Gastroesophageal Reflux Disease (GERD) and Newborns

by Elizabeth Soutter Schwarzer

When my newborn daughter Mary started having screaming fits at 7 weeks, everyone told me it was "colic." It was infuriating how quick people were to dismiss my mother's instinct that something was wrong. I was a new mother and she was a tiny newborn and this, they told me, is what newborns do.

But it wasn't, and I knew it. She had a fit of projectile vomiting that caused her to lose a pound in a week. The nurse midwife thought it might be pyloric stenosis, a condition where the stomach does not form properly and must be surgically repaired. This prospect had me up all night investigating pediatric surgeons.

But Mary didn't have pyloric stenosis. The vomiting stopped but the endless shrieking only worsened. Added to that, Mary wasn't eating enough and was still losing weight.

Anti-gas drops were useless. The pediatrician prescribed a stronger anti-gas medication and I eliminated all but the blandest foods from my nursing-mother diet all to no effect. She just screamed and screamed.

One Sunday when she was about 9 weeks old, Mary shrieked for nine hours without stopping. Our pediatrician's call nurse suggested that I feed Mary a bottle of formula. The suggestion seemed asinine - Mary had only ever had breast milk. There was clearly something wrong with her tummy. It did not seem like the time to be introducing a new food.

By 8:00 PM I was putting in my third call. "She still hasn't stopped?" the call nurse said, sounding concerned for the first time. "Let me check with another nurse and call you back."

I frantically dialed my aunt Emily's cell number. I got her at a Manhattan cocktail party, startling her with an earful of newborn screams.

"Are you okay? Is Mary okay?"

"She won't stop crying!" I said, crying myself. "I think she's in pain but no one believes me!"

"Give her Mylanta," Emily said, without hesitating. "2 mils. I'm absolutely sure of it."

Emily knew the shriek. She had heard it in her own newborn son, my cousin Matthew, now two years old.

"Is she arching her back?" Emily asked me.

As we spoke, my daughter was rearing out of my hands, her face contorted and red.

"Yes," I said.

"Mylanta." Emily said.

The nurse called back and said it was time to take Mary to the ER. I was loath to do that. My surgeon grandfather had instilled in me a fear of hospital germs. I did not want my newborn there if I could possibly help it. I ran the Mylanta idea past the nurse and she said, "I've never heard of that. I don't recommend it, and I am writing here in your file that I don't recommend it."

Her concerns of lawsuit aside, I knew my aunt would never tell me to give Mary something she was not absolutely sure was safe. I measured 2 mils into a dropper and dosed her.

"If this doesn't work, baby," I said. "We're going to the ER."

At that moment, my tiny newborn let out a gargantuan belch, sighed, and fell asleep.

The next day, armed with Internet research, we went to the pediatrician to make our case that Mary, like her cousin Matthew before her, was suffering from Gastroesophageal Reflux Disease (GERD).

Mary's tummy was not closing all the way. Stomach acid was coming up her esophagus and burning her. She was arching her back and screaming because it hurt. She was not eating because eating hurt.

Our pediatrician bought it, and put her on a prescription for Zantac. From that point on, our life with a newborn was redefined. I was never more than arm's reach from the Mylanta bottle and I kept clean medicine droppers in cups all over the house. Fifteen minutes before a feeding, we dosed the Mylanta. Three times a day, on a regimented schedule, we gave the more powerful Zantac. If we were late with her 3:00 dose, Mary was screaming at 3:02.

This was how we became devoted co-sleepers. I kept Mylanta-loaded droppers in a cup on the nightstand. When her back arched next to me, I was able to get the medicine into her before the pain woke her. The stretch between her 9 PM Zantac and 9 AM dose was rugged - the Zantac clearly wore off around 7 AM. But the doc was not willing to up her dosage so we had to gut those two hours out every day with lots of Mylanta, nursing and gentle distraction.

In this way, we did battle with GERD until Mary grew out of it when we introduced solids at six months.

Symptoms of Reflux

A lot of older parents shrug off my descriptions of reflux, telling me my child was just colicky. But colic is defined as long periods of unexplained crying with no cause. Reflux is a specific disease with a specific cause. Symptoms of reflux in babies include:

• belching
• projectile vomiting
• prolonged crying as if in pain
• back arching
• refusal to eat, accompanied by significant weight loss
• hiccups
• gagging
• choking
• frequent cough
• wheezing
• frequent upper respiratory infections (colds)
• rattling in the chest

Reflux and Nursing

It is not uncommon for doctors to recommend that mothers not nurse their reflux babies. Reflux is aggravated by acid in the diet and formula has very low acidity -- so that is one quick fix. However, it is very possible for a mother to nurse a reflux baby, with just a few considerations.

Milk supply The longer it takes to diagnose reflux, the more danger to the milk supply. A reflux baby isn't eating a lot because she is in pain. Reflux babies frequently lose weight, and in the meantime, the mother's milk supply can go way down. If your baby is diagnosed with reflux, you need to evaluate your milk supply to determine whether an aggressive strategy of pumping and formula supplements are necessary to get you and your baby back up to speed.

Diet Acidic foods worsen reflux. The mother nursing a reflux baby must eat as though she herself has reflux. This means no wine, tomatoes, onions, vinegars, citrus, whole milk, chocolate, fried foods, fatty meats or mint products or flavoring. Experiment with your diet to see what your baby can tolerate. If I ate a teaspoon of onion, no amount of Zantac would undo its effect on Mary. But chocolate and coffee had minimal to no impact on her. So just experiment with very low amounts of foods you like and would like to keep consuming. Read up on GERD in adults to see what you should and should not be eating.

I often wonder how many cases of "colic" were really undiagnosed cases of GERD. As more doctors are becoming aware of GERD in babies, diagnosis time and treatment improves. In this day and age there is no reason for a baby to suffer from this painful condition, nor for parents to sit helplessly while their children scream. If you have reason to think your child is suffering from GERD, take him or her to a pediatrician for evaluation.

author Elizabeth holds a degree in political science and prior to motherhood served as Press Secretary to a U.S. Congressman. She and her husband make their home in the northeast with their daughters Mary and Karenna and an impossible menagerie of cats, dogs, and the occasional stray Ducky.

Copyright © Elizabeth Soutter Schwarzer. Permission to republish granted to Pregnancy.org, LLC.