What Causes Reflux in Babies?

Spitting Up and Vomiting in Babies

Spitting up and vomiting in babies have become a huge area of parental concern. Part of the concern is positive because it reflects a better understanding of reflux disease, but another part may be negative and reflects a push to blame vomiting for all problems (such as colic). As a result, there is a trend to place younger and younger infants on medications they may not really need and for whom possible side effects have not been determined.

What Causes Reflux in Babies?

After your baby swallows milk, it glides past the back of the throat into a muscular tube (the esophagus) and, from there, into the stomach. At the junction of the esophagus and the stomach is a ring of muscles (lower esophageal sphincter) that opens to let the milk drop into the stomach and then tightens to prevent the milk (and the stomach contents) from moving back up into the esophagus. If the stomach contents should happen to re-enter the esophagus, this is called "reflux."

Infants are especially prone to reflux because:

1. Their stomachs are quite small (about the size of their fists or a golf ball), so they are easily distended by the milk.
2. The lower esophagus valve may be immature and may not tighten up when it should.

Is Your Baby a "Happy Spitter?"

Every baby spits up or vomits occasionally, and some do quite often or even with every feeding. If, despite the spitting, your baby is

• content
• in no discomfort
• growing
• experiencing no breathing problems from the vomiting

she is what pediatricians call "a happy spitter" and no treatment is needed. Typically, the lower esophagus valve tightens up sometime in the first year, usually around 4-5 months of age, at which time the spitting up may go away.

Could Your Baby Have Gastroesophageal Reflux Disease (GERD)?

Unlike happy spitters, babies are diagnosed with GERD if the vomiting seems to be causing significant problems, such as:

• discomfort and pain (presumably heartburn due to the acid-filled stomach contents irritating the esophagus)
• breathing problems of any kind (gagging, choking, coughing, wheezing, and, worst-case scenario, pneumonia due to inhalation of the stomach contents into the lungs, called aspiration).
• poor growth (due to the loss of so much nutrition from vomiting)

If your baby has any of the above GERD symptoms, talk to your pediatrician, who can perform different tests to diagnosis and treat it correctly.

Tips for Concerned Parents

For any spitter, there are a few things that might help:

• Keep your baby upright for a half hour or so after a feeding (to let gravity help out).
• Make sure there's no pressure on the stomach after a feeding. For example, try to wait at least 30 minutes after feeding before putting baby in her car seat.
• Thicken feedings (usually by adding some rice cereal) so they're heavier and less likely to come back up.

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Gastroesophageal Reflux

Gastroesophageal reflux is the return of the stomach contents back into the esophagus, the tube that runs between the mouth and stomach. Parents should be aware that this may occur in very healthy infants and is not necessarily a sign of illness or abnormality. Many children grow and develop normally despite spitting up their food from time to time. In very young children gastroesophageal reflux is often due to chalasia, a malfunction of the lower esophageal sphincter, which normally functions to prevent food from returning to the esophagus. This malfunction is considered by some to be simply an indication of immaturity of the sphincter, which in a few weeks or months begins to function as it does in adulthood. Most children who demonstrate gastroesophageal reflux before they reach the age of three months may be expected to be symptom free by the time they reach two years of age. Symptoms persist in some children until four years of age. By the time the child reaches 12 months of age he is spending most of his time in the upright position and even those whose sphincters are slower in development may expect improvement in symptoms with the change in position.

Gastroesophageal reflux can also be caused by hiatal hernia, but this is more common in older children than in the young age group most likely to suffer chalasia.

Symptoms include vomiting, failure to gain weight, irritability, refusal to eat, blood in the stools, and anemia. Vomiting is the main symptom in about two-thirds of all infants with gastroesophageal reflux. Onset may be at the time of birth or six weeks later. The vomiting may be mild, a sort of spitting up, or may be projectile, shooting out of the child’s mouth. Children may be hungry immediately after vomiting and wish to eat again.

The repeated return of food and hydrochloric acid into the esophagus may cause irritation or even esophagitis, making it painful for the child to eat. If the irritation becomes severe the esophagus may bleed, and blood may pass through the digestive system and be eliminated with or in the stool, or the child may vomit fresh blood. The continued blood loss may lead to anemia.

About one-third of these children fail to grow properly because of inadequate nutrition, but once successful treatment is begun they grow normally. Some children have episodes of cessation of breathing. There may be associated respiratory problems, such as cough or asthma, because of inhalation of the refluxed material. Cow’s milk placed in the trachea of some very young laboratory animals causes cessation of breathing. For this reason it may be well to avoid giving cow’s milk to children with gastroesophageal reflux. Older children who suffer gastroesophageal reflux, for whatever reason, may have heartburn.

Most of these children will rapidly outgrow gastroesophageal reflux. The treatment is controversial, but we will discuss both sides, and if one method does not work the other is worth a trial. Both sides claim high success rates.

For decades gastroesophageal reflux has been treated by keeping the child upright at about a 60 degree angle in an infant seat to enable gravity to assist in keeping the food in the stomach. However, some observers point out that children slump in the infant seat, increasing pressure on the abdomen, which encourages the food to reflux upward. These people claim that the proper position for the child is lying face down on a board slanted upward at a 30 degree angle. This may be done by the use of a board with a brace, or a harness attached to the head of the bed. This position is felt to encourage stomach emptying. The child should be kept in this position constantly during the treatment program, which should last at least six weeks. After this period of time the child may be taken off the board for short periods of time, gradually increasing the time if symptoms do not recur. During the treatment time the child should be removed from the slant board for bathing and diaper changes before feedings and held up to the shoulder or placed back on the board immediately after feedings. He should never be placed flat after a feeding.

Older children who have gastroesophageal reflux should have the head of their bed raised, and should not go to bed for several hours after eating. Foods high in fat and chocolate should be eliminated from the diet as these are known to decrease the lower esophageal sphincter pressure.

Some children develop a stiff neck while on the slant board. The parents should turn the head from one side to the other frequently to prevent this. Sometimes the position causes the child’s legs to swell from fluid accumulation. Simply lifting the legs up for a few minutes will often be effective in resolving this.

Until at least six months of age infants should receive only breast milk. For the older infant, feedings should be thick, as thick material is less likely to reflux. Whole grain rice cereal boiled gently for three hours or blended with expressed breast milk or fruit juice may be spoon-fed in small amounts every four hours, or at regular feeding times; or the child may be fed rice cereal prior to nursing. If the child is receiving formula it may be necessary to enlarge the nipple hole to allow the food to flow freely. Symptoms may worsen if the child swallows air in an attempt to get his food. He should be burped frequently. Many children on thickened feedings show improvement within about two weeks, but the feeding schedule demands cooperation on the part of all family members.

For esophageal reflux, we have found people have good benefit by sitting and standing in very good posture, and by yawning. If you are aware that you are having reflux, if you can induce a good yawn, sometimes that will help amazingly to relieve the sensation. If you take pills of any kind, the time to swallow them is when you have in your mouth already thoroughly chewed food ready to swallow. Introduce the pill, and swallow it all together. by Dr. Trash.

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Chron's Disease Treatment

TREATMENT
Patients with Crohn's disease should be on a diet having no free fats, but one providing plenty of essential fatty acids through the use of grains, legumes, and nuts if these foods can be tolerated.(20)

The intestinal flora may be changed in order that toxic products will not be produced. In order to do that, the diet must be such that refuse left in the colon will not cause putrefaction. All animal products should be eliminated, as they tend to putrefy in the colon. The colon must be kept empty by the use of high residue foods, enemas, and the application of brief cold compresses to the abdomen. Laxatives must be strictly eliminated as they cause congestion and irritation. Since the residue of breakfast will be found in the colon within seven to nine hours after breakfast is eaten, it is best for the colon to be cleansed of breakfast before lying down to sleep at 10:00 P.M. Ideally the bowels should move after each meal and should have about the consistency of soft ice cream. A formed stool is always an evidence of stagnation in the bowel. The toxic materials produced from these residues are capable of causing much suffering. If necessary, these patients should have enemas twice a day. The enema should be at about 115°F, and from one to two quarts may be used at a time. High temperatures are stimulating to the lining membranes and promote health. High temperatures also relieve pain. A water temperature of 120°F will discourage bleeding by the same principle that "hot lap packs" are used in surgery to discourage diffuse bleeding, as from a torn liver. Burning of tissues will not occur below 123°F.

The use of liberal quantities of complex carbohydrates such as found in fruits, vegetables, and whole grains is of such a character as to promote a luxurious growth of aerobic flora. Dextrinized grains are most efficient for this purpose. Grains may be dextrinized prior to the cooking process in cereals or breads, etc. and bread may be made into melba toast by putting whole wheat bread slices directly on the oven rack, turning the oven on at its lowest possible temperature setting, and allowing the bread to dry out for several hours.

Sunbaths should be taken when possible, exposing the entire skin surface, which helps to increase resistance and to develop immunity. Plenty of water should be taken by mouth to encourage proper cleansing of the blood and the gastrointestinal tract.

A bland, low-fat diet should be instituted. All foods should be chewed well, or mashed with a fork, or pureed in a blender. We especially recommend avoiding milk, most particularly cheese. We advise abolishing all foods that have been highly milled. There should be no free-fats, no fried foods, no sugar, and no extremely hot or cold foods. Avoid any gas-forming foods such as cabbage, corn, certain greens, pickles, relishes of all kinds, skins of apples and potatoes, and legumes. It is well to try an elimination diet to determine if one is sensitive to any group of the most common foods causing sensitivity: milk and all dairy products including whey products, sodium lactate, sodium caseinate, and all other milk residues; coffee, tea, colas, and chocolate; citrus fruits and juices; corn, wheat, and rice (may use oatmeal and millet); all other animal products (pork, eggs, beef, fish, chicken, etc.); strawberries, apples, lettuce, cane sugar, onion, garlic, nuts, peanuts, alcohol and beer, yeast, tomatoes, potatoes, and tobacco).

Two meals a day are preferable to three, as proper digestion and assimilation are more important to maintain good nutrition than is the quantity of food taken or the number of meals eaten. No spices or food additives, dyes, colorings, conditioners, or other additives are allowed. The principal foods should be fruits, vegetables, and whole grains. Anything added to the food should be looked at with great suspicion.

EXERCISE is excellent and should include walking and gardening if these are available. There should be strict avoidance of all drugs, as drugs almost invariably irritate the gastrointestinal tract. Drugs generally fail to accomplish any striking therapeutic results.(21) It is not necessary to take acidophilis bacteria, as these do no apparent good.

The long-term use of corticosteroids is contraindicated. Antidiarrheal medications cause narrowing of the small bowel and can result in obstruction. Surgery for Crohn's disease should be avoided except in the treatment of life-threatening complications. At least 50% of patients can date the onset of rapid progression of the disease and worsening of their symptoms to their first operation.(22)

To find out more and for proper diet, meal plans, herbs and lifestyle regiment that includes exercise call us at 305-396-1571 or email us thevital8@gmail.com

Publish Post

REFERENCES
Acta Hepato Gastroenterology, 26:257-259, 1979.
Modern Medicine, February-March, 1980, page 23.
Beeson and McDermott. Textbook of Medicine. Philadelphia: W. B. Saunders, 15th Edition, p. 1560.
South African Medical Journal, 47:1400-1406, August 11, 1973.
The New England Journal of Medicine, 289:1099-1103, 1973.
British Medical Journal, July 10, 1976, page 87.
Hepato-Gastroenterology, 26:257-259, 1979.
American Journal of Clinical Nutrition, 32:1898-1901, 1979.
British Medical Journal, September 29, 1929.
Digestion, 20:323-326, 1980.
British Medical Journal, April 9, 1977, page 929.
Southern Medical Journal, 71(8):935-948, August 1978.
British Medical Journal, June 11, 1977.
American Journal of Clinical Nutrition, 24:1608-1673, September 1971.
Psychosomatic Medicine, 32:153-166, 1970.
Gastroenterology, 69:618, 1975.
Lancet, 2215, 1976.
Journal of American Medical Association, 236:2213, November 8, 1976.
Gut, 11:338-343, 1970.

Chron's Disease Part 2

The incidence of Crohn's disease is increasing rapidly, and is more common now than ulcerative colitis, showing a twenty-fold increase from 1940 to 1970.(1) Crohn's disease is also called regional ileitis. It is a chronic, progressive, inflammatory disease of the bowel. The symptoms are most commonly that of diarrhea and pain. Weight loss, fatigue, and irritability are characteristic of the disease. The bowel movements often include mucus, blood, and pus because of the infection. Fat may be found in the bowel movements, making them bulky and foul smelling. Crohn’s disease tends to get worse as time goes by, and to spread along the bowel, accounting for the alternate name of "regional ileitis."

Fifty-seven percent of cases occur in women and seventy-one percent in Jewish people. The most common age of onset is 16 to 21 years. If the patient has one or more close relatives with Crohn's disease, the person is more likely to have the disease himself.(2)

Crohn's disease can occur in any portion of the gastrointestinal tract. There may be healthy areas of bowel alternating with diseased ones. Crohn's disease is limited to the small intestine in 90% of cases, and most frequently starts with the terminal ileum.

There is usually a reduction in the motility of the small bowel. There may be times when the disease is in remission, that is, there are no symptoms discernable and the person may think that the disease is cured. During the remission, it is important to use care to follow all known health laws to prolong or permanently establish the remission. A large number of patients with Crohn's disease eventually come to some type of surgical treatment, with an operative mortality of about 6%.(3)

There are some little known clinical aspects of Crohn's disease, such as a skin involvement, the skin around the anus being most likely to become involved. Fissures, fistulas, and thickening of the anal skin tags represent the most common skin manifestations. The skin may become swollen and discolored around the anus. Ulceration of the skin of the legs may occur. The skin tags around the anus may have a typical reddish-blue color. Biochemical disturbances in the liver are occasionally seen. A large proportion of these patients and their immediate families reveal a history of allergies, including hives and asthma. With this set of symptoms, there is often an enlargement of the ends of the fingers (clubbing). Ulcers in the mouth, lesions in the eyes (uveitis), and arthritis of the large joints may all precede the bowel disease by many years.(4)

There are no proven cases of spontaneous cure of Crohn's disease. The disease may be relatively mild, but more often the symptoms soon interfere with work and pursuit of productive activity. Despite drug treatments, new manifestations develop.

Crohn's disease is relatively rare in tropical areas. In Aberdeen, it was found to be infrequent in white collar workers and in country dwellers.

Cancer of the small bowel is rare except in people who have Crohn's disease, in which it occasionally occurs.(5) Immunity is depressed in Crohn's disease.(6) Allergies, arthritis, asthma, skin involvement, and food sensitivities may all be a part of the response or lack of response of the immune system.

CAUSES OF CROHN'S DISEASE
The cause of regional enteritis is said to be unknown, but overeating, chemical poisoning, or bacterial invasion all seem to be possible factors or etiologic agents.(7)

Substantially greater numbers of people with the disease give a history of using more refined sugar, less dietary fiber, and considerably less raw fruit and vegetables than the controls. This kind of diet favors the development of Crohn's disease.(8, 9, 10)

Some investigators point out that sugary foods tend to contain more chemical additives such as dyes, flavors, stabilizers, etc. These investigators also suggest that a high sugar intake itself may influence the intestinal bacterial flora to produce compounds toxic to the intestinal lining.(11)

Seasonings and cold fluids are not well tolerated and should be omitted. Lactose (milk sugar) malabsorption has been noted in as many as seven out of eight patients with Crohn's disease.(12)

It is postulated by some that a state of increased sensitivity develops in Crohn's disease, the immune system having been previously primed. In other words, substances capable of producing allergic states were able to penetrate the lining of the bowel because of some previous conditioning by circumstances, foods, or chemical injury. It is further postulated that during the neonatal period, particularly in premature infants, there may be an absence of certain defense systems allowing the penetration of antigens. Hypersensitivity could then develop in the intestinal lymphatic system, such as in infancy with a diet of cow's milk, before the establishment of the "mucosal barrier." It is of interest that patients with ulcerative colitis, a related disease, have a high incidence of using formulas of cow's milk in infancy as compared with controls.(13) One nine year old girl can remain well of Crohn's disease as long as she avoids all milk and dairy products, ham and bacon, blueberries, and cakes containing poppy seed.(14)

The story is reported of a thirteen year old boy with Crohn's disease who did fine as long as he was given no oral foods or fluids, and only hyperalimentation (a method of feeding entirely intravenously), but had his symptoms return when he was offered ordinary foods When hyperalimentation alone was reinstituted, his symptoms again subsided, but when given prednisone he got worse again, and had pain and bloody diarrhea. The prednisone was manufactured with certain substances such as lactose, starch, sugar, paraffin, oil, or tartrazine to hold the material together.

Some observations point to the possible role of gluten in Crohn's disease. Seven of ten patients with tropical sprue responded to a gluten-free diet, four patients with regional enteritis exhibited adverse effects with 12 days of taking 20 grams of gluten maximally and 5 grams minimally.(15) It is always worth a trial on a gluten-free diet to see if it is a factor. We have seen several striking remissions on this diet, but gluten must be strictly and rigorously excluded in order to give it a fair trial.

Crohn's disease patients have a high incidence of life crises during the six-month period prior to the onset of the disease. More than half of the patients in one series had been seen by a psychiatrist at least once during their lifetimes, and approximately 20% of all patients have been in psychotherapy.(16)

A viral cause of Crohn's disease has been suggested by some recent studies.(17, 18) In one study, clusters of viral particles were found in cases of Crohn's disease which could successfully inoculate tissue cultures, indicating the possibility of a virus as a cause of the disease.(19)

Crohn's disease diagnosed? Part 1

Crohn's Disease - Topic Overview

What is Crohn's disease?

Crohn's disease is a lifelong inflammatory bowel disease (IBD). Parts of the digestive system get swollen and have deep sores called ulcers. Crohn’s disease usually is found in the last part of the small intestine and the first part of the large intestine. But it can develop anywhere in the digestive tract, from the mouth to the anus.

What causes Crohn's disease?

Doctors don't know what causes Crohn’s disease. You may get it when the body’s immune system has an abnormal response to normal bacteria in your intestine. Other kinds of bacteria and viruses may also play a role in causing the disease.

Crohn’s disease can run in families. Your chances of getting it are higher if a close family member has it. People of Eastern European (Ashkenazi) Jewish family background may have a higher chance of getting Crohn’s disease. Smoking also puts you at a higher risk for the disease.

What are the symptoms?

The main symptoms of Crohn’s disease are belly pain and diarrhea (sometimes with blood). Some people may have diarrhea 10 to 20 times a day. Losing weight without trying is another common sign. Less common symptoms include mouth sores, bowel blockages, anal tears (fissures), and openings (fistulas) between organs.

Infections, hormonal changes, and smoking can cause your symptoms to flare up. You may have only mild symptoms or go for long periods of time without any symptoms. A few people have ongoing, severe symptoms.

It’s important to be aware of signs that Crohn’s disease may be getting worse. Call your doctor right away if you have any of these signs:

• You feel faint or have a fast and weak pulse.
• You have severe belly pain.
• You have a fever or shaking chills.
• You are vomiting again and again.

How is Crohn's disease diagnosed?

Your doctor will ask you about your symptoms and do a physical exam. You may also have X-rays and lab tests to find out if you have Crohn’s.

Tests that may be done to diagnose Crohn's disease include:

• Barium X-rays of the small intestine or colon.
• Colonoscopy or flexible sigmoidoscopy. In these tests, the doctor uses a thin, lighted tube to look inside the colon.
• Biopsy. The doctor takes a sample of tissue and tests it to find out if you have Crohn’s or another disease, such as cancer.
• Stool analysis. This is a test to look for blood and signs of infection in a sample of your stool. You can read more on this from Webmd.com

Treating Diarrhea

For generations, charcoal has been used for intestinal gas, diarrhea, nausea, and vomiting. The person with traveler's diarrhea will welcome a package of charcoal tablets or capsules in the purse. At the first sign of queasiness in the abdomen, four to eight charcoal tablets should be taken and repeated with every loose stool. The same can be used as a treatment for nausea and vomiting or an upset stomach. If a person vomits, the full dose of charcoal should be taken, and should be repeated each time the person vomits.

There are no ill effects of charcoal, since it does not react with the body. In some persons, it may cause a slight degree of intestinal irritation if taken in large doses such as 10 to 12 tablespoonful at a time. Some individuals who do not drink adequate water may experience some constipation. Charcoal does not cause cancer, but charred or burnt toast should be strictly avoided as the fats can cause potential cancer-producing chemicals when overheated. Wood products and coconut shells, the primary source of commercial charcoal, do not contain these fats.

Charcoal may be obtained in health food stores and pharmacies and should be kept on hand in all homes. Use 1-6 teaspoons for one ordinary dose.

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What Causes Diarrhea? Part 2

1. Diarrhea caused by medication

Sometimes good medicines lead to bad diarrhea. “As more patients are treated with antibiotics, we see more cases of Clostridium difficile colitis,” Rapisarda tells WebMD. While going after bad bacteria, antibiotics can also kill good bacteria that protect your intestines. “Ironically, antibiotics to treat one type of infection can make a patient more vulnerable to this other type of infection.”

Blood pressure medications, cancer drugs, and antacids can also trigger diarrhea. If you take any of these medications and experience frequent or ongoing diarrhea, let your doctor know.

2. Diarrhea caused by food intolerance

Diarrhea may be the result if your body has trouble digesting certain foods. Diarrhea-inducing fare includes dairy products and artificial sweeteners. The undigested food causes nausea, diarrhea, cramping, and gas, normally within 30 minutes to two hours of entering your system.

Lactose intolerance affects 30 million to 50 million Americans, most of whom are black, Hispanic, American Indian, or Asian American. The impact of lactose intolerance varies. Some people can drink small amounts of milk in tea or coffee without stomach upset. Some can eat cheese or yogurt, which have less lactose than milk. Note the type and amount of dairy products you eat and their effect. You can also talk to your doctor about dietary supplements that may improve your digestion of dairy products.

3. Diarrhea caused by chronic conditions

Diarrhea that doesn’t go away might be letting you know you have an untreated medical condition. If diarrhea lasts longer than three days, ask your doctor of you might have any of these diarrhea-causing conditions:

• Irritable bowel syndrome -- A common disorder that causes cramping, bloating, diarrhea, and general abdominal discomfort. Often, simple lifestyle and diet changes can bring irritable bowel syndrome under control.
• Inflammatory bowel disease -- The digestive tract becomes inflamed and damaged, reducing its ability to absorb and deliver nutrients to the body. Your doctor can help you reduce the symptoms and damage of inflammatory bowel disease.
• Celiac disease -- When people with celiac disease eat gluten, their immune systems attack the lining of their intestines. Gluten is a protein found in wheat, rye, and barley. Unless the condition is managed, the intestines can lose their ability to absorb nutrients over time.