Reflux Revisted

Goldfish -  one of the 5 things I currently eat!

Goldfish - one of the 5 things I currently eat!

Sometimes, mommy intuition knocks so hard on the brick wall I call a brain and STILL I manage to overlook the obvious.

My mother was talking with an old childhood friend of hers whose daughter Ali has a son with a lot of eating issues. Her son is now almost four and his problems started around the same time that Jasper’s did so she is a wealth of knowledge. She even gave me a name for what could possibly be part of Jasper’s problem – a Selective Eating Disorder. Sometimes all you need is the right term to google!

After sending her an SOS email, she replied with a whole slew of useful information but there was one paragraph that was the lightbulb moment for me:

I have some questions- does he have reflux?  I have done so much
reading about feeding aversions in children and many of them boil down to

Ding ding ding!!!!

I don’t know if you all remember (or did I even blog about it?) that I brought Jasper to the ENT at around 11 months for his fourth follow up for his laryngomalacia (a floppy larynx). I wasn’t really worried about the larygo so much as I wanted to know if when he scoped him he would see redness around his esophagus – I suspected back then that his eating abnormalities (fussiness, pickiness) could be a result of him still suffering from reflux. Not the baby spitting up everywhere kind of reflux which has thankfully long since ceased, but a more adult-like burning type.

But the ENT said his laryngomalacia was vastly improved, almost normal and he wouldn’t need to see us back. I asked about the redness and he said there was some, the same amount as the last time we’d seen him which was back when Jasper was still on prevacid.

Somehow I took this to mean that if the redness was the same on as off the prevacid, that there was no need to take the prevacid. But I failed to make the connection that ANY redness means reflux which in the presence of symptoms should not be ingored!

So after receiving Ali’s email I put in a call to the ENT. I explained that Jasper’s reluctance to eat had not improved, and infact had gotten worse and if in his opinion the amount of redness he saw could be consistent with someone who would be uncomfortable enough to have eating difficulties. He said ABSOLUTELY, that any amount of redness is NOT normal and that we should go back to the pediatric GI and get him on a medication. I really don’t know why we didn’t discuss this before.. at least in terms of “if his eating behavior does not improve we should treat the reflux again” type thing.  I honestly don’t even know if there is another possible explanation for the redness than reflux. I do know that he said that you can have reflux WITHOUT the redness, but I’m not sure if you can have the redness WITHOUT reflux. I should have asked.

So we have an appointment to see the pediatric GI next week.  I don’t have high hopes I’ll leave there with anything but another prevacid Rx but at least I feel like I’m doing SOMETHING. Unfortunately, even with medication it may be a bit of a long road ahead.. apparantly it can be quite difficult to break the child’s association between eating and pain once it has been established. And if Jasper’s reflux never really went away his has been very long established.

How could I have missed this? :(

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Justina says:

Ariana, thanks so much! I guess we have to rely on our “mother’s instinct” very often for such issues… Hang in there and I hope Jasper’s eating issues clear up… He’s lucky to have a mummy that bothers to read up and solve his problems and loves him so much! :)

Shane says:

I wasn’t gonna jump into this discussion ’cause I didn’t had much to add… but as Ava said my sister’s kids both had/have Reflex…… BAD!!! So a few comments triggered some thoughts. Happy to expand later w/ you if you want.

1. Not just WHAT foods but WHEN foods are consumed makes a difference. My niece can only handle a little chocolate a day BUT it has to be in the morning so her body has time to deal w/ it. She doesn’t eat ANYTHING after 5 pm — or else she ends up puking in the middle of the night even w/ her bed at an angle (she’s 9 and it’s been this way since she was she was small).

Thought: This could be an explanation for J eating at daycare during the day, but not so great in the afternoon/evening.

My mom HATES it when we turn G upside down — but he loves it and it’s just too tempting. But that can cause reflex to be worse. So pay attention to playtime positions.

jbhat says:

So GI Jasper retains his moniker. Good luck, Ariana! I’m sure you’ll get this resolved soon.


ariana says:

Justina, I’m not sure I know the answer to your question. But I’m beginning to think that any baby who suffered from GERD and has subsequent eating issues should be evaluated for reflux. But I don’t have all the answers (clearly!) and since Jasper is my first, I don’t have too much to go on to know what is normal picky toddler vs. something abnormal except my instincts. Also to some extent what I see with my friends’ babies and other babies at daycare. The other babies at daycare LIKE their food, they want it and are not afraid to try new foods. They sit around the little table and eat various things that Jasper will only throw on the floor!

One more thing – I think that one of the reasons all this is so hard to get a good grasp on is that there are probably SOME times when taste or hunger trumps the pain.. or when the pain is just not as present and so they will eat better some times than others. Like Jasper will never turn down goldfish or cheerios even though he will turn down all other real foods. I think in this case he likes the taste SO much that even if he is a bit uncomfortable he will still eat it as opposed to something less exciting.

Likewise for growth spurts, there have been a couple times when he’s downed like 3 times the amount he normally eats and I think maybe in those cases he’s SO hungry from a growth spurt or something that he eats anyway. Or else those are just random days when maybe he’s not suffering from reflux and that’s a glimpse of what he would be like without it. Not sure!

Samm Ivri says:

There’s just so much to worry about every single day. Eating, sleeping, child-proofing every corner, cleaning, laundry, fussiness…not to mention our jobs and once in a while taking care of ourselves. Its just hard to connect all the dots all the time.
I recently had a similar experience with Mia’s constipation. She’s been constipated since birth. I kept bringing it up to the pedi and he kept telling me to give her juice. It wasnt helping much but eventually I stopped mentioning it to him. This week she tried to poop for so long. WHen she finally got a couple pebbles out I noticed her diaper had blood streaks!! I was horrified. We went back to the pedi and suddenly he has recommendations! Milk of Magnesium, Mineral Oil, etc. Now why couldnt we have gotten these recommendations months ago!? Sigh…

ariana says:

So many things to respond to and Jasper is crying in his crib refusing to take a nap..grrr!

Macria, sound like reflux to me. As for pedi talking you out of it I feel like mine wasn’t ever supportive of him being on a high dose of zantac or PPIs but I learned my lesson the first time we went to the ENT because Jasper started choking on the milk while nursing and he had what the ENT described as “Massive redness” around his esophagus. I ALWAYS feel like that crazy hovering first time mommy that obsesses over things that might be perfectly normal – but then I usually find out that I was right to be concerned even though I’m the only person who seems to think so!

Michelle, I totally agree about the goldfish – I just switched to annies cheddar bunnies and he tries to stuff like 8 in there at a time!

Jenya, we did try probiotics (many kinds including bio gaia) and it didn’t make any discernable difference. That said, he eats the most natural, biodynamic local grass-fed yogurt for breakfast every morning so he’s getting a good bit of it that way!

Marcia says:

It’s always nice to have a reason why they do the things they do, I hope this is part of the problem so you can relax a little! This is making me wonder if Savannah really did have reflux and we just overlooked it (inconsolable since the beginning, screaming when nursing, not sleeping well, still not eating well). The pedi always talked us out of reflux being the problem and that it had more to do with her temperament, I still worry about it but she doesn’t seem to show enough of the signs for others to take us seriously. It sounds like you are doing everything you can to get to the bottom of this!

jenya says:

well, I would highly recommend taking Jasper to see “natural doctor”. With these medications your just destroy the natural bacteria. I’d recommend taking probiotics. The best one out there is florastor.
good lcuk

Stephanie says:

Hi! Poor you. Please don’t be so hard on yourself. This sort of thing happens more than you think and the good news is that you’re getting it figured out. It’s going to be OK. :)

I think most of what I was going to say was covered above. There are a couple of things I will add though.

Reflux works the same whether you’re tiny or grown up. If Jasper has reflux and his esophagus is irritated, he might feel better if his head is elevated when he sleeps. Tiny babies can be strapped into a Tucker sling, but that’s not going to work for a mobile toddler. He’s too little for a pillow, but have you tried propping his crib mattress up? You can put an adult-sized bed pillow under one end of his mattress so the mattress is at a slight incline. IF he will sleep that way – with his head and shoulders propped up higher than the rest of his body (my older daughter used to crawl down to the other end of the crib so she could lay flat – and then ended up with throw-up in her hair each morning!) what was I saying? Oh yeah – IF he will sleep that way – he’ll be positioned well to work against gravity – if he is refluxing duing the night, the acid won’t be able to work its way up as far in his throat as it would if he was laying flat.

If his throat feels less irriated, he may be more willing to swallow.

There are lots of different reflux medications and sometimes it’s just a case of finding the one that works best for your child. Zantac did nothing for either of my girls. Chloe did great on Prevacid though. Prevacid was OK fof Ginger but she was still throwing up a bit. She hated Zegarid (my husband had to pin her down and I had to force feed it to her while she spit it all over us) but she had no problem taking Protonix and it is working really well for her. She’s two and eating very well but still refluxing. Her sister was on Prevacid until she was three.

It’s OK to tell your GI when something doesn’t seem to be working – they will work with you to find a good fit – you both want the same things – a pain-free little boy!

I was also going to second your comment (hope I don’t sound like a broken record) that there is sometimes a connection between reflux and dairy allergy.

If you go the allergy testing route, I would suggest pressing for the RAST/blood test and not the skin prick test. I wish I had done that with Chloe – we had a bad experience with the skin prick testing.

If you ever want to chat about this stuff – reflux, food allergy, allergy testing, etc. just let me know. :)

Michelle says:

I hope you get better news than you expect. And, your photo is adorable as always. I truly think there is an addictive chemical in Goldfish. It is the only thing Jack loves more than Mommy! No joke… sometimes he gets so excited about his Goldfish that he swallows them whole just to ask for more.
I am sure you will keep us posted… hopefully everything will be okay!


Justina says:

Hi Ariana,
Oh dear, I mean, how could you have known? Seemed like the doctor himself didn’t know too… I’ve read that reflux may take more than a year to resolve, so hopefully Jasper’s “symptoms” get better as he gets older?

And actually, how do you tell if a baby’s refusal of solids is due to reflux or just him not being interested? My 8 month old Jude used to have reflux and I’m currently on a no-dairy, no-soy diet as they seem to be triggers. During his meals of solids he usually eats about 10 mouthfuls and then proceeds to whine and wants to breastfeed. After reading your post, I was wondering if his not wanting to eat could be due to reflux?

ariana says:

Kimberly, your H’s neice sounds a lot like Jasper :) How/when did they diagnose the allergies? I wonder if I should take J for allergy testing now that he’s old enough for blood tests for it.. I know that there is a pretty well documented link between reflux and milk allergies for example.

Ava, probably the prevacid is working for G – sounds like he responded to it much better than J even from the beginning! And YAY that he’s eating now!! That’s so great! Does he try new things? One of the websites I’ve been looking talks alot about neophobia – fear of new foods which Jasper definitely seems to have. He won’t try most things (throws them off the highchair or turns his head away).

Ava says:

We actually never saw a pedi GI. S’ family has a long (and scary) history of reflux, so when G went into constant scream mode at 6w, his family pleaded for us to talk to his pedi about the condition. His pedi didn’t do further tests, but gave us Zentac. He asked that we give him Zentac for a week, and if G didn’t improve to try Prevacid. Within a week or so of Prevacid, G was a completely different kid — calm, happy, didn’t spit up as much. After that we just assumed it really was the reflux and didn’t test further.
I WILL bring up the reflux at our next pedi appointment though and will also start looking for additional signs of reflux esp. during his “no eat” phases. At the moment he’s eating well. He’s not gaining weight (4oz in 1 month), but at least he’s eating.
Certainly something to discuss with his doc.

Kimberly says:

Don’t beat yourself up! The important thing is that now it’s been addressed and you can treat it and move forward.

While I’m no expert on reflux, I’ve worked with a few kids with food aversions (usually related to g-tube feeding though), and my husband’s niece had literally the WORST reflux I’ve ever heard of when she was a baby… screamed pretty much inconsolably for the first 7 months of her life, they tried every med under the sun,angled sleeping surfaces, etc. Turns out she also had some pretty severe food allergies that likely contributed to the reflux. The good news is that now she’s an incredible eater… eats just about anything and everything she can get her hands on! (And has been since she was a toddler… so there is hope!)

I’m glad you’ve identified the potential problem, and I hope Jasper’s reflux gets under control soon so he can start enjoying food! You’re doing a great job, Mommy… you’ve done everything a mother possibly could!

ariana says:

Ava, as you might have guessed this is what I was talking about on twitter. Don’t you think it’s too much of a “coincidence” that both of our kids had reflux and both have some level of food aversion? I wonder though if maybe Jasper AND G just aren’t/didn’t respond to prevacid as well as they might to another PPI. I know many of the more forward thinking pedi GIs are proscribing zegerid instead.

I’m curious though what your pedi GI has said about weaning from the Prevacid, I didn’t even realize G was still on it. My pediatrician (and my dad) were big proponents of the weaning and Jasper was eating decently at the time so I went ahead with it, now I’m not so sure that was a good idea. Do you or any of G’s docs have reason to believe he’s still suffering from reflux – does he have any symptoms other than food refusal? Actually, I think food refusal is a pretty big MAIN symptom, so it’s definitely something to consider. Does your pedi GI know about the food refusal issue?

I hate how in all of this there is no one doctor with the whole picture.. the ENT sees the redness, the GI doc goes off what I tell him and the pediatrician generally wants to take a hands off approach. It’s really frustrating!

Ava says:

Hey! DON’T be so hard on yourself. If his doctor missed this, why should YOU be expected to know?

I really hope that this really is why Jasper’s been turning food away. Not that I wish him to have bad reflux, but only so that you guys have an explanation.

In terms of associating some foods with pain, try giving him the same foods but in a different format/cut. For example mashed carrot vs, cubed carrot are considered different veggies by a kid. You and I both know it’s still carrot, but the kid doesn’t make that association. So if you do a different presentation of the same food, he might surprise you and eat it after you get the meds back under control.

And thank you for giving me some food for thought. I’ve been thinking that it’s time to try weaning G off of the Prevacid, but now I’m scared to. I guess we’ll see how that goes…