GER/colic

Here’s a brief summary of a good medical article on the treatment of colic/reflux/fussy babies:

http://www.ncbi.nlm.nih.gov/pubmed/25556017

You can link to the full text if you are more computer savvy than me, but its a medical journal full of specific technical jargon that may be unfamiliar to the average person who lacks medical training.

My children are grown now but I can sure remember their colicky infant stage.  And not so fondly–trying to cope with uncontrollable crying and a baby who spits up so much can be frustrating and even scary to young parents.

What’s going on?  Well, the jury is still kind of out on exactly what it is and the pendulum still swings back and forth on what to do.  For a long time now, many in the medical community have settled on gastroesophageal reflux (GER, “reflux”) as a big contributor, even though we cannot know for sure.  But there are good reasons–most of these kids spit up a lot, arch their backs when they cry suggesting heartburn, and have at least some vague temporal association with feeding.   So a lot of medications have been used to try and alleviate those symptoms.  Frankly, as the above article references, none have gotten the job done.  To the extent that there are any studies they mostly demonstrate no real efficacy compared to placebo in the large majority of infants.  And they are not free of risks in their own right.  Cisapride (propulsid) was used to improve esophageal musle tone until they found that lots of babies developed cardiac arrythmias from that drug.  For years now they have tried various acid neutralizing medicines–so called “H2” blockers like ranitidine(zantac), protein pump inhibitors(PPI’s) like omeprazole(prilosec) or lansoprazole(prevacid).  But as we can see from above, still–no good.  And use of these drugs have been shown to increase the risk of more serious lower respiratory tract infections like bronchitis and pneumonia (the acid environment of the stomach is effective in killing most microbes that we swallow before they can infect us; neutralize that acid and you neutralize that natural defense).

So, once again, we come back to what I say so often: let’s not rush to use a drug on your kid unless we have good reasons and some solid, scientific evidence that that approach is effective AND safe.  As the article suggests, most babies are going to gradually improve over the course of 6-9 months anyway, so a conservative approach is usually best and all that’s necessary.

There are special considerations for infants who:

1. Were severely premature
2. Serious congential abnormalities or infections
3. Serious neuromuscular disorders
4. Projectile vomit (shoots out of their mouth) frequently
5. Vomit blood, black, or green material
6. Frequent nasal vomiting with choking, cyanotic (blue) spells
7. Very fussy with disruptive coughing and wheezing
8. Colicky and not gaining weight

These infants require further evaluation; medications may be indicated.

Next time let’s try and review some things that may be effective for “everyone else.”  Thanks for following.