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| Division of Occupational Therapy - OT Connect Gastroesophageal Reflux Disease in Infants
Common symptoms/Course of the disease GERD is a pathological process that involves passive return of gastric materials retrograde into the esophagus. The main factor that seems to contribute to this is decreased tone in the lower esophageal sphincter, which allows the passage of gastric contents into the esophagus (Sandritter, 2003; Gold, 2003). If left untreated, GERD can eventually lead to growth problems, narrowing or closure of the esophagus, chronic pneumonia, Barrett's esophagus (a precancerous condition), and apnea (a tendency to stop breathing during sleep) (Rhudy, 2003). Infants diagnosed with GERD are also at a higher risk of aspiration and recurrent pneumonia (Grayson, 2003). Some common symptoms include:
(Sandritter, 2003; Jung, 2001; PAGER, 2003) Prevalence: GERD occurs approximately in 1 in 20 infants. Many infants will outgrow GERD by about 1 year of age. Less than 5% of infants carry this problem into their childhood (Rhudy, 2003). GERD is also prevalent in approximately 85% of premature infants. This may be due to the fact that premature infants are at an increased risk for feeding difficulties as a result of neurological immaturity, abnormal muscle tone, and an overall weak and irritable state (Gold, 2003). Issues Associated with an Increase Risk of GERD:
(Gold, 2003; Sandritter, 2003) Current Medical Treatment:
Occupational Therapy Involvement As part of the medical management of GERD, lifestyle modifications are often suggested. It is this area of care that Occupational Therapists play a role. OT interventions for GERD often include:
(Porr & Rainville, 1999) References
How OT Makes a Difference: Evidence-Based Practice Occupational therapists often use thickened feedings as an approach for GERD and other digestive disorders. It is within the domain of occupational therapy to assess and provide appropriate food consistencies to facilitate safe and independent feeding. In the following study the effectiveness of a pre-thickened formula in helping infants with gastroesophageal reflux was examined. Vanderhoof, J., Moran, J.R., Harris, C.L., Merkel, K.L., Orenstein, S.R. (2003). Efficacy of a pre-thickened infant formula: A Multicenter, double-blind, randomized, placebo-controlled parallel group trial in 104 infants with symptomatic gastroesophageal reflux. Clinical Pediatrics, 42, 483-495. In this article Enfamil AR was evaluated to see if it was an effective thickened formula for infants suffering from gastroesophageal reflux. Enfamil AR is the only infant formula in the US that is thickened and specially designed for babies who spit up frequently. 104 infants who suffered from GER were enrolled in a 5-week program. The results showed that the Enfamil AR group showed greater symptom reduction by the end of the first week. This formula was also effective in reducing regurgitation, choke-gag-cough symptoms, and improved sleep patterns in the most symptomatic infants by the end of the 5 weeks, without causing constipation. This is a story that a mother of an infant with GERD shared: In June 2002, we were blessed with our 3rd child, a baby girl. “Mollie” was our surprise baby, but welcome with open arms. Even in the hospital, she spit up (a lot). By week 3, she was crying non-stop for hours on end and nothing seemed to help. We tried everything---walking, gas drops, rocking, bouncing, swaddling, eliminate highly allergic foods from my diet (as she was breastfeeding), and so on. “Mollie” was fussy, hoarse, unable to sleep, throwing up (sometimes across the room), clingy, refusing to eat, and more. At her 6 months well baby check, the doctor prescribed Zantac, Reglan, and Levsin for acid reflux (GERD-gastroesphogael reflux disease). We also noticed that she did not have the social/emotional development that she should and we contacted our local early childhood specialists. She was eligible to receive Occupational Therapy based on many developmental delays. The therapist was a wonderful match for our family and made weekly visits to work with “Mollie” and to offer suggestions to us. The OT showed us different positions during and after feeding to prevent the symptoms of GERD. She also felt that Mollie had something else wrong and that it was causing the other delays and sensory issues that she was experiencing. She suggested we get a referral to an allergy specialist and a pediatric gasteroenterologist (GI). After allergy testing and several positives, the allergy doctor changed her to prevacid (in place of zantac) in March. We also began an allergy free diet and to battle environmental allergies the best that we could. “Mollie” is now on Prilosec and we will continue to visit the Pediatric GI frequently. We are praying that the muscle strengthens on its own. Mollie is finally growing and developing at a normal pace. She is still small for her age, but a happy girl. I am telling you our story in hopes that another baby does not need to wait a full year to get some help and answers for possible reflux. Our pediatrician did not send us on to other specialists. I requested the referrals upon suggestions from the occupational therapist. Parents must be an advocate for their child! Our OT was key in helping us with this process.
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