There are good reasons to be better educated about paediatric Gastroesophageal Reflux Disease (GORD).
Paediatric gastroenterology is a relatively young speciality. What is being learned about the causes of GI issues in children, like many areas of human learning, is moving faster than ever before. The pace of knowledge acquisition is astounding. An understanding of and solutions for issues that have plagued families for centuries are now very close to our fingertips. More of what these wonderful specialists know needs to be heard by the general health care profession.
We are well aware that too many parents going to visit their local health care professionals are met with distain and dismissal with many thinking that GORD isn’t real, that “all babies cry” and telling parents to just put up with it. Often those who are most helpful to parents are those with personal experiences of the condition.
We know that the babies who are diagnosed with GORD are often in constant pain and that is the reason for their screaming, settling and feeding issues. We would argue that, just as it is unacceptable for patients in palliative care to have pain, neither is it acceptable for an infant or child with GORD to suffer from chronic pain. Of course medication is not the only answer, but any child who is still in pain is a child whose treatment regime needs urgent evaluation.
There are over 34,000 babies likely to be suffering with reflux disease in Australia each year (based on a very conservative estimate of the incidence of infant GORD).
While the estimated rates of paediatric GORD vary quite a bit, most estimates put it somewhere between ten and 20 percent(1) – not dissimilar to the incidence among the general adult population; but the incidence among premature infants is significantly higher with recent studies suggesting around 90 percent(2).
34,000 infants means that there are many sets of parents who will bring home some very unwell babies this year. The ability of the medical profession to diagnose and treat in a timely fashion is of utmost importance to the mental health of those parents and the physical well-being of their children.
Frighteningly, the risk factors for Shaken Baby Syndrome (SBS) are the same as the symptoms for reflux bubs(3). Risk factors for post natal depression (PND) include symptoms experienced by GORD babies & their families(4). The environment experienced in the homes of these children will often cause PTSD in the parents.
There is also a significant need for better education in the area of childhood GORD, not just infant reflux. At least eight percent of children report symptoms of GORD. Like babies, they’re not terribly good at explaining what’s happening to them but they show it differently. They’re too often just very close to the edge: heartbroken, tired and cranky. There is often even less to indicate the root cause than there is in infants. Yet they very likely suffer equally. Their suffering can have life-long impacts on their sensory, emotional and physical development. And it can take years for them to realise that what they’ve dealt with all their lives is not normal.
Our dream is to avert the suffering of babies, kids and parents by finding an agreed standard against which children could be universally screened and intervention offered. We feel strongly that this would have a significant impact on both the rates of post-natal depression and various GI issues suffered by the general population. But there is much research and advocacy work to be done before we get there.
1. Vartabedian, B., Colic Solved: The Essential Guide to Infant Reflux and the care of your crying, difficult‐to‐soothe baby; Ballantine Books, 2007, pg 3
2. Whitney, H., Reducing Gastroesophageal Reflux in Preterm Infants, Advances in Neonatal Care, 2010, 10:3 157
3. Barr R. Curves of early infant crying and SBS incidence, 2002. Paper presented at: Fourth National Conference on Shaken Baby Syndrome; Sept 12-15, Salt Lake City, Utah & Ludwig S, Warman M. Shaken baby syndrome: A review of 20 cases. Ann Emerg Med 1984;13:104-107
4. National Health and Medical Research Council Information Paper on Postnatal Depression endorsed by NHMRC at its 136th session, Canberra, 31 July