Rejection to feeding? Your child may have GERD

Portal Somos Mães de Primeira Viagem | 02/23/2018
Get to know the Gastroesophageal Reflux Disease

It is common for babies to regurgitate, which is the return of milk to the mouth after the baby is done sucking, as soon as it is finished or some time later.  However, when this symptom reaches a whole new level and causes other problems, it should be investigated, as it could be a case of Gastroesophageal reflux disease (GERD).
GERD is the condition in which bothersome symptoms and/or complications occur, such as excitability, rejection to feeding, difficulty in weight gain, mostly followed by intense and unsoothable crying.
Children under these conditions require special care, as GERD may cause serious health complications, such as esophagitis, bloody vomiting and peptic ulcers, for example.

We talked to Dr. Fábio Ancona, pediatrician specialized in child nourishing, who answered some of the most frequently asked questions on this subject:

SMPV: What is GERD?
DR. FÁBIO: First of all, we need to understand that the gastroesophageal reflux is the passing of gastric content from the stomach to the esophagus, which might be normal in small children, and recedes spontaneously. In this case, food may or may not reach the mouth and pharynx. The Gastroesophageal reflux disease (GERD) is when this reflux becomes frequent, and ends up causing harm to the child. 

SMPV: Which is the most frequent age bracket in which GERD may occur with the child, and what is the main cause?
DR. FÁBIO: GERD may occur in small lactating children, and the cause is the immaturity of the digestive system, in which the sphincter that connects the stomach to the esophagus does not close. Therefore, food that is already in the stomach returns to the esophagus, and may or may not reach the mouth.
SMPV: When does regurgitating become a disease?
DR. FÁBIO: When bothersome symptoms and/or complications occur, such as excitability, rejection to feeding, difficulty in weight gain, mostly followed by intense and unsoothable crying.

SMPV: When exactly should parents be more attentive?
DR. FÁBIO: Small children should be observed, particularly with regards any discomfort after feeding.

SMPV: Which symptoms should indicate a more serious condition to the parents?
DR. FÁBIO: The main symptoms are those previously mentioned. The child gets continuously irritated, with intense crying apparently for no reason. Clinically speaking, rejection to feeding and difficulty in gaining weight are the main symptoms.

SMPV: What are the consequences?
DR. FÁBIO: GERD may affect child growth and development, which is why preliminary diagnosis is essential, so that the treatment may applied as soon as possible.

SMPV: What are the possible treatments for these cases?
DR. FÁBIO: Children in the breastfeeding period should be kept as such, with the treatment consisting in postural changes, such as staying upright with the baby after breastfeeding for about 15 to 30 minutes.
On the other hand, children that are fed with formulas require special infant formulas, developed to address nutritional requirements. International entities, such as the American Academy of Pediatrics, recommend thickened formulas, which are highly effective against regurgitation and reflux, as the first line of treatment. These products employ various types of thickeners, such as tapioca starch and carob gum. Parents and pediatricians must assess the best alternative for the child. The digestibility of the formula must be observed.  The use of two thickeners is also a positive differential in treating out little patients. Available formulas feature energy, protein and lipid profiles indicated to provide proper growth and development, and should include the proper amount of fat (linoleic and alpha-linolenic acid) for good brain and visual development of the child.
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