Guest blogger, Kris Benson, is mom to Chase, 9 months old who is doing very well. In fact, he started crawling on hands and knees at 7 months old! But Kris has also had to face many challenges that come with the diagnosis. One of which is reflux. Lucky for us, Kris has taken the time to share what she has learned in two informative blog posts. Oh, and she happens to be a professional writer! Be sure to check out part one: Reflux in Down syndrome.
Reflux is not CAUSED by excess stomach acid
Everyone associates reflux with excess stomach acid. And if that is the cause, then it makes sense that if you take medication to reduce stomach acid, you should reduce reflux. But it really only addresses the pain/discomfort associated with reflux.
A better way to think about this is reflux is (usually) CAUSED by the LES muscle not closing when it should. By reducing the stomach acid, you are not treating the cause of the reflux (failure of LES to close properly), but merely the consequence of reflux (stomach acid/food forced back into the esophagus). The reasoning for the antacid medication is that less stomach acid in esophagus = less pain and less chance of damage.
And that might be fine – if your child’s LES problem resolves quickly and everything starts working great. A short term reduction of stomach acid will most likely prevent the pain and damage caused by the reflux. However, the acid reduction may be causing more problems than it is preventing.
Low stomach acid is a problem too
At 3 months old, my son was diagnosed with “Silent Reflux” and put on Zantac with a TBD end date. When that stopped controlling his pain, they switched him to Prevacid and he has been on that for almost 6 months already with no end in sight. It seems to control his pain well and when it doesn’t, I have found that Mylanta and/or Mylicon treat his immediate pain.
At 9 months, he is only 14 lbs, rarely hungry, doesn’t sleep through the night, has severe constipation, and feedings are a constant struggle. He only eats 4-5 oz at a time, so I have to fortify his breastmilk with powered formula and must continue the night feedings in order to get enough calories into him each day. He’s been diagnosed with failure to thrive twice (for both times the doctors upped his reflux medication and threatened us with a feeding tube, which is major surgery and just a band-aid – it does not treat the cause of the poor feeding at all – and often causes severe feeding aversion and other complications)
I believe that it is actually the acid reducing medication my son is on that prevents him from being able to properly digest his food. This is causing a cascade of problems:
· He’s not hungry often enough. If his food is not fully digested in a timely manner, then food stays in his stomach longer, making him feel full longer, so he’s usually just not hungry. That makes he doesn’t eat enough and every feeding becomes a struggle.
· Gas build up causes pain and reflux. This bad digestion also causes gases to build up in his stomach causing extreme bloating, cramping, and pain that is easily mistaken for reflux and can also help cause reflux. He is constantly trying to stretch his torso – throwing his head back and arching his back to try to relieve the pain. This makes feeding painful and increases feeding problems. It also makes him wake up frequently and not want to be placed on his stomach or back. He has started sleeping on his side because of this gas problem.
· Nutrient absorption is reduced. Once the improperly digested food does leave his stomach, nutrient absorption is reduced because they have not been released from the food. This adds to slow growth and insufficient nutrient levels and calorie uptake.
· Increases constipation. Also, the poorly broken down food takes longer to travel through the intestine, causing more water to be absorbed from it making my child “super” constipated. This makes the whole system backed up and he’s uncomfortable, starts “holding it” because it hurts to poop, and can cause even more problems.
All of these compounding problems result in a poorly functioning GI system that could be causing my son’s eating and growth problems.
Treating the Problem Not the Symptoms
I do not believe that he is still suffering from reflux but rather low stomach acid that is causing symptoms that present like reflux. Even though he’s been on the Prevacid for so long, he still has some symptoms of reflux and I l have to treat occasionally with Mylanta. Interestingly, Mylanta is an antacid and anti-gas medication. I think that I may have been treating gas problems that have presented like reflux.
Over the past month, I have slowly weaned my son off of the Prevacid. He has been free of antacid medication for over a week now. I have added 1 tsp of Miralax 3x a day to treat his severe constipation and keep things going through his system more quickly. I have also added an increased dose of Nutrivene digestive enzymes – 1/2 to 3/4 capsule 2-3 times a day – to help him digest his food more completely and more quickly.
He tends to get gas build up in his stomach extremely easily and quickly. I let him stretch out across my body when feeding and give him Mylicon as necessary. Just today, I was trying to figure out why his diaper seemed to be gigantic on him and realized it was because his bloated budda belly was finally gone!
He is starting to be hungrier more often and is eating more at each meal. I am hoping that this will lead to better sleep at night and more rapid weight gain and make him a happier and healthier boy in general.
For More Information
http://www.westonaprice.org/
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