Eczema Kids Nutrition with Judy Converse: Infant Reflux

Judy Converse, founder of Nutrition Care for Children LLC, is a licensed nutritionist and a registered dietitian.

Judy Converse, founder of Nutrition Care for Children LLC, is a licensed nutritionist and a registered dietitian.

This is a 4-topic series focused on nutrition for babies and toddlers with eczema. I’m passionate about nutrition and believe that it’s of utmost importance to our health – after all, it’s one of the daily survival activities of breathe, drink, eat and sleep! I’m honored to have Judy Converse, founder of Nutrition Care for Children LLC, to help out in this series. Judy is a licensed nutritionist, a registered dietitian for more than 20 years and authored the first web-interface accredited learning module for health care providers on nutrition and autism.

More on Judy Converse, MPH RD LD – Judy has a master’s degree in public health nutrition and a bachelor’s degree in food science and human nutrition. She authored 3 books including Special Needs Kids Go Pharm-Free and Special Needs Kids Eat Right: Strategies to Help Kids on the Autism Spectrum Focus, Learn and Thrive. She has also testified for safer vaccines and consulted with industry partners on specialized formulas for infants and children with inflammatory conditions. Judy is available for nutrition consultation at http://www.NutritionCare.net

Dealing with Reflux in Eczema Infant

This week, we’re tackling a topic that’s not directly related to eczema but many moms of eczema children comment that their children have pretty bad case of reflux. I know mine had, from drinking more than 100ml per feed, it dropped as low as 20ml due to the reflux. I don’t even know what type of reflux it was – sometimes she simply seemed not hungry and refused milk; other times, she would drink all (after much coaxing) only to vomit a flying trajectory of milk over her head about 30 minutes later.

MarcieMom: Judy, thank you for joining me again. Is there any conclusive study linking eczema and reflux?

Judy: I have not looked for that, but I have witnessed it often in my practice. My experience agrees with often finding the two together. It doesn’t matter anyway, because the baby just needs to feel better! My first suspects are always protein intolerance, and gut biome imbalance – and yes, these two problems are often linked. It’s easy to assess and begin treating both, even with just a good history (no lab tests), though at most a stool test may be useful.

In my book Special Needs Kids Go Pharm Free, reflux, colic and eczema are what I address in the first chapter. What amazes me is that many pediatricians don’t seem to realize that while this is quite common, it is not normal, and may not be benign, for a baby to experience all this. It can mean that there is inflammation, weak absorption, or gut dysbiosis, especially after ruling out structural or mechanical concerns that cause a baby to reflux. Reflux medications assume that the baby’s stomach is too acidic, when the opposite may be true. If these can give a little short term relief, that’s fine, but I like to see them used only short term, and after a well managed trial of natural steps have failed. Long term, medications for reflux can exacerbate it. They diminish nutrient absorption, and favor colonization of the gut with fungal species – which in turn may worsen gut permeability. Once you have more permeability, you are likely to have more allergy/eczema.

MarcieMom: What types of reflux are there? I looked it up online and but got quite confused; could only understand that Gastroesophageal Reflux Disease (GERD) is when the lower esophageal sphincter does not close properly and the stomach reverses its contents back into the esophagus. Judy, what are the common types of reflux affecting infants?

Judy: Many things can trigger reflux in any age group, and a sudden onset of it warrants your doctor’s attention. Your pediatrician or pediatric gastroenterologist can rule out structural or mechanical triggers, or very unusual causes or circumstances that may warrant different treatment. In any case, the norm is to have peaceful digestion – not reflux, spit up, projective vomiting, or chronic hard colic (gas with a hard belly and inconsolable crying). Most often babies with reflux do not have a serious medical circumstance or mechanical flaw causing the trouble, and natural steps may solve the problem. It is more common that the baby is not tolerating the feeding well, or has a weak gut biome that does not aid digestion. This biome is so important for the baby especially at birth, when the gut is not immune-competent and has limited ability to digest food. Certain microbes appear to “train” the immune system via the gut, and help us digest first feedings. I discuss this in Special Needs Kids Go Pharm Free too. It’s an exciting niche of medicine that I think will become more and more important – what is our relationship to the biome in general, how do we best co-habitate with it, and what are the best ways to nurture a supportive biome in the body? This is where I think medicine needs to go.

MarcieMom: In Singapore, it’s common to burp the baby and if the baby still refuses milk, the common assumption is that there is air in the tummy creating fullness. Remedies that parents use are usually anti-colic drops available in pharmacy and herbal oil that purports to reduce tummy air. Judy, are the abovementioned correct remedies for reflux? (or are these not reflux issues/treatments? My baby’s reflux disappeared at 3 month old, around the time I use Dr Brown, a bottle with a tube insert to release air.)

Also, when should a parent start to be concerned with the reflux, i.e. no longer a common reflux that affects babies, and seek doctor’s advice?

Judy: I’m not sure what is in the drops you mention. One brand called Mylicon (which is simethicone, an artificial compound that helps air bubbles stick together into larger ones, presumably so the baby can burp better) was found to be least effective of all treatments, compared to changing the baby’s primary protein source or using herbal remedies. Items noted as “least effective or worse than placebo” are described here. Meanwhile I have been pleased in my practice with natural measures, like certain herb drops, changing up the feeding strategies and protein source, probiotics, homeopathy, and treatment for fungal species overgrowth in the baby’s gut.

As for when to intervene, include your baby’s comfort and your intuition in this process. Reflux medications have been overprescribed for infants, at least in the US. Reflux is common, but it has been normalized to a point where placing a baby on reflux medication is considered benign. I don’t agree. A little spit up is normal as the baby is developing coordination in swallowing and in digestive functions. But losing most of each feeding is not normal, nor is it normal for a baby to suffer constantly with hard inconsolable crying and a hard belly, or to drop away from his growth trajectory on the growth chart. Chronic projectile vomiting is not normal. Your baby deserves to feel well, comfortable, and happy, to gain and grow steadily, and to pass stools easily every day, eg, soft formed, or wet/mushy for breasts fed babies. Stool that explodes up the baby’s back or runs down the legs, or is dry and painful to pass, or are less frequent than daily or every other day – these are all signs that digestion is impaired and things can be made more comfortable for your baby. If those symptoms occur along with reflux and eczema, intervene for your baby’s contentment and comfort.

MarcieMom: Thank you Judy, once again I’ve learnt much and should I ever decide to have a second baby and he/she has reflux, the first person I think of calling is you!

For previous posts in this series, see

Reliable Nutrition Information (part 1 and part 2)

Newborn – Just Milk, but Complicated (part 1 and part 2)

Breastfeeding – Impact on Eczema

Breastfeeding – Breast Milk

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