Cry Baby
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Wondertime: You used the phrase "urban legend" in your book to describe colic.
Yes, colic has evolved into a bit of an urban legend and the criteria are loose too. I have one pediatrician friend who describes a baby as having colic only if she can't be put down. There are others who say it's colic if the baby quiets with white noise like a hair dryer or a washing machine.
The reality is that any baby who is suffering with any kind of pain or discomfort — be it from an ear infection, a sore throat, or pain in the intestinal tract — is going to be happier when he is surrounded by that humming white noise.
So that by itself doesn't define a baby as having colic. That's more related to a baby's central nervous system and what he likes.
Wondertime: According to your book, there's a pretty high percentage of these so-called colicky babies who have acid reflux disease. How many kids, roughly?
Well, in my practice, between acid reflux disease and milk protein allergy, probably 60 percent of the kids I evaluate for inexplicable irritability are ultimately found to have one of those two problems.
Wondertime: Let's talk about acid reflux disease for a bit. It used to be thought that just grownups had it. When did the field start to recognize that babies and children had reflux too?
Well, I think it's been known for a long time that babies spit up and regurgitate, and that this represents acid reflux. Now, this is a very important point: There's a difference between acid reflux and acid reflux disease. As it turns out, all babies have acid reflux, and that's kind of a shocker to a lot of parents.
In fact, all people have reflux continuously throughout the day. Material passes from the stomach up into the esophagus on and off throughout the day, but our bodies have a way of handling that. The bicarbonate in our saliva helps clear it, our esophagus squeezes and helps push it back down to the stomach. Typically it's not a problem.
There are some people, though, for whom those natural protective mechanisms don't work very well. And that acid that comes up hangs out a little bit longer and doesn't get flushed away the way that it should. And it can create problems.
Now what defines gastroesophageal reflux disease in babies? We put the D on it. We go from GER (gastroesophageal reflux) to GERD (gastroesophageal reflux disease). GERD is when babies have an inability to feed or marked difficulty with feeding, failure to thrive or poor growth, chronic lung disease, wheezing and coughing, that sort of thing. Or in very young babies, apnea, where they stop breathing. When we look at those problems, those are the babies we consider to have acid reflux disease.
The past 20 or 30 years have allowed for the development of new technologies for actually examining the lining of a swallowing tube and examining the reflux activity with pH probes, and that's allowed us to define GERD.
Some babies are actually very sick with acid reflux — kids who, 30 or 40 years ago, we never knew existed. I think that back then, reflux disease as a serious problem was probably vastly underestimated.
Wondertime: Let's talk a little bit about the influence of pediatric gastroenterology. You belong to the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). This group got together in 2001 to create a consensus for how to manage acid reflux disease in kids. So is that consensus the gold standard now?
The NASPGHAN position paper is as close to a gold standard as we can come. Let's put it this way: I see Colic Solved as kind of an extension of the NASPGHAN position paper. I've tried as much as I can to embody the standards that are printed in the NASPGHAN position paper. But some parts of the book represent my own opinions about things, my own point of view based on my extensive experience with babies with reflux.
I think some of my colleagues, as I've said, probably think I overstate the role of reflux in irritable babies. And perhaps I do. We're sort of still in the infancy stages of understanding babies with reflux, babies with milk protein allergy. So we do have more to learn.
There was a study, interestingly, just published in January in Pediatrics in which they gave babies what's called "probiotics." They're the live bacteria found in yeast and other active cultures that have beneficial effects on the health of an individual when given in appropriate quantities. These researchers gave probiotics to 83 babies. Half got simethicone, which are the standard infant drops. The other half received a probiotic by the name of Lactobacillus reuteri.
The babies who received Lactobacillus reuteri showed a significant decrease in their crying scale, in their screaming, compared to the simethicone babies. This is kind of interesting because it raises the questions: What were these probiotics doing and what role do colon bacteria have in the irritable baby?
For sure, we know that probiotics are effective in treating inflammation. Perhaps it's possible that a chunk of these babies who got better had milk protein allergy and had relief because of the effect of the probiotic on the inflammation. So the study raises as many questions as it answers.
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