Acid Reflux Across the Pond -- Questions from Parents in the U.K.
Acid reflux is not limited to the United States. Parents and support groups from around the world contact us with questions about acid reflux. In England, there is a website and support group for U.K. parents called Babyreflux (babyreflux.co.uk). Here, parents can discover acid reflux products that are available to help them care for babies with acid reflux.
This and my next SharePost provide answers to questions from the site's founder. These questions were submitted by parents of children with acid reflux. As you will see, the experiences of families living with acid reflux in England are shared by many of us.
Q: My daughter vomits after each feed and then generally dribbles sick right up to the next feed. She has gained weight well. She by no means projectile vomits. Does this mean it can't be acid reflux?
A: Your daughter may have "silent reflux," which refers to acid reflux without any outward or typical symptoms. This type of acid reflux is also referred to in the medical community and literature as "a-typical reflux." Just think of all the adults you know who do not projectile vomit, but certainly suffer from acid reflux.
In my own son's case, he has reflux episodes, but the refluxed material does not come high enough into his esophagus to actually come out of his mouth. Our doctor determined this early on with a remote sensing gastrointestinal probe. The probe had two sensors -- one upper and one lower -- that determined how far up his esophagus the reflux traveled.
Unfortunately, silent, or a-typical acid reflux can be much more difficult to diagnose, and also more damaging. Some in the medical community are not as familiar with silent reflux as others, and will begin and end the medical assessment with the question, "Does your daughter projectile vomit?" If you answer no, then they might be tempted to look for another cause besides acid reflux. Silent reflux can cause pain and damage to the esophagus on the way up and on the way down, which can almost double the acid exposure to the delicate lining of the esophagus.
Some symptoms of a-typical acid reflux are listed in our book, Acid Reflux in Infants & Children and include:
- Sleep apnea
- Sudden infant death syndrome (SIDS)
- Acute life threatening events (i.e. stops breathing and turns blue)
- Recurrent ear infections
- Nighttime awakening
- Back arching behavior
Q: Why is reflux worse at night?
A: Reflux is worse at night for at least five reasons:
1) Gravity. When a person is standing up, versus lying down, gravity is able to help the reflux material return to the stomach. Therefore, the reflux material can remain in the stomach longer at night, and cause more discomfort than in the daytime.
2) Distraction. People are not as distracted at night as they are in the day. Preliminary research supports the power of distraction for pain management. Many times, a person may have acid reflux-related pain in the daytime, but he or she is too busy and distracted to focus on the discomfort.
3) Swallowing. The bicarbonate in our saliva tends to neutralize the acid in our esophagus. At night, a person is not swallowing as much as in the daytime.
4) Medication. The half-life of most acid reflux medications is too short to stay effective throughout the night. My son takes acid reflux medication just before bed and by 3 a.m., the medication is completely metabolized and no longer effective. This phenomenon leads to nighttime acid "breakthough."
5) Snacking. Some individuals tend to eat the "wrong" foods just before bed, which can also make reflux worse at night. Foods which are difficult to digest, like meat or raw vegetables, or greasy foods like chips or pizza can make reflux worse if eaten just before bed.
Next week, I will answer the remaining questions submitted by our British counterparts.