I’ll tell you what I’ve learned, from being in this ‘world’ for eleven (11) years now:
1) It’s Structural: the Lower Esophageal Sphincter (LES) is immature; the valve, the sphincter between the top of the stomach and the bottom of the esophagus isn’t yet fully developed, so the stomach acid comes up (and goes down) as it pleases.
a) Spitting Up: if there’s no pain, you’ve got what ‘they’ call a Happy Spitter and a Laundry Problem. If there’s PAIN, well, this is the burn of the acid and your baby is spitting it up and out.
b) Silent Reflux: isn’t silent at all! This is when there isn’t any spit up; your baby is bringing the acid up and swallowing it back down. This is a DOUBLE BURN! One mother writes: The Screams of Silent Reflux
2) It’s Related to Diet: i.e. a reaction to one, or more, PROTEINS in whatever it is that your baby is ingesting (formula or breastfeeding).
a) Milk Soy Protein Intolerance, MSPI: The ‘main’ proteins that babies react to are milk and soy. About 60% of babies (I’ve also read 40%; regardless, it’s a high percentage, hovering around 50%), who react to milk protein also react to soy protein.
A reaction to milk protein is NOT lactose intolerance! Lactose is milk SUGAR, and babies are ‘designed’ to ingest it (the principal sugar in human milk is lactose). Reaction/reflux due to diet has to do with proteins, milk and otherwise. Milk Names (also has soy names).
1) Some babies won’t need medicine! Their mother goes on a diet to make her milk void of the offending protein(s) and there is a vast improvement with baby’s reflux! Or, the baby is formula-fed and the parents find the right formula and there is a vast improvement with baby’s reflux!
2) Getting rid of the offending proteins helps, via mother’s diet or formula, and a big difference is seen with baby’s comfort and pain. However, medicine is still needed…
3) It’s Both Structural and Protein Related
2) Getting rid of the offending proteins helps, and a big difference is seen with baby’s comfort and pain. However, medicine is still needed…
Mild cases may be controlled with diet, unfortunately it isn’t always that easy. Once a baby is in that hyperacidity mode, the vicious cycle needs to be broken. Some babies (yes it’s possible) don’t even need medication for too long, they get back on track with it, and once diet is optimized they can get weaned from meds; some need medication longer. Also, it is not always diet causing it, in some cases it is anatomy, ex: enlarged pyloric valve or an LES that is too floppy. For these babies (anatomical issue) it is not manageable with diet alone, although it does helps in many cases to cut out milk protein, too, along with medication, however, they would be lost without an PPI until they outgrew their reflux. Some even require surgery at a point, but on the other side, surgery can be avoided if reflux is manageable with PPI; it all depends on the case. But to not medicate babies just out of sheer stubborness or fear or because of “assuming” they don’t need it, THAT is inhumane. Acid gives them pain, and they shouldn’t be in pain at all. (Anke Tillman, FB, 4/17)