Gastroesophageal Reflux
Pediatric advice to parents changes from time to time, on issues like feeding, the position of the child while asleep, holding, etc. In this comprehensive review, Dr. Susan Orenstein, who is one of the world’s experts on gastroesophageal reflux has some new advice for clinicians and parents. The reader will be surprised to learn that what for decades has been the standard recommendation, i.e. to put the child in a sitting position, is now thought to be counterproductive. The new recommendation is to have the child lie on his/ her belly, as this tends to diminish the amount of reflux into the esophagus. The prevalence of the condition is thought to be around 8% of unselected infants, although many clinicians have the impression that this is diagnosed with increasing frequency. Gastroesophageal reflux is associated with asthma, and “apparently life threatening episodes” as they are called now, i.e. episodes of near asphyxia. Dr. Orenstein does recommend thickening the feedings in the younger infant, for instance with rice cereal, making each meal more consistent and richer in calories ( going from the usual 20 Kcal/ounce to 30Kcal/ounce), including breastmilk ( put in a bottle and thickened). There is a review of medical and surgical treatment and their relative success rate.
Reference. Orenstein, S.R., Izadnia, F, Khan, S., Gastroesophageal reflux disease in children. Gastroenterology Clinics of North America. 1999. Vol. 28. No.4. 947-970