GERD (GastroEsophageal Reflux Disease) is a chronic digestive disease. GERD occurs when stomach acid or sometimes, stomach content, flows back into the esophagus. This acid laden reflux irritates the lining of the esophagus and causes GERD. It looks a lot like this:
Whenever there is discomfort, that can be a significant barrier to sleep. If a family suspects their child is uncomfortable, or their GERD is not well managed, we work with that child’s physician to ensure they are comfortable before proceeding with any sleep training.
From a personal perspective, I can tell you it’s no fun to parent through GERD. From a professional perspective, I can tell you that these are the families most in need of support, sleep is clearly impacted, and in my anecdotal observations in working with families; GERD diagnosis seems to be increasing.
In the past week I’ve attended several continuing educations events, with one physician indicating that GERD is likely overdiagnosed (notable pediatric gastroenterologist Warren Shapiro, MD), while the other indicated that it was underdiagnosed (notable pediatric sleep expert, Judy Owens, MD). The jury is out and it’s difficult to know if the instances of GERD are increasing or if more of these cases are being caught.
Some symptoms of GERD include:
- Recurrent vomiting
- Poor weight gain or even more extreme, a failure to thrive
- Poor sleep
- Bad breath
- Respiratory concerns including coughing, asthma, Apnea
- Recurrent pneumonia
- Esophagitis (inflammation that may damage tissues of the esophagus)
- Dysphagia (difficulty swallowing) or feeding refusal
- Upper airway symptoms (ear infections, throat infections, vocal issues, tooth enamel/dental issues)
Severity of reflux in infants is often focused on weight gain, respiratory issues and pain. If a baby is gaining well, reflux is still a significant matter, but the baby who is not gaining well is obviously a more serious concern. If your baby is exhibiting a combination of the symptoms above, please discuss the possibility of GERD with your child’s physician or pediatrician.
There are some easy things parents can do to mitigate some of these symptoms:
• Ensure baby is not over eating (easier for bottle fed babies than breast fed… small volumes more frequently is more desirable than larger volume less frequently)
• Consider non-prone sleeping position (elevated mattress; only for non-rolling babies. ALWAYS place an infant on their back to sleep unless you have discussed GERD with your physician and an alternative position is medically indicated)
• Consider trial of hypoallergenic formula
• Consider thickened formula (medically supervised)
There are a number of different pharmacological approaches to treating GERD:
1. Antacids – effectively neutralizing the acids.
2. Pro-kinetics – which can encourage the esophogael sphincter to close, and have the stomach empty more rapidly and frequently, so the acid can’t get to where it’s a problem.
3. Surface Agents – coating the lining of the esophagus so it’s protected.
If medication is unhelpful, or the severity indicates further treatment, surgical intervention is also an option.
I encourage families to consider chiropractic treatment as well. There doesn’t seem to be a body of scientific evidence that would indicate a chiropractor would be helpful in preventing GERD. However, I can tell you in my professional experience and in an isolated case study, chiropractic adjustments have been helpful to improve symptoms of GERD.
The good news is that most babies will outgrow GERD as their digestive system matures. Until then, there are treatment options worth exploring to help make your baby more comfortable. When GERD is well managed, we can then go about addressing better sleep.
 Warren Shapiro, MD, The Incidence , Pathophysiology and Treatment GERD During Infancy, Presentation
 Judith A. Owens, MD, The Assessment and Management of Common Behavioral Sleep Problems in Children, Presentation at The Hospital for Sick Children Pediatric Sleep Symposium 2015, Toronto.
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