Friday, July 5, 2013

A follow up to my share on infant acid reflux

You may have read my post on our journey with infant acid reflux - http://gcrealestategirl.blogspot.com.au/2013/02/reflux-hell.html  ... One of my most hellish and painful experiences ... watching my tiny baby scream in agony and be helpless to stop it. I still get tears thinking about those days. 

E is now 12 months old and his doctor has recommended weaning him from the Losec medication that removes acid from his gut in the hopes he is now developed enough to no longer require it. The Losec takes 2-4 weeks to wean from his system so for the last two weeks we weren't expecting any real changes however we have noticed that while E has never been a great sleeper, he had improved over the past few months and has now gone back to his old ways of waking every hour or so the past 3 nights as opposed to sleeping from 7pm-12am then a 2-3 wakeup until 7am. I can't be sure this is the result of his reflux and the Losec weaning but he is waking crying and is extremely restless, settling best propped on my pillow beside me rather than flat on his bed or ours.  

I would prefer not to start him on Losec again but obviously, will do whatever helps him. To this end, I have been doing more research and reading on 'silent' acid reflux and have come across several instances where it has been suggested that breastfeeding mothers taking antibiotics in the early weeks of their baby's birth can be a factor in causing infant reflux.

I had tearing during E's delivery and as a result, was administered antibiotics by IV every 4 - 6 hours for the 48 hours post birth. I was then put on 2 lots of strong antibiotic tablets for the 2 weeks following. I was assured they were compatible with breastfeeding and were to prevent any infections. The sad thing is, they may have contributed to either E developing the reflux or the severity of it.

Here is some of the stuff I found:

Probiotics are the good, live bacteria that live in our body. One of the things they do is coat and protect our entire digestive tract (and also the ears and nose). When the stomach produces too much acid then it is forced up the esophagus and down the intestines and will kill probiotics. (Antibiotics also kill probiotics.)  When the probiotics are depleted then the acid is traveling right up next to the esophagus and intestines with no protection. This is often why reflux burns so badly and why the intestines will sometimes bleed. 

and

Whilst in your womb, your baby’s intestinal tract is sterile – and so its free from bacteria. From birth though, your baby begins the process of acquiring the friendly bacteria in the gut that play such a critical role in health and wellness.
How your child is born, strongly influences what kind of bacteria your child will acquire. Infants that are born vaginally begin accumulating beneficial bacteria including Lactobacillus, Bifidobacterium, Escherichia coli (commonly abbreviated to E. coli) and Enterococcus in the birth canal with the very process of birth. These bacteria form the foundations of a healthy digestive flora and originate from healthy maternal vaginal and fecal flora.
Babies born via cesarean on the other hand, receive a different mix of bacteria at birth. This comes from the maternity hospital itself, notably from nursing staff and equipment and includes Clostridium and Streptococcus.
Following birth, the acquisition of digestive flora continues until your baby is around two to three months of age with most of this beneficial bacteria coming from the mother via touch, suckling and kissing.
The way in which you feed your baby also has a strong influence on his or her digestive flora. A breastfed baby tends to have greater numbers and types of beneficial bacteria than a formula fed infant, notably Bifidobacteria, Lactobacillus and Enterococcus. These bacteria, specifically those belonging to the Bifidobacteria clan (genera) thrive in the presence of breast milk proteins and constitute up to 90% of a breastfed infant’s micro flora. They help prevent harmful bacteria colonizing the infant’s intestine.
Newborns have an immature digestive system that has never processed food. The gastrointestinal system is literally just learning to function. Muscles that support digestion have not developed the proper rhythm for moving food efficiently through the digestive tract. Furthermore, newborns lack the benevolent bacterial flora (probiotics) that develop over time to aid digestion. This explains why a lot of infants outgrow colic within the first six months.
This is obviously not a conclusive reason as to why E has reflux but interestingly, my sister, sis in law and two other friends who had babies this past year also experienced a same degree or worse tear than me and received none or one round of antibiotics by IV and nothing further ... none of their babies have or developed reflux.

It makes me sad to think E might have developed reflux as a result of my medications and it makes me angry that the doctors prescribed them to me without consideration to this fact. However I also accept that this may not be a fully proven factor in reflux and I haven't researched any studies etc on this apart from one I found at http://www.bellybelly.com.au/forums/f36/study-links-maternal-antibiotic-use-colic-reflux-98850/ ...

FEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY
Volume 56 Issue 1, Pages 80 - 87
RESEARCH ARTICLE
Influence of antibiotic exposure in the early postnatal period on the development of intestinal microbiota
ABSTRACT
The influence of antibiotic exposure in the early postnatal period on the development of intestinal microbiota was monitored in 26 infants including five antibiotic-treated (AT) subjects orally administered a broad-spectrum antibiotic for the first 4 days of life and three caesarean-delivered (CD) subjects whose mothers were intravenously injected by the similar type of antibiotics in the same period. The faecal bacterial composition was analysed daily for the first 5 days and monthly for the first 2 months. Terminal restriction fragment length polymor-phisms in the AT subjects showed less diversity with the attenuation of the colonization of some bacterial groups, especially in Bifidobacterium and unusual colonization of Enterococcus in the first week than the control antibiotic-free infants (AF, n=18). Quantitative real-time PCR showed overgrowth of enterococci (day 3, P=0.01; day 5, P=0.003; month 1, P=0.01) and arrested growth of Bifidobacterium (day 3, P=0.03) in the AT group. Furthermore, after 1 month, the Enterobacteriaceae population was markedly higher in the AT group than in the AF group (month 1, P=0.02; month 2, P=0.02). CD infants sustained similar, although relatively weaker, alteration in the developing microbiota. These results indicate that antibiotic exposure at the beginning of life greatly influences the development of neonatal intestinal microbiota.
________________________________________
Received 11 July 2008; revised 17 January 2009; accepted 15 February 2009.
First published online 6 April 2009.

With consideration to this information though, I am going to start E on some children's Inner Health plus (a probiotic) in the hope of promoting good bacteria in his gut thus improving and aiding in his digestion.

Do you have or know a bub with reflux? Have you heard of this or had any success with treatments other than medication for severe cases?

I recommend going to http://www.reflux.org.au/ for some information if you think your baby might have reflux.

3 comments:

  1. That must have been some tearing you had! I had it pretty bad (as to be expected with a super fast delivery) but no antibiotics.
    Hope E is better soon and can once and for all be off the meds.
    x

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  2. I had c-section....not planned...had anti biotics but no one mentioned the increased risk of thrush in nipples. Very painful! I did get told in hospital that probiotics are good for breast feeding...so I had been eating that yoghurt from day 1 or 2. I took inner health pkus for the thrush in nipples and it helped a lot. No reflux or signs of. Only really vomited with the thrush and even then it was more dribble vomits. I think the benefits of probiotics and breast feeding is new to hospitals, that was impression I got.

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  3. Thanks Sammie - I hope so too. Apparently it was my mum tells me ... I barely remembered and healed pretty well quickly xx
    I think you're right CBrain. Hopefully that education improves. x

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