[NPInfo] Peds GI/Pulmonary people/Infant Reflux

[Judi Shea-Vaillancourt]

Laura,
as a FNP  who works  in pedi ( 21.5 years) with certification in asthma  I
will tell you the following:
the advice that most babies  out grow Gerd by 9 months  has been basically
true  yet  in many-not all - the symptoms  of gerd  may continue through
life\
and while many can wait it out with varying degrees of treatment  many can
not.
There are a  few "True-isms"

every one who flushes  even minute amounts  of acid  into  their  esophagus
has inflamation in their bronchus and alveoli
Inflamation in the bronchus and alveoli causes  cough and wheeze and some
just shut down some of their airway

everyone who wheezes  squeezes  acid  into their  esophagus.....setting up
more wheeze

the old thicken the formular( or feed them solids  if breast feeding ) does
help in some
the more frequent smaller feedings help in some   since you empty almost all
of the breast by 5 minutes of nursing   are you only going to nurse 2
minutes   or should you torture yourself and  pump to feed less by bottle???

I would seek a Pulmonology consult  since cough is a major component of
inflamation in the chest  ie asthma ignoring this has been shown to cause
nonreversible scaring by age 6
I follow  many children who are both GERD  and Moderate Persistent Asthma
who  by todays research might have had less esophageal and respiratory
symptoms  had they been managed more agressively as infants
and not to scare you but Barrets Esophagus  does exist I follow 2 children
with that diagnosis- yes they both have asthma too

Judi Shea-Vaillancourt MSN BC NP-C FNP
Pediatric Specialists of Foxboro and Wrentham  Massachusetts





----- Original Message -----
From: "Laura Baker" <laurarn at rochester.rr.com>
To: "'NP Info'" <npinfo at nurse.net>; "'ACC-Circle'"
<ACC-Circle at listserve.com>
Sent: Wednesday, January 03, 2007 4:37 PM
Subject: [NPInfo] Peds GI/Pulmonary people/Infant Reflux


> Hello,
>
> Looking for advice about my 6 month old daughter. She has severe GERD
since
> about 3 weeks old. She was born at 36 weeks )due to my cardiac problem) by
c
> section. She spent 8 hours in the NICU for transitional Her symptoms
started
> with some spitting and arching early on. She started on Zantac at about 3
> weeks old and I actually stopped it after about 3 weeks because I thought
> she didn't need it anymore. Then she started coughing and getting
congested
> all the time but especially with feedings. We restarted Zantac and the
> symptoms went away. About a month later they came back so we started
Reglan
> too. Then they went away again. That lasted about a month then the same
> thing happened so we added Prilosec. Then she went to GI who ordered a
> gastric emptying study and an upper GI. Both showed she had delayed
gastric
> emptying and reflux, no anatomic abnormalities. She stopped coughing for
> awhile and I cancelled the Peds Pulmonary appointment because I didn't
think
> they would do anything else for her and the GI NP told me she didn't need
to
> go.
>
> She's gaining weight and very happy. Most of the time her reflux doesn't
> seem to bother her but she coughs after feedings and sounds congested when
> she cries after she's just eaten. She also coughs at night and when
napping
> in her carseat. We keep increasing her doses and she's now on the max of
> Reglan, Zantac and Prilosec. I'm also giving her gaviscon 2-3 x per day.
She
> is breastfed and gets baby food twice a day. She gets some formula when I
> work (1 day a week) and we went through formula roulette and it didn't
make
> any difference. I also gave up dairy products for a month and it didn't
make
> a difference.
>
> I'm willing to wait this out until she outgrows it. We're certainly not
> doing anythiung drastic like surgery unless there's a really good reason.
> But I'm worried about her lungs. Has anyone even seen respiratory meds
used
> in these types of kids? Her lungs are always clear so I doubt she's
> aspirating but I wonder if she needs something like Flovent.
>
> Thanks for any advice.
> Laura Baker NP
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