Investigations

BARIUM SWALLOW

The baby/child is given a white strawberry flavoured liquid to swallow. For babies this will be administered from a bottle, or through a nasal gastric tube if necessary. An X-ray is taken by a Radiologist (X-ray Doctor), which is projected on a video screen, and then analysed.

This investigation is positive in approximately 50 to 60 percent of babies/children who clinically suggest GOR (gastro-oesophageal Reflux). The examination may demonstrate reflux, the wave pattern in the oesophagus, and the rate of emptying of the stomach. Importantly, this investigation shows whether the anatomy of the oesophagus and stomach are normal and if the baby/child has a hiatus hernia.

Babies/children with GOR may not reflux during the period of the screening, producing a normal reading. A Barium Swallow is therefore not a very reliable test for reflux, as it is possible for a baby/child to have reflux but it not to be picked up by this investigation.

It is common for the Barium preparation to cause constipation, and it should not be left to harden in the bowel. Therefore a laxative may need to be used if constipation is, or becomes a problem. It is useful to take the baby/child’s favourite bottle or cup to administer the barium preparation, as this may make the procedure more acceptable to them.


GASTROSCOPY/ENDOSCOPY

This investigation involves 15 minutes under a general anaesthetic if the symptoms and signs suggest reflux oesophagitis. The endoscopist (the doctor who performs the endoscopy) is able to assess the degree of oesophagitis (inflammation in the oesophagus), and whether there are any problems in the stomach and duodenum. A biopsy (specimen of the oesophageal lining) may be taken for pathological examination.

Other conditions such as coeliac disease (gluten intolerance), food allergies, lactose and other sugar intolerances, helicobactor pylori etc. can also be diagnosed from appropriate biopsies taken during an endoscopy.

This investigation is also a very important step before surgery is considered.


pH PROBE

A probe sensitive to pH changes (thus an index of acidity) is positioned in the oesophagus. This investigation demonstrates the presence, frequency and duration of reflux episodes. For accuracy of result, the probe is left in the oesophagus for 18 – 24 hours, and an X-ray needs to be taken once the probe is in place to confirm it is positioned accurately.

This is a good test for determining whether a baby/child has reflux or not, and the severity of the condition. Several types of readings are taken, but the most crucial one is the % of reflux over 24 hours. In general: – under 5% is normal, 5 – 10% is mild, 10 – 20% is moderate and over 20% is severe. However, the severity of the condition is no indication of treatment needed e.g. a baby/child with mild reflux may still need Omeprazole, whereas a baby/child with severe reflux may remain well controlled on Zantac.


OTHER

Diagnosing GER in Children – http://www.medscape.com/viewarticle/742615?src=mp&spon=9“The measurement of pH is the predominant modality used to diagnose gastroesophageal reflux (GER) in children. However, pH monitoring provides only part of the answer with respect to whether a child has reflux episodes. Multichannel intraluminal impedance monitoring can measure acidic and nonacidic reflux episodes using pressure-sensing electrodes along the length of the probe.” I haven’t heard of impedance monitoring being used in New Zealand.

baby colour large

© Gastric Reflux Association for the Support of Parents/babies (GRASP) and Crying Over Spilt Milk Gastric Reflux Support Network New Zealand for Parents of Infants and Children Charitable Trust (GRSNNZ) 2004. Used, edited and added to by GRSNNZ with permission.

Page may be printed or reproduced for personal use of families, as long as copyright and Crying Over Spilt Milk‘s URL are included. It may not be copied to other websites or publications without permission and acknowledgement. This information (unedited) was also provided (by GRASP) to health professionals in New Zealand to use ” to continue to support and inform families with babies/children with Gastro-oesophageal Reflux.”

  • The GRSNNZ 0800 number and cell phone is currently not being answered or messages cleared. I haven't had a chance to change the message on it either.
    I know there is a message there from last week I haven't cleared too.
    My daughter has been in hospital since Monday and we had several visits last week. I'll attend to the messages hopefully next week.

  • My 4 week old baby is on Ompreazole granules and we are going to start weaning him off in a few weeks to see how we go. I am considering starting him on probiotics to help this process. Can I give probiotics to a 4 week old or do I take them and he gets the benefit through my breastmilk? If I give it to him how do I administer it and what brand is best?

  • Alisha is now 3 1/2 months old, she is around 5 kg. We have had heaps of trouble with her. Put her on various medications and changes in my diet, then onto Neocate Formula with Losec Capsules. She has pretty much improved 100% from where she was a couple of months ago.

    My question is, what quantity of formula does your baby drink and roughly how long inbetween? I've been trying to give her three hours inbetween each feeding which she can manage totally fine. But when food is offered she hardly drinks much in a sitting. I can usually get 100ml of formula into her over an hour, sometimes takes me longer.

    Is this normal for a reflux baby??

  • Is infant gaviscon at all effective for 2.5 yesr old? my son reacts to ranitadine and omeprozole but has had a reflux flare up which is now resulting in vomiting after lying down in bed. He's even coughing and gaging on water during the day probably from the irritation in his throat etc. I'm having to wait quite some time after dinner to give him rice milk and again before attempting bed. It's pushing bedtime out too far with him not napping. Any suggestions? Can't pinpoint anything dietry wise that may be causing it.

  • Hi everyone. I'm after a bit of advice, my 20month old has recently commenced on liquid iron supplement (after we were told his iron levels are low from blood tests) but we've found its giving him a really sore tummy. Have tried halving the dose but I still have a tearful distressed little man on my hands. Does anyone have any ideas? Or can recommend something else.

  • Hi there, I'm wondering if someone could please advise me. I have been dairy free for 3 weeks today and introduced some back in today; just butter on one piece of toast and a splash of cows milk in 2 hot drinks. My daughter's been crying and not sleeping most of the day unless held. I've also been block feeding to try to prevent her choking etc on my fast flow, however Plunket advised I may like to rethink that now she's 8 weeks old so my supply doesn't diminish. She's a frequent feeder and I've managed to push her out to 2 1/2 hourly feeds over the last few weeks (on Plunket and Dr advice as they said her always feeding would make the reflux worse). She had been quite a bit better over the last week. Tonight I offered her the other breast at her feed as well, instead of the same one as usual and she had a good feed, so obviously needed it. But my goodness, the reflux has been really bad afterwards with lots of gagging and choking and pained crying etc etc (she's not much of a puker). I don't know if this is from having both breasts at the one feed (surely not) or she's super sensitive to the dairy? I'm wondering how long it will now take to see if there's improvement now that I've quit the dairy again? Please tell me it won't be a whole other 3 weeks again!! As I said, it was only a small amount reintroduced today.

  • Paging Rebecca who left a message on the Gastric Reflux Support Network NZ Support Answer Phone on Monday!
    Sorry, for some reason I can't return your call. Can you either text us again on 022 585 5935 or send us an email through the website (which is now working) - http://www.cryingoverspiltmilk.co.nz/contact/

    Contact Gastric Reflux Support Network New Zealand for Parents of Infants and Children Charitable Trust Phone/Text 022 585 5935 Phone 0800 380 517 * indicates required field Name:* Email:* Subject:* Message:* CAPTCHA Code:* Request Skype Call/Conversation using the form above. Page last updated…

  • Just trying to access the website about allowances in nz.. nothing will load?

  • In all the reading I've done about reflux babies it seems common that they don't settle to sleep to well
    During the day but will at night? Why is that?

  • I don't know if any of you have noticed, but as the website is having a lot of updates at the moment, I have started adding a blog about it to the website. The posts appear on the home page, under the Facebook Preview. Roslyn, National Coordinator.

    For infant and child gastric reflux support in New Zealand: Phone/Text 022 585 5935 Phone 0800 380 517 Contact GRSNNZ via email form Join Gastric Reflux Support Network NZ for Parents of Infants and Children Charitable Trust for access to our Newsletters and Private Local and National Support Networ…

  • Interesting article on dreamfeeds:

    Will ‘dream feeds’ work for your baby? Dorothy Waide shares her insights on this late night option.

  • does a thickener help for Elecare formula? It seems to be so thin and my little granddaughter is spilling a lot with this formula.Would welcome your feedback thanks

  • Christchurch people - there is a new post from someone needing help finding Karicare Aptamil Food Thickener. If you know where to find it, can you please reply on their post?
    Thank you!

  • Does anyone in CHCH know where to find the formula thickener for Elecare formula?? My wee one has just been put onto Elecare and I am finding it needs to be a bit thicker as she is bringing up a lot just like the breast milk. Not all pharmacies sell it

  • After some advice, I have a 10 week old with possible silent reflux ( just started gaviscon) we are wanting to progress to help him achieve self settling. Does anyone have any methods that worked? Absolutely no comfort in patting and shushing... Or am I asking too much from my little man that finds a lot of comfort in being rocked to sleep?

  • Hi all, Just wondering if someone could confirm for me that going dairy free means you can still have non cows milk products like sheep or goat products? I read the spilt milk site and seems to be a cows milk protein issues, not other types of animal products? I just ate sheeps feta then second guessed if it's OK.

  • My 16 month old just saw an allergist today and he told me it sounded like he had reflux. He had it as an infant but around 9 months he stopped needing meds and was fine, but now this winter he has stayed sick! So I'm really trying hard to wrap my head around this... I feel like my baby has been sick for months (stuffy, sneezing, coughing, wheezing, fever.. the list goes on and on) and it's just reflux! I mean if that's the case I guess I'm relieved because that seems like a simple fix. I just feel like he's really been suffering. His pedi was thinking he had asthma and sinus infections. The allergist did swab his nose to see if anything comes back on it but for now he is just taking nexxium(sp?) and a nasal spray.

  • Ignore my previous message (If you saw it), http://www.cryingoverspiltmilk.co.nz is back!

    For infant and child gastric reflux support in New Zealand: Phone/Text 022 585 5935 Phone 0800 380 517 Contact GRSNNZ via email form Join Gastric Reflux Support Network NZ for Parents of Infants and Children Charitable Trust for access to our Newsletters and Private Local and National Suppor…

  • I asked for a script for infant gaviscon and was given Acidex. Whats the difference?

  • Hoping for a bit of help/more advice. My now 8 week old baby has what we believe to be silent reflux, no one has actually diagnosed her with it, but have been given meds to help. She definitely regurgitates milk, and sometimes projectile vomits (she has only started doing this recently). I am getting so lost of what to do next, we have another appointment with the GP on Thursday, but in the mean time would love any advice on what I can do to help her.

    We started out on Infant Gaviscon, which didn't help much at all. Then onto Ranitidine, which didn't help either. We got prescribed Losec by my GP to use with gaviscon. Which seemed to help for two weeks, but now she is back to being so unsettled and unhappy. From birth she could only ever drink a small amount before she got really uncomfortable and started screaming, I started expressing to get an idea of what she is really drinking, which turned out to be bugger all, this was why i was feeding her 20 odd ml every 1/2 hr to an hour. I'm doing everything I can to help her, have got the bassinet head raised, burp after what seems to be every mouthful! I wear her in my wrap a fair bit during the day for some of her naps.

    I took her to the osteopath last week, and her said she was very sore and had a very tight diaphragm. Two nights later she slept 6 hours! But the next night she was back to a couple of hours at a time. I have another appointment on Thursday.

    As I have a 20 1/2 month old toddler and, expressing got too much as I could never find the time to do it, so now have her on Karicare Formula, which i'm not 100% sure if this is upsetting her stomach aswell. She was induced at 38 weeks as they were concerned about her growth, she was 6lb 3 oz at birth.

    What would be the best formula to have her on? She is still currently on losec and gaviscon. AND how can I ease the screaming after every feed? I'm really starting to stress alot about it and find myself getting pretty emotional.

    Thanks and sorry for the long story!
    Emma

  • Hi everyone, my daughter had severe gerd up until about 9 months and was treated with losec and gaviscon and eurthymician (sp). Four about 3 months she was really good, not needing any meds at all so we weened her off them. She has been med free for about 6 months, but the past two months we are back to screaming and crying every hour each night ( was previously a good night sleeper!) very unsettled etc, but no vomit . My question is can reflux suddenly come back ?

  • Just popping in to clarify our website/forum guidelines.
    Please see this page: http://www.cryingoverspiltmilk.co.nz/guidelines/
    In particular:

    "As the moderators, GRSNNZ reserves the right to remove or edit any posts:

    that recommend another medication as being better or to treat conditions that it is not indicated for

    where dosages of medications are being compared (especially in an unsafe manner) as each child is an individual with differing needs
    where personal advice is given on choosing a formula (sharing experiences is fine)

    where volumes of fluid drunken are counted and compared
    with personal attacks against other users including GRSNNZ staff

    Medications and prescription foods and formula may not be offered for sale/give away on these forums."

    And:

    "Please seek assistance from your Doctor, Midwife, Health Professional or Dietician about feeding your baby. "

    We are getting a lot of requests for advice regarding choosing formulas over the phone, by email and on the forum. Members can tell you their experiences, but they are only their experiences and do not apply to your baby. Please contact your health professional for advice in the first instance or Nutricia also have qualified dieticians.

    GRSNNZ supports the Baby Friendly Initiative and promotes Breastfeeding. GRSNNZ will not give personal advice on formula.

    Kind regards
    GRSNNZ Committee

    Site Guidelines Most of the information on Crying Over Spilt Milk is copyrighted and may not be reproduced on another site/publication without permission, but some may be printed for the personal use of families (and these pages will be clearly marked at the bottom with instructions.) Some material…

  • Please help i am desperate! My wee 9 week old is under a paediatrician forbreflux and a maybe dairy allergy. My milk supply is starring to drop and she has been given Elecare but she refuses to drink it. Have tried vanilla essence and mixing it with my breast milk but still no luck. Any help/advice will be greatly appreciated 😊

  • Hi. I am having real trouble settling my 9 week old baby, especially at night. I would like to wean her off me and have tried both pepti Jr and neocate but no luck. Also on ranitidine for refulx. Am i just best to breast feed or is there other options?

  • Sharing for your information. Please read the whole article - there are safe options.

    A survey of portable cots for sale in New Zealand has uncovered potentially fatal safety defects - including folding mechanisms that could trap a child's neck. - New Zealand Herald