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Dr. Barry Steinmetz is one of the most sought after pediatric GI’s in Orange County and because of our personal experience, I can understand why.  He is calm, confident, encouraging and really helps you understand what your baby might be experiencing.  I’m thankful we have him as a resource in our community to help make our babies feel better and to help us feel more confident as moms!

Below are some questions I thought you might want to know answers to.  If you think your baby might be suffering from reflux or other digestive issues, they don’t need to suffer!  I hope you’ll love Dr. Steinmetz as much as we do.

The New Mom School:  What are the most common symptoms or signs a baby is suffering from acid reflux?

Dr. Steinmetz: Most common presenting symptoms for an infant with GERD are irritability with feeds, poor feeding, spitting up, chronic cough, and poor sleeping.  They can present with just one symptom or a combination of them.

NMS: At what point would you recommend moms bring their babies to a pediatric GI specialist?

Dr.S: If conservative management attempts listed in question #3 below and initial medical therapy trial by your pediatrician fails. 

NMS: What are some things mom can try at home to relieve baby’s discomfort? 

Dr.S: Keeping the baby upright after feeds, limiting volumes of feeds and feeding more frequently, or trial of thickening of formula with rice cereal.

NMS: What is the timeline for acid reflux to appear and diminish?

Dr.S: Infantile reflux usually starts around 4-6 weeks, peaks around 3-4 months of age and usually improves dramatically by 10-12 months of age.

NMS: Do you find that more babies are being diagnosed with acid reflux than before?  If so, what do you think the causes could be? 

Dr.S: People (mothers and doctors) are more aware of the issues and frankly, what was tolerated in the past is not tolerated currently.

NMS: Do you think that colic could contribute to and/or be a symptom of acid reflux?

Dr.S: Colic and reflux with irritability can appear similar, but colic is not usually clustered around feeding, the baby is usually inconsolable, and usually occurs during a specific time of the day.  They are similar in overall appearance, but not related.

NMS: How can a new mom benefit from taking their baby to see a GI specialist?

Dr.S: Education.  If a baby is spiting up, growing well, not having respiratory problems, and is not excessively irritable, then no treatment is needed, as the vast majority of babies will grow out of it in time.  When the baby is treated for reflux, we are primarily treating the problems of reflux, not the act of spit up itself. 

NMS: Does a breastfeeding mom’s diet contribute to acid reflux symptoms?

Dr.S: Studies are not conclusive on this.  Many mothers report their babies are fussier with certain food that they eat, but this may be due to gas production and not reflux.  The jury is still out on this.

NMS: What is a hypoallergenic formula and how does it help babies with severe reflux?

Dr.S: Hypoallergenic formulas are formulas that are either cow’s milk based and hydrolyzed (enzymatically broken down) so the body does not recognize the cow’s milk protein, or they are elemental in that they are formed from just amino acids.  They do not help with reflux and are primarily used for cow’s milk protein allergy, which in some cases can behave like reflux, but is not the same thing. 

NMS: What is the difference between acid reflux and gas?  

Dr.S: Acid reflux is the act of acidic gastric contents “refluxing” or moving backwards up the esophagus.  Some degree of reflux is physiologic (normal) and occurs in all people.  It becomes reflux disease or GERD when it causes some sort of problem such as respiratory distress, irritability, poor feeding, etc.  Gas is excessive accumulation of gas in the GI tract that can cause irritability but is not necessarily reflux.  Many children develop excessive gassiness with reflux, as the babies tend to repeatedly swallow the reflux and thereby introducing more air into the GI tract.

NMS: What is silent reflux?

Dr.S: Silent reflux is reflux that causes some sort of problems (hoarse voice, asthma exacerbations, poor feeding), but does not have the spit up or vomiting frequently associated with reflux.  It can also be non-painful, thereby earning its name as “silent”, as there are not the normal clues to its existence.

NMS: Can some reflux be treated without medication?

Dr.S: Yes.  Conservative measures as mentioned in question #3 for babies. Lifestyle changes for older kids and adolescents – improving constipation, lose weight if obese, or well control asthma or other potential diseases thatcan cause chronic coughing.  Change in eating and social habits, such as less tomato based products, garlic, onion, peppermint, chocolate, caffeine, and spicy foods.