Is it Colic, Infant Reflux or GERD?

Learn How to Tell the Difference
by Roni MacClean

It can sometimes be difficult for a parent to understand whether the baby has colic or reflux (and even GERD) since some of the symptoms (eg. poor sleep, constant crying) can be similiar. It's also extremely important to rule out reflux as a cause of this crying, as it's becoming widely acknowledged that many cases of colic are actually undiagnosed and untreated cases of reflux. In these cases, simply treating the reflux may eliminate the colicky behavior. The easiest way to determine whether a baby has colic or reflux is to look at the definitions and symptoms of each. Then compare them to your child's symptoms.

COLIC

Colic can be defined as uncontrollable, extended crying in babies who are otherwise healthy and well-fed. All babies cry, but when they cry for more than three hours a day, three to four days a week, they are said to have colic. Symptoms of ColicThe main symptom is continuous crying for long periods of time. This crying can occur at any time of day but it usually gets worse at night. It's not believed that colic is caused by pain although a colicky baby may look uncomfortable or appear to be in pain. They may lift their head, draw their legs up to their abdomen, pass gas and become red-faced. Poor sleep habits is also common.

REFLUX

The term reflux is a shorter way of referring to GER (Gastro Esophageal Reflux) and is simply defined as the backward flow of stomach contents up the esophagus. GER is a physiological process that happens to everyone—young and old—from time to time, particularly after meals and many times we are not even aware it is happening. In babies it generally occurs from immaturity of the LES (Lower Esophageal Sphincter) which is the muscle between the stomach and esophagus. Some common symptoms of uncomplicated reflux can include:

• constant or sudden crying or colic like symptoms
  
• irritability and pain
  
• poor sleep habits typically with frequent waking
  
• arching their necks and back during or after eating spitting-up or vomiting
  
• wet burp or frequent hiccups
  
• frequent ear infections or sinus congestion
  

Your child does not need to exhibit all of these symptoms, in fact, only having one of the above could mean they have reflux. It does not; however, mean they need treatment. If your child is showing one or more of the above symptoms but is otherwise happy and healthy then some simple lifestyle modifications will likely make life better until they outgrow it. Visit InfantRefluxDisease.com for more info on treatments.

GERD

In contrast, GER (Gastro Esophageal Reflux) is referred to as GERD (Gastro Esophageal Reflux Disease) when complications arise. GERD is a pathological process and the complications can be typical (failure to thrive, feeding and oral aversions, esophagitis, etc) or atypical (wheezing, pneumonia, chronic sinusitis, etc). Patients with GERD have complications arising from their GER that necessitate medical intervention. GERD is also referred to as "Pathogenic GER". It is estimated that approximately one in three hundred children will present symptoms of GERD and is more common in children with neurological impairments. Symptoms indicative of Reflux Disease or GERD:

• refusing food or accepting only a few bites despite being hungry or the exact opposite requiring constant *small meals or liquid
  
• food/oral aversions
  
• anemia
  
• excessive drooling
  
• running nose, sinus infections
  
• swallowing problems, gagging, choking
  
• chronic hoarse voice
  
• frequent red, sore throat without infection present
  
• apnea
  
• chronic ear infections
  
• respiratory problems—pneumonia, bronchitis, wheezing, asthma, night-time cough, aspiration
  
• gagging themselves with their fingers or fist (sign of esophagitis)
  
• poor weight gain, weight loss, failure to thrive
  
• erosion of dental enamel
  
• neck arching (Sandifer's Syndrome)
  
• bad breath
  

About the Author

Early in 2001 Roni MacLean launched InfantRefluxDisease.com. One of the best sources of info online, it's an informational website to help others survive what MacLean had been through with their daughter. She has also written the highly acclaimed book, Life on the Reflux Roller Coaster, published in 2004. Currently she dedicates all her time to the website and it's visitors.

14 Tips for Improving Your Baby's Infant Reflux 
by Roni MacLean

It's important to realize that not all babies with reflux will require medication or have difficulties with their reflux. Many infants, usually called happy spitters, will benefit greatly from some simple steps that you can start trying right now. Many of the things listed below will help with your baby's discomfort and spitting up, eliminating the need for medication.

If, after trying all the below listed tips, your baby is still spitting up, or having difficulties with their reflux, visit InfantRefluxDisease.com to read about whether or not medication may be needed and what medications will likely be used.

POSITIONING STEPS FOR REDUCING REFLUX

Positioning During and After Feeds
Keeping the child upright during and for at least thirty minutes after feeds can help to reduce reflux by allowing gravity to work at holding the food in their tummies. As well, after feeding, try to keep them as motionless as possible for at least thirty minutes after feeding. Formula fed babies may require longer periods since formula is digested slower than breastmilk.

A Word About Car Seats
Some car seats position baby in such a way that they hunched and slouched over, putting added pressure on their tummies which can increase reflux episodes. Look for a car seat that allows baby to be reclined enough that they aren't slouched yet, inclined enough that they are fairly upright.

Sleeping Position
As with positioning after feeding, keeping baby propped during sleep is essential when they have reflux. It can help reduce painful reflux episodes and reduce the risk of aspiration. For more info on propping baby, see the article on propping at InfantRefluxDisease.com.

Prone vs. Supine (Front vs Back)
The American Academy of Pediatrics recommends all babies sleep in the supine position (on their backs) because it has been shown to reduce the risk of SIDS. This is fine for babies with reflux as long as the baby is safely propped up to at least 30%, we found the higher baby is propped the better. Having said that, many babies with reflux prefer sleeping in the prone position (stomach), also elevated of course, and may have less reflux episodes in this position. Discuss this with your doctor and he can help decide if it's okay, and how to safely manage allowing baby to sleep in the prone position. It's very important to discuss this with the doctor before trying it as babies with reflux are already at an increased risk of SIDS.

Carrying
Try carrying baby around as much as possible in a baby carrier through out the day. Carried babies tend to cry less and crying will make reflux worse, plus, it keeps baby upright.

CLOTHING AND REFLUX

Avoid Tight Clothing
Tight clothing, particularly clothing that's tight around baby's tummy, can make reflux worse by increasing pressure on the LES (lower esophageal sphincter). Make sure baby stays in loose fitting, elastic waists whenever possible.

FOOD / FEEDING TIPS AND SUGGESTIONS

Food
Breastfeeding is definitely best for a baby with reflux because it is more hypoallergenic than formula and is digested twice as fast as formula. If breastfeeding is not chosen or not possible by the mother, formula changes can help some babies. If the baby has a milk or lactose allergy or intolerance giving the baby formula that is milk based can make reflux worse. Learn about the different types of formula available and discuss this possibility with your pediatrician.

Thickening
Some babies with reflux will respond well to thickening their feeds with cereal. Thickening formula can help for a few reasons. The added weight of the cereal in the food helps to keep the food from splashing around in the baby's belly and can help keep it down. Babies who are having difficulty gaining weight may also benefit from the added calories. Generally, it's recommended that about one tablespoon of cereal should be added for every ounce of formula. If the formula isn't thick enough, it won't work. Also, some babies may react poorly to rice cereal which is generally the first tried, so adding oatmeal instead may work better for some babies. As always discuss this with your pediatrician before trying it.

Feeding Time
When and how much a baby is fed can also have an impact on their reflux. Smaller more frequent meals through out the day work much better than larger, less frequent meals. Also, avoid feeding baby right before bedtime, particularly if the baby is already a poor sleeper.

Breastfeeding
If you are breastfeeding, try eliminating the foods that can make reflux worse. Dairy products are a big offender, as is caffeine, fatty foods, spicy foods, citrus fruits. If eliminating these things seems to help, you can slowly (about one thing a week) start to introduce one thing at a time back into your diet and watch baby's reactions. This will help give you an idea of exactly what was making the reflux worse, so that you (hopefully) don't need to give up everything you love, just one or two things.

Burping
Stopping to burp baby frequently (at least after every ounce) during feedings can help.

Provide a Pacifier
Sucking on a pacifier or dummy, can increase saliva production. Saliva is alkaline which can help neutralize some of the acid that may come up.

Avoid Certain Foods and Liquids
More so for older children and babies, there are certain foods that are known to make reflux worse, as mentioned above. These should be avoided.

OTHER

Infant Massage
Try infant massage, it's been shown to improve digestion and will help relax baby.