 17.
  • Wan J, Mitra N, Hoffstad OJ, Gelfand JM, Yan AC, Margolis DJ; “Variations in risk of asthma and seasonal allergies between early- and late-onset pediatric atopic dermatitis: A cohort study”; J Am Acad Dermatol. 2017;77(4):634. Epub 2017 Aug 14.
  • Yaghmaie P, Koudelka CW, Simpson EL;” Mental health comorbidity in patients with atopic dermatitis”; J Allergy Clin Immunol. 2013 Feb;131(2):428-33. Epub 2012 Dec 13.
  • http://www.uptodate.com
  • Thank you to the “National Jewish Health” site for the illustration.

REFLUX – part 2

Tips & Tricks for the Management of Reflux in Babies, by Dr Nické Theron

In the last few weeks I have spoken to many moms and read many blogs to do some more research regarding reflux in babies. (SEE THE PREVIOUS POST to learn more about what reflux is). There are some interesting and scary treatments suggested out there! As a mom I wish I could give you a miracle-cure that would help your baby sleep better, cry less, spit up less. Unfortunately I know such a cure does not exist, no matter how alluring some moms on social media make it sound. As a pediatrician I would like to stick to what has been proven to work and what is safe for your precious baby now and in the long run. So here goes:

General management for all babies with reflux (GER and GERD):

• Upright positioning (90°) for 20-30min after feeds.
Babywearing keeps your hands free and keeps baby happy and safe.
“Reflux pillows” that elevates your baby’s head while sleeping has not been proven to make a big difference. Please remember the safest sleeping position for a baby is flat on his back to reduce the risk of SIDS (Sudden Infant Death Syndrome).  Even though babies with reflux sleep better on their stomach or left side down, I cannot recommend this if your baby is not monitored continuously.
Placing your baby in a rocker or car seat can worsen reflux due to the scrunched up positioning and increased pressure in their stomachs.

• Feeding volume and frequency:
It helps to give smaller feeds (so that you do not overly distend the abdomen) more frequently. Working out the smaller volumes if you are bottle feeding also prevents over-feeding and unhealthy weight gain.
Breastfeeding moms can feed on demand, but try to help soothe baby in other ways (baby-wearing, sucking on your fingers or a dummy) if the previous feed was less than two hours ago so that you do not worsen the reflux symptoms. Breast milk has a protective effect against reflux, so you are doing a great job!

• Thickening of feeds:
Studies have proven that this can decrease the episodes of spitting-up, but it is a very laborious process. Formula or expressed breastmilk can be thickened with rice or oatmeal-porridge or Maizena.

• Trial of a milk-free diet:
If you are breastfeeding, you can cut out all dairy and beef products from your diet for 2 weeks to see if there are any change in symptoms. You might have to cut out soy-products too.
If you are formula feeding, you can try a trial with an “extensively hydrolyzed formula” (also called hypo-allergenic such as Neocate or Similac Alimentum). It is not recommended to change to a soy-based/ goats-milk based / lactose free formula for this trial as there can be a cross-reaction to the allergens. Once baby is diagnosed with a milk-allergy you can try these substitutes under guidance of your doctor and dietitian.

• Avoid exposure to tobacco smoke as this can further decrease the pressure in the lower esophageal sphincter (see previous post), causing more frequent episodes of reflux.

• Adding probiotics has been suggested, but there is not enough evidence to prove if it will help.

• The use of a Chiropractor is not recommended as most of their procedures are not evidence based. “Subluxations of the spine after birth” mostly cannot be proven, will not cause reflux and the interventions they apply are either too delicate to really change anything in the bony structure, or too rough to be safe for the developing spine of your child. Please be careful.

If you have tried all of these tips and your baby still shows SIGNS OF GERD (as discussed previously) you can discuss the following steps with your doctor:

1. Is it really GERD?
Many diseases can mimic reflux and will not respond to reflux medications:
• Cow’s milk-protein allergy: this is a type of food allergy that can best be diagnosed by an exclusion diet.
• Eosinophilic esophagitis – this is inflammation of the esophagus due to an allergic reaction involving a specific type of white blood cells. These babies can have trouble swallowing, vomiting and chest pain. Diagnosed with a biopsy during an endoscopy.
•  Anatomic abnormalities of the esophagus – sometimes there is a connection between the esophagus and trachea (air pipe), or a web of veins causing a partial occlusion of the esophagus. This can be diagnosed with the help of a contrast swallow.
• Celiac disease – allergy to gluten causing inflammation in the esophagus, stomach and intestines, can also have many other symptoms. Diagnosed with an exclusion diet and can be confirmed with a blood test.

👉As you can see an endoscopy (looking at the esophagus and stomach from the inside with a camera, your baby will need sedation or anesthesia) can help to clarify the diagnoses. It can also evaluate for inflammation and check the response to treatment with PPI’s.

👉Another diagnostic test often used is Ph monitoring where the height of the acid reflux and the amount of episodes over 24hours are tested. Because reflux can also happen in normal infants this test cannot give us a definitive answer.

2. Does my baby need acid suppressing medication?
PPI’s (Proton Pump Inhibitors for example Nexiam, Losec) are used to suppress the amount of acid formed in the stomach. It will NOT decrease the number of reflux episodes or the amount of vomiting, but it could make your baby more comfortable if there was inflammation and pain due to the acid.
The acid in your stomach is actually very important for your baby’s digestion and immune function, and decreasing the acid content certainly does have risks.

👉Who should get PPI’s and for how long ?
• Babies with proven esophagitis seen on endoscopy (use for 3-6months and then re-asses)
• Babies with severe symptoms of GERD that does not respond to conservative measures can be given a trial of two weeks. If there is a definitive improvement, medication can be continued for 3-6months and then re-assessed.

👉Possible complications of PPI’s:
• Higher risk of acute diarrhoea and pneumonia because you remove a line of immunity defence. This can also lead to infection of the gut with Clostridium Difficile.
• Interferes with the absorption of Iron and Vitamin B12 and lead to anemia (low red blood count).
• Can affect calcium absorption and lead to increased risk for fractures.
• Allergic sensitization – there is a link between using acid suppression in infancy and later development of allergies.

When you want to stop the PPI, it is important to wean it slowly as there can be a rebound higher acid production for the first few days after stopping the medication.

3. Are there other medications that could help?
• Antacids such as Gaviscon have been shown to provide some relief in the symptoms of reflux. It works by coating the stomach contents with an alkaline layer which makes it more difficult to push back and less painful to the esophagus. It can be used in the place of thickening feeds in breastfeeding babies. Although there are not a lot of studies done in babies, it seems safe to give for short periods (less than two weeks) or on occasion. Using it for longer periods could lead to aluminium toxicity or rickets (Vitamin D deficiency).
• Prokinetics such as Domperidone (Emex), metoclopramide or erythromycin could help to speed up the passage of feeds through the esophagus and stomach. They could however have many unpleasant side-effects affecting your baby’s movement, brain and heartrate.

4. Will surgery help?
Surgery is usually not indicated in children under 1 year of age. Even in older children and adults the results of a Fundoplication surgery are not very satisfactory.

“Be joyful in hope, patient in affliction, faithful in prayer”

Romans 12:12

If you have read all the way to here you must truly have many questions! I hope that I could give you some answers, some advice and some hope. Remember that you are not alone. Talk to other moms and share the burdens and the joys. Talk to your doctors and walk the road with them, they want to help you.

These days feel long, but the years are short and before you know it your child will be waving goodbye on their first day of school (without vomiting all the milk from their morning porridge)!


Pediatrics and Playdough
Medicine Mommy

Resources:

1. Rosen R, Vandenplas Y, Singendonk M, Cabana M, Di Lorenzo C, Gottrand F, Gupta S, Langendam M, Staiano A, Thapar N, Tipnis N, Tabbers M; “Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)”; J Pediatr Gastroenterol Nutr. 2018 Mar; 66(3): 516–554. ; doi: 10.1097/MPG.0000000000001889
2. Rybak A, Pesce M, Thapar N, Borelli O; “Gastro-Esophageal Reflux in Children”; Int J Mol Sci. 2017 Aug; 18(8): 1671; Published online 2017 Aug 1. doi: 10.3390/ijms18081671
3. Campanozzi A, Boccia G, Pensabene L, Panetta F, Marseglia A, Strisciuglio P, Barbera C, MagazzùG, Pettoello-Mantovani M, Staiano A; “Prevalence and natural history of gastroesophageal reflux: pediatric prospective survey.”; Pediatrics. 2009;123(3):779.
4. Davies I, Burman-Roy S, Murphy MS, Guideline Development Group ; “Gastro-oesophageal reflux disease in children: NICE guidance”; BMJ. 2015;350:g7703. Epub 2015 Jan 14
5. https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/symptoms-causes/syc-20351408
6. Safe M, Chan WH, Leach ST, Sutton L, Lui K, Krishnan U; “Widespread use of gastric acid inhibitors in infants: Are they needed? Are they safe?”; World J Gastrointest Pharmacol Ther. 2016 Nov 6; 7(4): 531–539.; doi: 10.4292/wjgpt.v7.i4.531

REFLUX

What is Reflux?

Dr Nické Theron, pediatrician, is here to empower our mommies with knowledge.

Most moms know the feeling of getting your little one all dressed up and ready to go, just to have them spit/vomit milk all over everything just before you leave!

Thank you for all your questions and comments about your journey with reflux. I will try to answer most of you in the next few paragraphs while I explain more about the what, why and how of reflux:

Gastro-Esophageal Reflux (GER) is a 100% physiological (natural) occurrence in healthy babies, children and adults where the contents of the stomach push back into the esophagus (swallowing tube). It is more prominent in babies (40-60% of healthy babies struggle with reflux) because of their immature lower esophageal sphincter (the gate that is supposed to contract to keep the stomach content inside), fluid diets (fluids push back easier), slower passage of food through the stomach and the fact that they are mostly laying down (yes, gravity does play a role here).

Preterm babies have even more trouble with reflux because the esophagus is still too immature to “swallow” the milk down and they are often fed via feeding tubes (which opens up the lower esophageal sphincter even more).

“So do flux and reflux–the rhythm of change–alternate and persist in everything under the sky.”
― Thomas Hardy, Tess of the D’Urbervilles

Symptoms of reflux can start from the first few days of life when they start drinking larger volumes of milk, and usually subside by the age of 12-18months. This is due to a combination of all the factors mentioned above improving. There are some studies that show that children who had reflux as a baby are more prone to struggle with it as they get older.

Babies who have reflux (GER) usually spit/vomit up milk after feeds (yes, it can come up through their noses), (yes, it can be quite a lot!), they can also be irritable after feeds or arch their backs. They often sleep for shorter stretches and want to feed often (the milk actually soothes their throats, but more milk can also cause more trouble). Remember this is still NORMAL baby-behaviour!

“Silent reflux” is a non-medical term applied when a baby has episodes of reflux into their esophagus and airways without vomiting it out. (Making it more difficult to diagnose). In the end the same diagnostic and treatment rules apply.

Most babies with reflux grow well, feed well, are not extremely irritable and do not have any danger signs. These babies are often referred to as “happy spitters” and do not need any further medical intervention. It is very rare for the stomach contents to contain enough acid to cause discomfort or damage to the esophagus / airways. Even in studies where they monitored the reflux episodes by pH monitoring, they often could not associate the episode with the baby being unhappy or waking up from the reflux.

If your baby is failing to thrive (not gaining weight, not reaching developmental milestones), is refusing feeds (turning away his head while arching his back – Sandifer syndrome) or has signs of esophagitis (this is painful inflammation of the esophagus that can only be diagnosed with a gastroscopy, clues will be excessive crying and irritability when lying flat, shortly after feeds and while refluxing) your baby has Gastro Esophageal Reflux DISEASE (GERD). This is pathological and should be treated.

There are many other causes for the symptoms of reflux. Your baby could be going through a growth spurt or be overstimulated or have flu or gastro-enteritis, but if your baby has any of the following Red Flags, please see your doctor asap to exclude more sinister diseases:

  • Recurrent projectile vomiting (when the vomit hits the other side of the room)
  • Yellow bile or blood-stained vomiting
  • Any other abdominal signs: distension or pain of the stomach, constipation or diarrhoea
  • Fever
  • Any seizures, abnormal movements, abnormal head size or other neurological signs
  • Recurrent pneumonias (lung infections)

When you visit your doctor with symptoms of reflux they will probably be able to exclude most of the dangerous conditions by taking a history from you and doing a good examination. Hopefully this, together with the knowledge you were armed with in this article will help you cope with the day-and-night realities of reflux.

I know the mountains of milk-stained washing and sleep deprivation are tough – check back tomorrow to see what you can do to make your little one a little more comfortable.

Resources:

  1. Rosen R, Vandenplas Y, Singendonk M, Cabana M, Di Lorenzo C, Gottrand F, Gupta S, Langendam M, Staiano A, Thapar N, Tipnis N, Tabbers M; “Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)”; J Pediatr Gastroenterol Nutr. 2018 Mar; 66(3): 516–554. ; doi: 10.1097/MPG.0000000000001889
  2. Rybak A, Pesce M, Thapar N, Borelli O; “Gastro-Esophageal Reflux in Children”; Int J Mol Sci. 2017 Aug; 18(8): 1671; Published online 2017 Aug 1. doi: 10.3390/ijms18081671
  3. Campanozzi A, Boccia G, Pensabene L, Panetta F, Marseglia A, Strisciuglio P, Barbera C, MagazzùG, Pettoello-Mantovani M, Staiano A; “Prevalence and natural history of gastroesophageal reflux: pediatric prospective survey.”; Pediatrics. 2009;123(3):779.
  4. Davies I, Burman-Roy S, Murphy MS, Guideline Development Group ; “Gastro-oesophageal reflux disease in children: NICE guidance”; BMJ. 2015;350:g7703. Epub 2015 Jan 14
  5. https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/symptoms-causes/syc-20351408