As discussed in Part I of this series on reflux in infants, the prescription of acid-suppressing medications in pediatric populations has skyrocketed in recent years, making them among the most frequently prescribed medications for infants. Despite their common use, research indicates that the use of acid-suppressing drugs in pediatric patients is neither safe nor effective. Acid-suppressing drugs disrupt the infant's gut flora, which has a pivotal role in immune system function, and they also negatively impact the functioning of the digestive system and the ability to the infant to make use of the nutrients consumed. Stomachacid is necessary for the proper digestion! The many important roles of stomach acid include:
- Breakdown of proteins into a form that they can be digested (called proteolysis).
- Activation of the enzyme pepsin, which is responsible for protein digestion.
- Inhibiting the growth of microorganisms that enter the body through food to prevent infection.
- Signaling when the food (referred to as chyme) is ready to leave the stomach and move into the small intestine for continued digestion.
When stomach acid is suppressed through the use of medications or simply due to imbalances in the body, a whole series of events occur that compromise digestive function. Eventually, this can lead to increased digestive problems, leaky gut syndrome, and systemic health problems, even in the infant. Instead of using acid-suppressing drugs in an attempt to mask symptoms, it makes much more sense to get to the root cause of what is behind persistent and distressing symptoms of reflux in the infant.
It is possible to address symptoms of reflux and indigestion in infants through holistic nutritional therapy. *As always, you should consult with the licensed prescriber before discontinuing any of your child's medications. Be prudent and seek appropriate medical attention if your child experiencing undiagnosed symptoms of digestive distress.*
To get to the root cause of reflux in the infant, consider the following:
1.) Some amount of spitting up is completely normal. Most babies spit up and it is especially common in the first 3 months of life. The majority of children will stop spitting up by 12 months of age. Spitting up is common in infants because their stomachs are quite small and can become easily distended during feedings. At the same time, the lower esophageal valve is immature and opens easily to a short esophagus, allowing the stomach contents to reflux. If your baby is spitting up, consider if it is truly an excessive amount versus a normal amount of spitting up for a baby of a particular age. Even a small amount of liquid can appear to be quite a bit if spilled on clothing. Make sure that you are burping your baby after feedings and avoid excessive play for the baby immediately following feedings.
2.) If the baby is breastfed, getting to the root cause of distressing reflux symptoms starts by addressing the mother's diet. Abnormal reflux and other digestive issues in an infant often result from food sensitivities. Proteins and other nutrients from the foods that the mother eats do end up in the breast milk. It is not possible for a baby to be "allergic" or "intolerant" to the mother's milk, but it is possible for the baby to be sensitive to foods that are present in the mother's diet. Besides reflux, other signs of food sensitivities in infants and children may include:
- Congestion and stuffiness
- Frequent ear infections
- Wheezing or asthma
- Sleeping disturbances
Although I advocate a Paleo nutrition template, at a minimum, the mother should start by eliminating all processed foods, which includes almost everything that comes in a package--including bread and whole grain products, which are typically highly processed. In addition, it may be necessary to eliminate the most common food sensitivities from the diet, including:
- Wheat (and gluten)
- Peanuts (a legume--not a nut!)
Conventional medical tests to identify food "allergies" are not effective at uncovering food sensitivities. A food allergy is a specific immune system response that involves an IgE immune-mediated reaction. On the other hand, a food sensitivity involves non-IgE immune system pathways and these are much more complex and difficult to identify. The best approach to identify underlying food sensitivities is to completely eliminate the suspected food(s) at once. This is another reason why a Paleo template (i.e. REAL nourishing food--meat, veggies, and fruit) works well for discovering food sensitivities in the infant. Food sensitivities are insidious and once an offending food is consumed, its effects on the body can remain for quite some time. It is important to give it at least 30 days before determining if eliminating a food from the diet has made a significant impact on symptoms; however, some improvement in the infant should be noticed within a week or two of eliminating the suspected food. If symptoms are severe or persistent, it may be best to eliminate several or all of the common food sensitivities at once. For this type of elimination diet, the Paleo Autoimmune Protocol would be a great template to follow.
Other suspected foods that may be causing reflux or other symptoms of food sensitivity include any food that a family member has a known allergy or sensitivity to, a food that was recently introduced into the diet (if the infant's symptoms are new or suddenly appeared), or any food for which the mother has either a persistent craving or aversion. Food sensitivities sometimes present as either abnormal cravings or unexplained aversions. It's also important to note that food sensitivities in the mother can be passed to the infant while breastfeeding.
Dairy is a common food sensitivity, although conventional medicine will often describe this as a "lactose intolerance". In the majority of cases in which "lactose intolerance" is suspected in an infant, it is highly likely that the root cause is damage to the intestinal brush border where lactase is produced. This damage is often caused by food sensitivities and resulting inflammation in the GI tract. Some forms of congenital lactose intolerance can develop in a small percentage of infants, but this is rare.
3.) If the infant is bottle-fed or eating solid foods, address the infant's diet. Many conventional infant formulas are full of processed sugars, synthetic nutrients, artificial preservatives and many of the common food sensitivities discussed above. Although breast milk is always preferable, if the mother is unable to breastfeed, alternatives to synthetic, processed infant formulas include human milk donors and homemade baby formula.
Because an infant's immune system is immature, the intestinal lining of an infant is normally "leaky" and allows proteins and food particles to pass through easily to the bloodstream, contributing to the development of food sensitivities and systemic immune problems if foods are introduced too quickly. Most babies should be breastfeed exclusively for about at least the first 4- 6 months.
When foods are introduced, processed foods and grain-based products, including the popular rice cereal, Goldfish, and crackers, are not the best choices for the baby's first foods. In order to digest grains, the enzyme amylase is needed. Amylase production doesn't make a complete appearance until the molar teeth are fully developed, which can occur anywhere from 1-2 years of age. Egg yolks from pastured hens and liver from grass-fed cows are excellent, nutrient-dense choices for the baby's first foods. A mashed banana is also appropriate as it contains its own amylase to allow for digestion. As the baby's teeth come in and the immune system matures a bit, meats and vegetables can be fed to the baby. There is no real need for packaged baby foods. See this Weston A. Price Foundation resource for other suggestions on how to introduce foods to an infant.
Probiotics are another natural solution for improving gut health in infants. It is safe to introduce a small amount of the juice from fermented vegetables to infants, which will be loaded with naturally occurring probiotics. Start with 1/2 teaspoon and increase to 1 teaspoon daily. For more severe gut symptoms or in infants with risk factors for disrupted gut flora, supplementing with a probiotic may be necessary. In general, probiotics are safe for infants and children of all ages. There are probiotic formulas that are marketed for infants and children; however, be cautious because these are often loaded with artificial flavors and processed sugar. If you can find a high quality, broad spectrum probiotic, it does not need to be specifically for infants and children. Simply break open the capsule and add the probiotic to the baby's formula, food, or if breastfeeding, around the mother's nipple. It is always best to start at a low dose of the probiotic (1/4 of the capsule) and increase slowly.
Reflux and food sensitivities often go hand in hand in both pediatric and adult populations. The use of acid-suppressing medications to mask symptoms will not uncover the root cause, but by addressing the diet of both the mother and infant, it is possible to improve or eliminate symptoms.
Have you tried any of these tips in addressing reflux and other symptoms of food sensitivities in your baby? I would love to hear about your experiences!
Photo Credit: http://en.wikipedia.org/wiki/Baby_colic