Reflux disease

I noticed that it has been 3 months since I updated my blog. To all my followers, i apologize. Too many things at hand
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Recently I came across many infants in my clinic, where parents complained that their child is vomiting frequently. Of course after much probing, that vomiting was actually regurgitation.
Next question is how can we differentiate the 2. There are simple questions that we, as parents can ask ourselves and see if it's vomiting or regurgitation.

1. Is the child well?
2. Is the child gaining weight?
3. Is the child satisfied after feeding?
4. Does the child sleeps after feeding?
5. Does the amount of milk comes out from the mouth or nostrils minimal amount?

If the answer is yes to all the questions above, then chances are it's just regurgitation.
A small percentage of children, especially infants, will have recurrent regurgitation, sometimes to a certain extend that parents began to be very worried. The child may have GORD (gastroesophegeal reflux disease). Some of us may be familiar with GERD instead, well it's just American or British spelling.


There are essentially 3 types of severity for GORD, mild, moderate or severe.

For mild cases, symptoms will usually be just mild regurgitation. Sometimes milk can come out, not only from the mouth, but from the nostrils as well. Children with mild GORD do not have weight loss, still gain weight well, and eager to feed. To treat mild cases, we simply just need to prop the child up for a little longer and 'burp' them for a longer period of time. The commonest myth is people think that after burping once, then it's considered done. We can burp the child longer or even more than once!

For moderate cases, we probably need to change the types of feeds for children. There are in the market formulas that are AR (anti regurgitation). As long as we see the word 'AR', then that formula is specially made for children with regurgitation. If you are from Malaysia, AR formula can be brought from any hypermarkets. These children may not have adequate weight gain.

For severe cases, the child will usually have weight lost. For these children with severe reflux, then they need drugs to make them better. Sometimes, they need to be admitted to the hospital to stabilise them, push up their weight. To a certain children we may need to 'tube' feed them.

Next question is why does GORD occur? In our food pipe, called the 'esophagus' is connected to our stomach. Just at the point of connection, there is a 'door like' valve which we call 'sphincter' that helps to ensure that contents in the stomach do not goes up back to the esophagus. (see the diagram above). The function of this 'door' is to provide one way traffic for milk to go into the stomach. If this door is not 'shut' properly, then stomach contents will be able to move up back to the esophagus, and hence the term 'reflux'. In infants, this is particularly common. Reflux happens in adults too. Public term reflux in adults as 'heartburn'.

The good news is, for most of the infants, when they grow older, the 'door' will tend to function better and keep the 'traffic' of milk one way. Usually by the time, children reaches 8-9 months, that is by the time they started to sits on their own, the symptoms of reflux will gradually disappear. They 'grow out' of it.!

Facial Congestion in the Newborn

It seems to be sometime since I updated my blog. Well for personal reasons I did not have much time to do just that. And one of the reason is, my wife just delivered a beautiful baby boy, and there's something on this baby that I would like to share for my blog today, that is facial congestion.

Some babies are born with their cord round the neck. This is something that rarely happen, but do happen at times as well. It is not the cord is around the baby's neck when the baby is in the mother's womb, but only happen when the baby is delivered. As the baby is delivered, the cord got round the baby's neck and when the baby comes out, it will be as if the baby got 'strangulated'. Well, i say 'as if', meaning, it appears to be strangulated. Not always.

When this happen, there will be some sign of congestion on the babies face and this can sometime be mistaken as 'petechiae' or red spot on the body. When a baby (or any human being for that fact) has got petechiae, it is abnormal and tells us few things.

1. the person got some capillaries problem, therefore leading to petechiae

2. severe viral infection (like dengue)

3. Congenital infection (TORCHES infection). 'Congenital' means, infection acquired from birth

4. Low platelets due to whatever reason.

My baby has got some red spots but at the same time the baby's face appear darker compared with the rest of the body. This is facial congestion. This may be due to the delivery process (which is very stressful to the baby also) or because of cord round neck.

Facial congestions disappear after few days. However, if it is not congestion, then the red dots are petechiaes and need to be checked out by a doctor.

The photo on the right is my baby's photo that show's some red dots and darker colour face.

So, the next time anyone of you face this problem, don't worry. It's not permanent.

Diarrhea in Children

Happy New Year !

For the first post of the year, I was hoping this particular post will share some light for many of us as parents.

Diarrhea is something very common in children, especially during the toddler's age group.

Diarrhea, most of the time is due to a viral infection, affecting the intestine. Many times, the treatment is very simple, that is just hydration. In the clinic or hospital, we would always give salt water.

Most of the children with diarrhea will start off with vomiting. Most of the time, parents will bring their children to see us at this 'vomiting' stage. The treatment is also the same. After this vomiting stage, by the 2nd day, the diarrhea will set in.

There are however many myth and misconception on this simple childhood illness.

1) Concentrate feeds during diarrhea.

This is so not true. Some how, many parents told me this, that if they were to concentrate their feeds, there will be more nutrient to their babies as well as reduce the diarrhea (less water means less water coming out from the bottom!). Concentrating feeds will make the salt in the child's body go haywire and will definitely worsened the condition. So, feed like usual. On top of that, give rehydration salt (ORS). 

2) Must change to soy based formula.

This is also not true. Many GP will tell parents to change milk for their children to soy based, because soy based will lessen the diarrhea. There is no need to change any milk powder during the first week of diarrhea. However, there are some diarrhea will persists to more than 2 weeks. This type of diarrhea is call 'post infection lactose intolerance'. It is only by this stage, then a lactose free formula is indicated. When we start to give a lactose free formula/soy based formula for a child that is having diarrhea, this must continue for at least one month, then we can reintroduce normal milk powder slowly. There are risk of recurrence of the diarrhea after restarting normal milk powder in some cases.

3) Need to take medication to stop diarrhea.

Anti-diarrhea medications are NOT used in children. In fact, we don't give at all! This medication causes the intestine to slow down it's function and cause the child's tummy to be distended. This will cause more discomfort for the child. Moreover, the toxins in the intestine will be absorbed into the blood stream and cause a child to be unwell. These medications also will cause lots of side effects. So the next time your GP give you medications to stop diarrhea, think twice!