As we stock the book ‘Acid Reflux in Infants and Children’, we decided to invite Tracy Davenport (author/reflux expert) to a Q & A session with some of the questions that have been coming up in recent forum discussion and being asked of me personally.

Tracy has answered a few at a time and here is the first instalment.

1. My daughter vomits after each feed and then generally dribbles sick right up to the next feed. She has gained weight well. She by no means projectile vomits. Does this mean it can’t be reflux?

Your daughter may have “silent reflux,” which refers to reflux without any outward or typical symptoms. This type of reflux is also referred to in the medical community and literature as “a-typical reflux.” In my own son’s case, he has reflux episodes, but the refluxed material does not come high enough into his oesophagus to actually come out of his mouth. We were able to determine this information early on, by way of a remote sensing gastrointestinal probe. This probe had two sensors, one upper, and one lower, and the information provided by this probe enabled us to determine how far up his oesophagus the reflux travelled. If you are still unsure about whether or not it can be reflux if projectile vomit is not present, then just think of all the adults you know who do not projectile vomit, but certainly suffer from reflux.

Unfortunately, silent, or a-typical reflux can be much more difficult to diagnose, and also more damaging. Some in the medical community are not as familiar with silent reflux as others, and will begin and end the medical assessment with the question, “Does your daughter projectile vomit?” If you answer no, then they might be tempted to look for another cause besides reflux. Silent reflux can cause pain and damage to the oesophagus on the way up and on the way down, which can almost double the acid exposure to the delicate lining of the oesophagus.

Some symptoms of a-typical reflux are listed in our book, and include:
1) Sleep apnea
2) Asthma
3) Sudden infant death syndrome
4) Acute life threatening events (i.e. stops breathing and turns blue)
5) Recurrent ear infections
6) Coughing
7) Hoarseness
8) Sinusitis
9) Night-time awakening
10) Back arching behaviour

2. Why is reflux worse at night?

Reflux is worse at night for at least five reasons:
1) Gravity. When a person is standing up, versus lying down, gravity is able to help the reflux material return to the stomach. Therefore, the reflux material can remain in the stomach longer at night, and cause more discomfort than in the daytime.

2) Distraction. An individual is obviously not as distracted in the night, as he or she is in the day. Preliminary research supports the power of distraction for pain management. Many times, a person may have reflux-related pain in the daytime, but he or she is too busy and distracted to make it the focus.

3) Swallowing. At night, a person is not swallowing as much as in the daytime, and since our saliva contains bicarbonate, the swallowing action in the daytime tends to neutralize the acid in our oesophagus.

4) Medication. The half-life of most reflux medications is too short to stay effective throughout the night. My son takes reflux medication just before bed, and by 3 a.m., the medication is completely metabolised and is no longer effective. This phenomenon leads to night-time acid “breakthrough.”

5) Snacking. Some individuals tend to eat the “wrong” foods just before bed, which can also make reflux worse at night.