Food Allergy Living Blog Tagged Results

There has been a lot of talk about dysphagia lately so we wanted to repost our blog from a few months ago called “Dysphagia, GERD and Silent Aspiration”

Dysphagia, GERD and Silent Aspiration

We’ve talked about Gastroesophageal reflux disease (GERD) before, and today we wanted to talk about dysphagia and aspiration, two things that can be associated with GERD.

GERD

Dysphagia refers to the inability of food and/or liquids to pass easily from the mouth, into the throat, through the esophagus and into to the stomach during the process of swallowing.[1] In more simple terms, it means “difficulty swallowing.” Many medical conditions can cause dysphagia but in children, it is usually due to physical malformations, neurological conditions or digestive problems like GERD.

How can GERD cause dysphagia?

GERD is a condition where the muscles at the end of the esophagus do not close properly and allow stomach contents to leak back into the esophagus. The acidity of stomach contents can cause inflammation in the esophagus (esophagitis) and may lead to ulcers and scaring. The scarring can result in narrowing of the esophagus which may make swallowing more difficult. Patients with dysphagia may experience pain in the throat or chest, heartburn, regurgitation or the feeling that they have something stuck in their throat or chest.

Aspiration:

Both GERD and dysphagia are risk factors for aspiration, where foreign substances (food, liquid and/or stomach contents) are inhaled into the lungs. GERD can cause stomach contents to flow back into the esophagus and dysphagia can cause food and/or liquid to remain in the esophagus after swallowing. If these substances are inhaled and move into the lungs, it can lead to serious respiratory problems, such as aspiration pneumonia[2].

Silent Aspiration:

Silent aspiration describes aspiration without any obvious signs of swallowing difficulty, such as coughing or breathing difficulty[3]. Silent aspiration is especially common among children with dysphagia. In fact, an estimated 94% of children with dysphagia experience silent aspiration. This form can be especially dangerous because caregivers may not know that aspiration is occurring until the child becomes sick.

Because GERD and dysphagia are risk factors for aspiration and because children are more likely than adults to experience silent aspiration, you may want to do a swallow study if your child has these conditions to rule out aspiration. If it is detected, don’t worry! There are various ways to manage it so that respiratory problems don’t develop, such as altering the thickness of your child’s food and drinks.

*Update*

Eosinophilic Esophagitis

Our previous post focused on GERD as it relates to dysphagia and silent aspiration but in this post, I want to mention Eosinophilic Esophagitis (EoE), which is another condition that is linked to dysphagia and silent aspiration. Patients with EoE may have feeding problems, vomiting, dysphagia, abdominal pain or food impaction. In fact, a recent study urged professionals to screen for EoE when patients present with dysphagia. If your child has been diagnosed with EoE, you may want to discuss the possibility of silent aspiration with your health care provider since dysphagia is a risk factor for aspiration. Symptoms of EoE are often controlled by diet so dietary management may be sufficient to control dysphagia and the risk for silent aspiration. Feeding therapy and food thickeners may be considered as well.

Have any of your children with GERD or EE experienced dysphagia? How do you manage the dysphagia and the risk for silent aspiration?

-Mallory

[1] Dysphagia. Children’s Hospital Boston:
http://www.childrenshospital.org/az/Site815/mainpageS815P0.html.
[2] Palmer & Drennan et al. Evaluation and Treatment of Swallowing Impairments. Am Fam Physician 2000;61:2453-62
[3] Lee J, Blain S, Casas M, Kenny D, Berall G, Chau T. A radial basis classifier for the automatic detection of aspiration in children with dysphagia. J Neuroeng Rehabil. 2006 Jul 17;3:14.

We often get calls from parents asking about their child’s “spitting up” habits. If your little one has had vomiting problems in the past due to food allergies, it may be hard to know when it’s a regular spit up or something more serious. Every baby spits up or vomits occasionally, and some do quite often or even with every feeding. If, despite the spitting, your baby is

• Content
• In no discomfort
• Growing appropriately
• Experiencing no breathing problems from the vomiting

then your little one is what pediatricians call a "happy spitter" and no treatment is needed.

Infant Reflux and GERD

Reflux occurs when the contents of the stomach flow back up into the esophagus. When reflux is severe, it can progress to a more serious condition such as GERD (gastroesophageal reflux disease). GERD symptoms include heartburn, regurgitation of food or sour liquid, difficulty swallowing, coughing, wheezing and chest pain. Typical reflux should not be causing any pain for your baby. If you notice your little one is in discomfort, please see your pediatrician.

Reflux Remedies

Infants are especially prone to reflux because 1) their stomachs are quite small and are easily distended, and 2) the lower esophagus valve may be immature and may not tighten up when it should. Typically, the lower esophagus valve tightens up sometime in the first year, usually around 4-5 months of age, at which time the spitting up may go away. For any spitter, there are a few things that might help:

• Keep your baby upright for a half hour or so after a feeding (to let gravity help out).
• Make sure there's no pressure on the stomach after a feeding. For example, try to wait at least 30 minutes after feeding before putting baby in her car seat.

If your child has more serious reflux or GERD, your pediatrician may also prescribe some medication to help control the acid.

What remedies work for your little spitters?

- Christine

[Image Source]

We’ve talked about Gastroesophageal reflux disease (GERD) before, and today we wanted to talk about dysphagia and aspiration, two things that can be associated with GERD.

Dysphagia refers to the inability of food and/or liquids to pass easily from the mouth, into the throat, through the esophagus and into to the stomach during the process of swallowing.[1] In more simple terms, it means “difficulty swallowing.” Many medical conditions can cause dysphagia but in children, it is usually due to physical malformations, neurological conditions or digestive problems like GERD.

How can GERD cause dysphagia?

GERD is a condition where the muscles at the end of the esophagus do not close properly and allow stomach contents to leak back into the esophagus. The acidity of stomach contents can cause inflammation in the esophagus (esophagitis) and may lead to ulcers and scaring. The scarring can result in narrowing of the esophagus which may make swallowing more difficult. Patients with dysphagia may experience pain in the throat or chest, heartburn, regurgitation or the feeling that they have something stuck in their throat or chest.

Aspiration:

Both GERD and dysphagia are risk factors for aspiration, where foreign substances (food, liquid and/or stomach contents) are inhaled into the lungs. GERD can cause stomach contents to flow back into the esophagus and dysphagia can cause food and/or liquid to remain in the esophagus after swallowing. If these substances are inhaled and move into the lungs, it can lead to serious respiratory problems, such as aspiration pneumonia[2].

Silent Aspiration:

Silent aspiration describes aspiration without any obvious signs of swallowing difficulty, such as coughing or breathing difficulty[3]. Silent aspiration is especially common among children with dysphagia. In fact, an estimated 94% of children with dysphagia experience silent aspiration. This form can be especially dangerous because caregivers may not know that aspiration is occurring until the child becomes sick.

Because GERD and dysphagia are risk factors for aspiration and because children are more likely than adults to experience silent aspiration, you may want to do a swallow study if your child has these conditions to rule out aspiration. If it is detected, don’t worry! There are various ways to manage it so that respiratory problems don’t develop, such as altering the thickness of your child’s food and drinks.

Have any of you had experience with GERD, dysphagia or aspiration? Do you have any additional advice for little ones who are diagnosed with these conditions?

- Mallory

[1] Dysphagia. Children’s Hospital Boston: http://www.childrenshospital.org/az/Site815/mainpageS815P0.html.
[2] Palmer & Drennan et al. Evaluation and Treatment of Swallowing Impairments. Am Fam Physician 2000;61:2453-62
[3] Lee J, Blain S, Casas M, Kenny D, Berall G, Chau T. A radial basis classifier for the automatic detection of aspiration in children with dysphagia. J Neuroeng Rehabil. 2006 Jul 17;3:14.

Does it seem like your baby spits up all the time? Do you have to constantly change their clothes (and yours) because they have trouble keeping formula or breastmilk down? If this sounds like your little one, you might be dealing with either GER or GERD.

Gastroesophageal reflux disease (GERD) a more serious form of Gastroesophageal reflux (GER), which is very common. According to the National Institutes of Health, GER occurs when the lower esophageal sphincter (LES) opens spontaneously, for varying periods of time, or does not close properly and stomach contents rise up into the esophagus. GER is also known more commonly as acid reflux, because digestive juices (acids) rise up with the food.

Occasional GER is common, so if this sometimes happens to your baby it doesn’t necessarily mean they have GERD. If the reflux is persistent and happens more than twice a week, then it is considered GERD, which can lead to more serious health problems for babies including failure to gain weight, bleeding, respiratory problems or esophagitis.

So how can you tell if your child is spitting up a lot or has the more serious GERD? According to Dr. Samuel Nerko, MD, MPH from Children’s Hospital of Boston, gastroenterologists often look for the following symptoms to diagnose GERD in infants:

• Vomiting or spitting up frequently
• Pain associated with regurgitation
• Back arching
• Refusal to eat
• Constant or sudden crying
• Chronic hiccups
• Irritability or fussiness

If you think that your little one might have GERD, check in with your doctor or a pediatric gastroenterologist. They will probably recommend an infant dose of medications typically used to treat heartburn in adults. A hypoallergenic amino acid-based formula can often help babies with GERD too because it is sometimes caused or made worse by allergies to milk or soy protein.

What treatments have helped your little ones with GERD? Are there any tricks that you rely on to manage their reflux?

-Nita

Yesterday, I came across an interesting article in the Wall Street Journal on the increasing number of babies being diagnosed and treated for GERD (gastroesophageal reflux disease). According to the article, a few years ago, most of the symptoms were put off as colic. To read the whole article, click here.

As a nutrition specialist, I often hear from parents with these questions: Is it colic? GERD? A milk protein allergy? Sometimes, it can even be all three with 42% of infants with GERD also having a milk allergy! The article mentioned a few treatments, including Pepcid and the use of a proton-pump inhibitor, but it did not include changing the baby’s diet. Often, an allergy to milk/soy is the cause of GERD, in these cases nutritional management can help.

If this is the case, nursing moms need to remove all milk and dairy proteins from their diet if they are using nutritional management as treatment. If the baby is formula-fed, parents should switch to a milk- and soy-free elemental formula, such as Neocate. With the protein broken down to its simplest form (amino acids), babies with a milk allergy and/or GERD can easily digest the formula while getting the nutrition they need to grow and thrive.

Check out the article. It has some interesting diagnosis stories that might help your little one get better!

And for more information on this topic, click here.

As always, send any questions my way!

-Sarah

Twins Clare and Shane were born two months premature. In addition to dealing with the issues of prematurity, they were diagnosed with gastroesophageal reflux disease (GERD) and the Neonatal Intensive Care Unit started them on Neosure.

Clare and Shane immediately reacted negatively to the Neosure, crying for hours on end and arching their backs.

“I didn’t know what to do,” says Laura, the twins’ mother. “I thought I was a horrible mother because I could not comfort them.”

After reacting to the Neosure, the twin’s home care nurse switched Clare and Shane to Gentlease formula, but there was no change in their symptoms.

For five months, Clare and Shane had frequent visits with their neologist pediatrician and tried everything from switching formulas multiple times, varying feeding schedules and trying Zantac and Mylicon. Nothing seemed to ease their pain.

Finally, Clare and Shane’s visiting home nurse suggested that the twins try Neocate®, a hypoallergenic formula comprised of amino acids (the building blocks of protein) instead of the full or partial protein chains in other formulas.

After the first bottle, Clare and Shane showed instant improvement. “I had two completely different babies” says Laura.

Clare and Shane After Neocate

It took five long months for Clare and Shane to receive the right treatment option for their GERD. Once on Neocate, there was an immediate difference.

“Clare and Shane now laugh and smile,” says Laura. “They burp, get sleepy and barely ever cry.”

If you want to share your before and after photos, we’d love to see them! Send us an email at FoodAllergyLiving@nutricia.com.