Acid Reflux and MSPI Myths

This is a collection of information from various sources including Colic Solved by Dr. Bryan Vartabedian, Midwest Acid Reflux Children’s Institute and also from moms with personal experience in getting their babies acid reflux and/or allergies treated appropriately. All of these things are acid reflux and MSPI myths that have been told to moms who’ve had part in contributing to this site. If you hear any of the below from either your pediatrician or a pediatric GI, we strongly recommend getting a second, or even third opinion if necessary. These are signs that the practitioner may be in over their head or behind on the most current treatment options. It is not intended to offend anyone and is only to help parents understand their baby’s condition and treatment options.

Your infant just has colic

Colic is not a diagnosis. The National Digestive Diseases Dictionary defines colic here on page 11. It’s a description of a behavior that is used when the doctor can’t figure out what is wrong. If your infant is crying all hours of the day, acting extremely uncomfortable, having trouble sleeping, refusing to eat, over eating, having diarrhea or mucous in diapers, arching, vomiting etc. it may be the result of reflux and/or a dairy/soy intolerance and not “just colic”. Proper medication for your baby and the right diet for you if you are breast feeding, or the right formula, can make a huge difference in your baby’s comfort. Babies do not cry without a reason. They cry to let us know something is wrong. Sometimes it’s because they are sleepy, hungry, tired, wet, dirty, etc., but sometimes (particularly if it’s constant and inconsolable) it’s because they hurt and it’s up to us and our baby’s doctors to find the right treatment to make the pain stop. Check out the book “Colic Solved” www.colicsolved.com and get a second opinion before your let your child cry constantly if you hear the colic “diagnosis” from your pediatrician.

There’s nothing that can be done for acid reflux but wait it out

This is another common myth that many pediatricians who are not up to date on available infant acid reflux treatments may tell families. Most babies with acid reflux respond well to the same reflux medications that adults take for reflux, including H2 blockers like Zantac or Axid and PPI’s like Prevacid, Prilosec or Nexium. If your baby’s acid reflux and “colic” symptoms are the result of food allergies or intolerance; most of the time eliminating the allergens from your diet if you are breast feeding or getting your baby on the right formula can completely eliminate the reflux and other symptoms.

Just be patient your infant will outgrow this

Many babies will begin to outgrow their acid reflux after the 6 month point, but many will continue to struggle with reflux until a year, 15 months or even longer. How long is it okay to let your baby suffer just because they’ll likely outgrow it? There are consequences to leaving acid reflux untreated, they can be severe and lifelong. These include and are not limited to:

Permanent damage and scarring to the esophagus as a result of repeated exposure to stomach acid
Potential eating aversions and oral aversions from the constant pain
Potential pneumonias, lung damage and asthma if there’s any aspiration of the refluxed material into the lungs
Chronic sinusitis
Hypertrophic tonsils and adenoids

The only medication available to treat acid reflux in infants is Zantac.

While it is true that Zantac is the only FDA approved reflux medication for babies under one year, it is very common for pediatricians and pediatric GI to prescribe PPIs such as Prevacid to babies who do not respond to Zantac. In fact, there is research done at the Midwest Acid Reflux Childrens Institue that shows PPIs are just as safe and more effective than H2 blockers like Zantac and Axid. The only reason that they haven’t been approved by the FDA is because the drug companies themselves have not conducted the research to get the approval for use in children under 1. It is difficult and expensive to conduct research on infants and most drug companies choose not to do it.

Prevacid is the only PPI available for an infant and if your’s doesn’t do well with Prevacid then nothing is going to work.

Again, this is just not true. Prevacid is not approved for children under a year, it’s just been used longer than the others and often doctors are leery of trying new medications. There are at least 3 different PPI’s that are regularly used for infants including Prevacid, Prilosec (or immediate release Zegerid) and Nexium. Babies who do not respond well to Prevacid often may respond better to Zegerid or Nexium, just as some adults will do better one PPI than another. These medications are not all the same.

It doesn’t matter what time of day or when you give a PPI to babies

Just like adults, infants with acid reflux need to be given PPI’s on an empty stomach 30 minutes prior to eating. Even the included pamphlets read this truth. These medications are delayed release (with the exception of Zegerid) and are coated with an enteric coating to protect it from the stomach acid. The medication must pass through the stomach and into the small intestines where it will slowly be released and absorbed into the blood stream. If the enteric coating is dissolved while the medication is still in the stomach, the stomach acid will break down the medicine and make it useless. If you give the medication while food is in the stomach or give and then immediately feed your baby, the medicine will not pass through the stomach immediately and will be exposed to the stomach acid for too long. This greatly increases the chances of the medicine breaking down and not being absorbed appropriately. The only prescription immediate release PPI is Zegerid. It was specifically designed to buffer the stomach acid as it passes through and is then immediately absorbed by the small intestines. For this reason, it does not have to be dosed on an empty stomach (see marci-kids.com for further information).

If Zantac isn’t working, you may need to put your infant on Reglan

Reglan is not an acid reflux medication. It is a medication to speed the emptying of the stomach and is only useful if the baby has delayed gastric emptying. Reglan has severe and sometimes permanent side effects, including Tardive dyskinesia (repetitive, almost seizure-like activity) Video Link, lip smacking, tongue protrusion, etc. The longer the baby is on this medication, the stronger the chances of developing these side effects and stopping the medication will not always reverse the effects. The FDA has put out a black box warning for Reglan because of these side effects click for info. Reglan should always be a very last resort and only for confirmed delayed gastric emptying. If Zantac isn’t working, the next step is a PPI (see above), not a motility drug. For more on Reglan click here.

If your baby has a dairy and/or soy intolerance, you need to stop breast feeding and put him/her on hypoallergenic formula

In most cases babies with milk and/or soy intolerance or allergies are reacting to the small amounts of dairy and soy proteins that pass into your breast milk. Eliminating these things from your diet will usually be all that’s necessary for your baby to stop reacting. (painful excessive gas, diarrhea, rashes, mucous stools) It will take some time to see results since it takes 2 full weeks for dairy proteins to leave your system and then another 2 to leave your baby’s, but typically symptoms of MSPI will be eliminated once you eliminate dairy and soy from your diet for a month. Hypoallergenic formulas like Nutramigen or Alimentum do contain dairy proteins that are partially broken down, but still present. The amount of dairy proteins in these formulas is much greater than the small amount of dairy proteins that get through to your baby in your breast milk. So if he/she is reacting to those proteins, then it’s very likely that he/she will react to the proteins in the hypoallergenic formula as well. Only in Neocate, Elecare, and Nutramigen AA are the dairy and soy proteins completely broken down into their amino acids and are safe for babies with confirmed dairy and/or soy intolerances.

Your baby is fine because he/she is gaining weight

Many doctors use growth charts as the only indicator of a baby’s health. If your infant is miserable all the time and you know something is wrong yet hear this from a doctor, run away fast! Many babies who have reflux will comfort eat because the milk soothes their irritated throats. This will cause them to actually gain excess weight. It does not mean that they are happy, pain free or lacking risk of permanent damage. Regardless of whether your child’s position on the growth chart, most parents agree that allowing him/her to suffer with untreated acid reflux is not acceptable. An adult would never be told to wait it out.

It’s impossible for a baby to react to the dairy in Prevacid Solutabs

Technically, it’s pretty unlikely as the dairy in Prevacid is medical grade lactose. However, even though lactose is the sugar from dairy and doesn’t contain proteins, isolating lactose without some trace amounts of the proteins is an extremely difficult task. Very allergic or very sensitive babies may actually react to these trace proteins.

There’s no such thing as a food intolerance

Intolerance and allergies are very similar and many doctors mistakenly think that if your baby doesn’t have a true allergy, then there’s nothing wrong. A food/protein intolerance just means that the baby has trouble breaking down and digesting proteins from certain foods. The main culprits are usually dairy and soy, but can also be wheat, nuts, fish, eggs, corn, etc. Just because a baby doesn’t have an immune system response, doesn’t mean they are able to tolerate dairy proteins. Many of the GI symptoms of allergies and intolerances are the same.

No blood in the stool means no allergy or intolerance

This is a very common myth that pediatric GI’s often will tell parents. Blood in the stool comes from the GI tract being damaged to the point that there are open sores and bleeding ulcers along the tract. It takes time and repeated exposure to the proteins to get blood in the stool. Just because your baby doesn’t have blood in his/her stool now, doesn’t mean there isn’t an allergy or intolerance. Depending on the severity of the issue, some babies may not ever present with blood in the stools, but it still doesn’t mean he/she doesn’t have an intolerance to dairy. A good GI will look at the whole picture and all the symptoms and not just test for blood and then blow you off if it’s negative.

You just have a “high needs” baby, or she/he is just spoiled, or she/he just needs held/comforted a lot, or she/he just has an attitude problem and will wake up one day different (or various other versions of this)

This is a variation of the “your baby just has colic” myth and again is a completely unacceptable diagnosis. Some babies are higher needs than others, but if your baby is crying inconsolably alot of the time and refusing to eat or wanting to comfort nurse/eat all the time, never comfortable lying down or being put down, screams and arches his body in pain, then there is something wrong and any doctor who makes any of the above statements is not treating your baby as he needs to be treated.

You have to mix Prevacid solutabs with water and dose with a syringe. Holding the Solutab in the cheek will make the medicine ineffective

Only 2 things can make the solutabs or any other PPI ineffective:
1. The baby spits the entire dose back out
2. You don’t dose on an empty stomach 30 minutes prior to feeding (except for Zegerid).
Any method that you use to get the medication into the baby is perfectly fine as long as it stays down.

Apnea monitors are only for refluxers on oxygen

Apnea monitors, SIDS monitors, Angel Care monitors etc. are for ANY parent who has concerns about their baby aspirating on reflux and stopping breathing. That’s one reason why those monitors were invented. If your baby has had any apnea spell related to acid reflux, or even if you baby has choked badly on refluxed material, you can request a monitor from your pediatrician or pediatric GI. The only thing to note with these monitors is that you can get a lot of false alarms, this can be greatly reduced by following this handbook.

Reflux medications are only for babies who have been diagnosed with failure to thrive (FTT) or chronic pneumonia

Reflux medications are for any baby who has acid reflux and who has symptoms of pain related to reflux. The point of the medications is to PREVENT diagnoses such as FTT or chronic pneumonia.

Babies often choke just pat his/her back when he/she chokes

Choking on refluxed material is not a “normal” thing and patting the back isn’t a good idea (any person trained in CPR can tell you that patting the back is not something you should do for anyone who is choking as it can actually lodge the material further down the wind pipe). If your baby is choking frequently or having apnea spells (actually quits breathing) you need to have a swallow study done to determine whether he/she is aspirating fluid into his/her lungs, determine whether his milk needs to be thickened to prevent aspiration and have coordinated care with a pediatric GI and pediatric Pulmonologist.

Reflux is just a mechanical issue that you just wait for them to outgrow.

Sometimes this is true, but allergies or intolerances (particularly to dairy) can often CAUSE reflux. In these cases if you eliminate the allergen, often the reflux will stop as well as the other symptoms.

It is not possible for a baby to react to, have an intolerance of or be allergic to breast milk

99%of the time this is probably true, but there are rare babies who react even to the proteins in mother’s milk regardless of elimination diets. It’s definitely best to breast feed and it’s usually best to try eliminating dairy and soy or even try a total elimination diet before giving up breast feeding, but there are rare cases where a baby needs an elemental formula like Neocate or Elecare because of a complete inability to digest any dairy proteins, including the ones present in mother’s milk.