Reflux and Failure to Thrive

What is failure to thrive, and is my child at risk of being diagnosed with failure to thrive if he or she is in the lowest part of the growth chart?

Being small in size is not necessarily a sign of failure to thrive. For example, if your child is in the fifth percentile for weight and stays consistently in that percentile as she ages, while also meeting all of her developmental milestones, she may simply be smaller in stature. However, if your child suddenly or continually drops into a lower percentile for weight, there could be an issue with your child’s health or nutrition.

Other factors may accompany this weight change and cause further concern. If this lack of weight gain appears to be affecting your child negatively and is accompanied by some or all of the following signs: constant irritability, excessive sleeping, lack of age-appropriate social responses such as not engaging with caregivers by smiling, babbling, making little or no vocal sounds, or showing motor development delays, it may be possible that your child is experiencing failure to thrive.

Reflux, or the more serious gastroesophageal reflux disease (GERD), can occasionally cause or lead to failure to thrive when it causes babies so much discomfort that they begin to associate eating with pain. Reflux is the regurgitation of stomach acid and food into the esophagus and throat, and in more severe cases into the lungs and bronchial tubes. GERD is a more severe form of reflux, a chronic problem that will not resolve itself on its own with treatment. Babies with GERD will require treatment in order to be able to eat the appropriate amount of calories to maintain proper nutrition and growth.

Reflux and GERD can occur in infants not only due to the size and shape of their esophagus but also due to food allergies. Reflux is more common in infants, and more likely to cause infants pain. As previously mentioned, reflux or GERD may lead an infant to associate eating with pain, which can result in the infant refusing to eat or eating very little. This can lead to a drop in her weight and may contribute to other symptoms of failure to thrive.

Although not every baby who regurgitates has GERD, a dramatic change in a baby’s growth percentile may indicate a need to focus on baby’s eating habits to determine if reflux or GERD is causing failure to thrive. One clue that reflux or GERD is a factor is the smell of your baby’s breath. Infants with reflux will likely have breath that smells like old vomit or sour orange juice. Keeping a detailed daily journal or log book that includes this and other information can prove extremely helpful in finding answers:

• Number of wet and dirty diapers baby has each day
  Do the soiled diapers smell foul? Is there any mucus or blood present in the stool?

• How often baby eats, how long it takes baby to finish eating -
  and if baby seems satisfied after eating. If baby is nursing at the breast, keep track of when and how many minutes baby spends nursing. If baby is bottle-fed, keep track of when and how much baby consumes.

• The nursing mother’s diet
  Record all food and drinks that you consume. This can help in narrowing down potential food sensitivities and food allergies that could possibly be causing your baby’s reflux.

It’s important that doctors observe the infant to distinguish between reflux and GERD in order to know if their condition warrants treatment, and, if so, what type. Reflux can be caused by a mild histamine reaction to allergens such as gluten, cow’s milk, eggs, nuts, or soy proteins consumed by the nursing mother or used in commercial infant formulas. Treatments will vary but some can include dietary changes to eliminate any allergens, positioning of the baby and sometimes anti-reflux medication.

When it comes to failure to thrive, a perceptible change in a child’s size can matter. Zeroing in on your infant’s eating habits, digestion and overall disposition may be a good place for you and your health care provider to focus when you have concerns about your child’s development.

Should You Stop Breastfeeding if You Have the Flu?

It's flu season and moms everywhere are worried about how to keep their families - and their babies - healthy. You might be wondering - if the dreaded virus does come to your house, should you stop breastfeeding?

When I was still quite new at motherhood and just getting the hang of breastfeeding, I woke up one morning with flu-like symptoms. I remember thinking that it might not be safe to breastfeed my baby during my illness. I had a slight fever, aches and pains and I definitely did not want to pass this on to my little girl. Not knowing the best thing to do, I decided I would pump and give my daughter a bottle of previously pumped breastmilk. What I learned later that day, and what I want you to know, is that although it may seem counterintuitive, breastfeeding when you have a cold or the flu is actually beneficial for you and your baby!

Dr. Jack Newman, the founder of the International Breastfeeding Centre, has been helping and advising breastfeeding mothers and their babies for over 38 years. According to Dr. Newman, especially when it comes to infections the mother may have, continuing to breastfeed while sick is ideal.

“Very few illnesses require the breastfeeding parent to stop breastfeeding,” Dr. Newman states. “This is particularly true for infections the breastfeeding parent might have, and infections are the most common type of illness for which breastfeeding parents are told they must stop.”

When you consider the way many infections operate, the logic for breastfeeding while sick makes a lot of sense. As Dr. Newman explains, “Viruses cause most infections, and most infections due to viruses are most infectious before the breastfeeding parent even begins to feel sick. By the time the breastfeeding parent has fever (or runny nose, or diarrhea, or cough, or rash, or vomiting, etc.), [the potential for] infection has probably already passed on to the baby.”

So, even if you think you are protecting your baby by stopping breastfeeding when you feel symptoms, the reality is, before you even showed signs of being sick, you had the capacity to infect others. The good news is that breastfeeding actually can shield the baby from the effects of your infection. According to Dr. Newman, “breastfeeding protects the baby against infection, and the breastfeeding parent should continue breastfeeding in order to protect the baby. If the baby does get sick, which is possible, he is likely to get less sick than if breastfeeding had stopped.”

But how can this be? Consider the way immunization works. The person being immunized is given a weakened version of the virus in order to elicit an immune response so that in the future, if the body is exposed to the illness, the body will remember how it fought off the infection before and will engage this process. According to Dr. Newman, a similar process happens for your baby when you are sick and breastfeeding.

“Breastmilk protects the baby from getting seriously ill (usually) while, at the same time, the baby gets some virus,” he says. “It is, in effect, an immunization.” In fact, parents who breastfeed while sick may be surprised by the results. As Dr. Newman notes, “Often breastfeeding parents are pleasantly surprised that their babies do not get sick at all.”

So, it turns out that breastfeeding while ill is actually best for your baby. But how can it help you? As Dr. Newman states, “Illness sometimes seems to cause milk supply to decrease, especially if a mother has a fever; keeping the baby at the breast and close to the mother skin-to-skin as much as possible can reduce this risk. “

With flu season in full effect, it’s important that parents know the facts: breastfeeding while sick is actually the best course of action for mother and baby!

For more information about breastfeeding when you have the flu, please click here to read this article by Dr. Jack Newman: https://ibconline.ca/information-sheets/breastfeeding-and-illness/.