Cry Baby
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Wondertime: It sounds like this is, to say the least, an interesting time in the history of medicine to treat sick infants.
It is! There's still a lot that isn't known, though. We look at irritable babies a lot differently than we did 30 years ago.
Wondertime: How?
Because 30 or 40 years ago, we really didn't have super-hypoallergenic formulas to treat these babies. Because we didn't have appropriate medication for treating acid-related disease. And because we didn't even know a lot of these [conditions] existed in these irritable babies.
Because of that, back then, pediatricians had no other options than to tell a family that "this is the way it is, and we need to cope with it." While coping strategies are good, it's much nicer to have something to wrap our hands around.
Wondertime: Well, along those lines, let me ask you about the beginning of your field, pediatric gastroenterology. I think that it was 1988 that it was officially recognized?
That's the year the American Board of Medical Specialties developed a board for that. Pediatric gastroenterology extends beyond that; it didn't necessarily start then. There've been people well before then who devoted their time and attention to the digestive health of babies.
Wondertime: But it's interesting to me that it became official, so to speak. Is that because we were learning that circumstances warranted it being a new specialty? Did the field start and then the studies were done, or were studies starting to be done and they realized a specialty needed to be set up?
Well, I don't have the answer to that, except that I would probably think that the research was evolving. Our understanding of the infant or the childhood digestive tract had evolved to the point where we recognized that babies and children are different from adults.
Back in the old days, there were adult gastroenterologists who were oftentimes forced to treat children because there were no pediatric specialists in many parts of the country. So as the field evolved and as treatments evolved and as diagnostic procedures evolved, it became evident that there needed to be a body to certify specialists in pediatric care and pediatric gastroenterological care, and I think that's how it came together.
Wondertime: I'm going to switch gears here and ask you to tell us a bit about how reflux affected you and your family.
Nicholas, my firstborn, was a good baby. No problems with him, except he spit continuously throughout the day. Just a fountain! And everywhere we went, we had him in bibs. And we would exchange these crusty bibs — one for another — and in many of our pictures with him he's shown with a crusty bib. Right before his baptism picture, you know, we pulled the bib away so we wouldn't have it. So beyond that he was a happy kid who had just this innocent spitting up, which was not an issue for us.
Wondertime: And then your daughter came along a few years later.
She was a different story! Laura spit up some, but she was miserable beginning late in the first month of her life and had symptoms that are really pretty typical of reflux disease: difficulty feeding, arching back, pulling from the nipple.
My wife was breast-feeding at the time, and it was very difficult. It was difficult on Deidre, my wife, but also on Nicholas and the rest of the family. I think when you have a remarkably difficult baby living in the house, it impacts everyone, not just the baby.
Wondertime: How did this impact you as a father and as a doctor?
Well, I think it gave me a newfound respect for what parents go through when they live with one of these babies day in and day out.
Prior to that experience, when I was speaking with a family late at night who had a bundle of misery or markedly irritable baby, it was very easy to distance myself. Very easy to make judgments about their coping abilities. And that changed when I had Laura, because I recognized that it's very difficult for anyone to cope with a remarkably irritable baby.
Honestly, in many respects, it's made my job a whole lot more difficult.
Wondertime: How so?
Because, in a way, I empathize a little bit too much. As physicians, we try to keep a certain distance from sick patients because when you get too involved it's emotionally exhausting.
I think it's the perfect physician and the perfect pediatrician who knows how far to get involved with a family but also when to pull back. Because when you get in too close with people, it just, it just can be exhausting, and you burn out a lot quicker.
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