Originally Published in the Daily Mail on 20th July 2010
By Henrietta Norton
As with so many first-time parents, my husband Charlie and I had a starry-eyed view of how things would be once we had our much wanted baby. So when Alfie arrived, ten days earlier than expected and following a smooth birth, we left hospital within hours, eager to start the perfect family life we anticipated.
That night, after five hours of attempting to breastfeed, rocking, fan off, fan on (it was summer), Moses basket, our bed, with vest, without vest, we all finally fell into a deep sleep at 4am. This was not how it was meant to be; we were in shock.
Over the next four weeks, a worrying pattern developed. After each feed, Alfie would arch his body and throw his head backwards with surprising force.
His crying escalated from a few tears to a scared, inconsolable screeching, sometimes to the point of choking.
Well-meaning midwives, health visitors, family, friends and our GP all tried to reassure us it was ‘ just colic – all babies get it’. Over-the-counter remedies which others swore by raised our hopes but did not ease the problem.
When we were told it would pass by three months, we were desperate; we did not know how to get through the next three hours.
Racked with self- doubt about our parenting skills, we searched the internet tirelessly and read endless books.
Had I eaten something which was affecting the breast milk? Was he feeding in the wrong position? Had we winded him enough?
Our stress levels escalated out of control and while I spent a lot of time near to tears, Charlie slipped a disc in his back with tension. In agony, he was forced to stay in bed for weeks. Now I had two patients to care for.
At five weeks, Alfie was losing weight. After two trips to A&E we were prescribed Gaviscon, but were no nearer to a diagnosis. Gaviscon needs to be mixed with milk and, as I was breastfeeding, this involved getting hold of a breast pump.
The medication did not work anyway, and it was at this point that Alfie stopped feeding altogether.
Frustrated by what felt like a serious lack of professional support, exhausted and at the end of our tether emotionally, we enlisted the help of a night nurse, a wonderful woman called Sarah, who by night three agreed that there was more to this than colic, whatever everyone else said.
Sarah suggested Alfie had reflux, where stomach acid was coming back up his oesophagus.
It’s a condition that can be difficult to detect in infants. We were doubtful because of the absence of the most common symptom of such a condition, vomiting. Alfie had not been sick once.
Friend, both of whose children had suffered from reflux, recommended we consult a private paediatrician. Under normal circumstances, our finances did not run to private health care, but these were not normal circumstances. We would have re-mortgaged the flat if necessary.
It took minutes for us to be given a life-changing diagnosis of silent reflux. I had gone to the consulting room armed with a number of symptoms, but before he had even examined Alfie, the paediatrician mentioned every one on the list.
I welled up with tears of relief and if I’d still had the energy I would have thrown my arms around this saviour of my sanity.
We’d done nothing wrong, Alfie was not a ‘tricky’ baby; we were simply one of many families to experience this challenging and largely unrecognised condition.
‘It took minutes for us to be given a life-changing diagnosis of silent reflux… We’d done nothing wrong, Alfie was not a ‘tricky’ baby’
According to Dr Edward Douek, consultant paediatrician at the Portland Hospital , London, silent reflux is ‘ notoriously underdiagnosed’.
It’s extremely common – around 80 per cent of babies are affected, although many will have only mild symptoms.
It occurs when the valve between the stomach and oesophagus is not working properly. Instead of closing after food or liquid enters the stomach, the valve remains relaxed – in children this is usually because the valve is underdeveloped, which is why they often grow out of it.
Until then, when the stomach contracts to force food out through the intestines, the relaxed valve allows the food, now mixed with stomach acid, back up the oesophagus, causing intense pain as the lining becomes more inflamed with each episode.
The contents may come all the way up, resulting in projectile vomiting, or only part way up, which is what happens in silent reflux.
Amazingly, reflux causes suffering in one in five babies, ranging from mild and tolerable to extreme pain and distress, as in Alfie’s case.
In some cases, no medical intervention is needed as the infant does not experience any detrimental symptoms, whereas severely affected babies may require hospitalisation if feeding becomes harder and weight loss becomes a concern.
The symptoms to watch for are persistent crying, arching of the back and vomiting. Once diagnosed, Alfie was prescribed Ranitidine, a stronger antacid medicat ion which, unl ike Gaviscon, is syringed directly into the mouth, which made a significant difference to both his and our lives within three days.
There were times when he was still uncomfortable, usually around 4pm, and administering the medicine through an oral syringe was not something either he or we relished. Other changes also helped – we were advised never to lie Alfie flat to discourage the stomach acid from travelling upwards. He was fed at a more upright angle and kept more or less in that position for at least 20 minutes after each feed.
We propped up one end of the cot so he lay with his head slightly higher than his body. Winding had to be very painstaking and gentle as patting the baby only exacerbates reflux – unlike with colic where you pat more vigorously. (I think of the amount of time we paced the flat patting and jiggling the poor little mite without the knowledge we were only making matters worse).
Most surprising of all, though, was the paediatrician’s advice that we use a dummy. Dummies encourage saliva to pass down the oesophagus which helps to neutralise the stomach acid and soothe the burning.
We withdrew the dummy after seven months so that he did not become attached to it, but it did seem to help.
As a nutritionist, I know only too well that dairy products have been associated with symptoms of reflux in both adults and in infants, so while breastfeeding I eliminated all dairy from my diet and boosted my calcium intake with nuts, green leafy vegetables and goat’s milk and cheese ( goat’s milk and its products are less acidic and low in the offending protein lactose, heavily present in cow’s milk).
After I stopped breastfeeding, Alfie went on to a lactose-free formula, Nutramigen, which suited him very well and was worth its weight in gold.
By the time an infant is sitting up and the oesophageal valve is stronger, symptoms can subside or stop completely. Now aged two, Alfie has been symptom and medication-free for 18 months, and as far as we can tell there has been no lasting damage.
Reflux is not a very serious-condition and we certainly do not wish to compare our experience with that of truly sick children. However, as new parents our experience had the ability to physically and emotionally disable both of us and there were times when we felt we were unable to cope for much longer.
I now know we were not alone in those feelings. Looking back, we count our lucky stars we found such a knowledgeable paediatrician at a relatively early stage. I now know of others who have experienced reflux in their children without any support or diagnosis for months, even longer.
There is help out there, but it seems you need to know about the existence of reflux in order to ask for it. Most importantly, you need the confidence to trust your instinct when you feel something isn’t right.
Our experience with Alfie prepared us to do just that with our second little boy, Ned, now eight weeks old. Showing signs of silent reflux at two weeks, we swiftly took him to the same paediatrician, resulting in an easier and less fraught start to his life for both him and us.