THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 524.5 Guest: Mary Jo Minton, M.D. Topic: Reflux in Children - One Part Host: Steve Girard Producer: Ed Graham

NEMA: You hate to go to the pediatrician because your infant is crying and screaming, but many times that's what happens with reflux...because parents don't know much about it, and are looking for the reason the child won't or can't sleep, and sometimes seems to be in a lot of pain. We're with Dr. Mary Jo Minton....

MINTON: Probably about 50% of kids will have some reflux, or some spitting up.....and most kids will do fine, they grow well , they don't have more than normal amounts of crying spells, but there are some who are extremely irritable. We find that often associated with the spitting up they will have a lot of arching, they will have a lot of crying, they will resist eating and they will be really fussy babies, above and beyond the normal fussiness you may see. And we find that a lot of this is not just the spitting up but the irritation in the esophagus, or the tube that connects the mouth to the stomach. And we find that if that's real irritated, that can cause a lot of burning and discomfort and that's why we see all the fussiness and crying."

NEMA: What's the reason behind reflux?

MINTON: We think that there's probably some sort of pressure difference in that connection...we used to think that was a loose connection but that's probably really not the case anymore, there's just something a little bit wrong that causes a relaxation at an inopportune time, so you will have the connection between the stomach and the esophagus relaxing at times when it shouldn't, and the food will propel backwards and go up into the esophagus"

NEMA: Does the position of the child when feeding contribute to the problem?

MINTON: We know that children who are in a flat position after eating or during feeding will often have increase reflux. We also know that kids who are moving around and have increased abdominal pressure ...from maybe gassy or fussy babies, for that reason may have increased pressure and cause it to back up. We do encourage parents to position them in a more upright position, and we try to have breast fed babies positioned so they are a little more upright...or after a bottle fed baby is fed, put him in an upright position. We do see it more now because babies are sleeping on their backs, and the supine, or back position does seem to also increase reflux.

NEMA: How do you determine whether a child needs treatment for reflux?

MINTON: "The first step is to sort of tease out which kids are having significant problems, particularly we are looking for kids who are not growing well, who have episodes of respiratory symptoms, pneumonia's because they aspirate the food contents, or even apnea, where they actually stop breathing because the food comes into the upper airway and causes some sort of a reflex laryngeal spasm...some sort of problem that causes apnea. And the first line of treatment for those kids is going to be medical therapy, and there are several drugs that we use for medical therapy....some of which have been shown to be effective in a lot of kids but not every kid's going to respond extremely well to any of them.".

NEMA: What do you tell parents of a child with reflux when they come to you,eyes, bloodshot, looking for an answer?

MINTON: Kids outgrow this. Most children, as they get to be about one year of age, and who are upright, eating more solid foods tend to spit up a whole lot less, and they tend to be a lot less fussy. And by two, 70 to 80 percent of the kids have totally resolved their reflux. So it really is something that kids outgrow."

NEMA: Dr. Minton says in her experience, she's only recommended surgery for reflux in cases where a child has neurological problems. I'm Steve Girard.