Treating Reflux and Colic in Babies
By Randall Neustaedter, OMD (Excerpt from The Holistic Baby Guide)
The Four-Step Holistic Treatment Plan
Since drugs are not the answer to reflux and crying babies, another method for treating these symptoms is necessary. Fortunately, a holistic treatment plan will provide relief for these babies and usually completely resolve their symptoms. If your baby does a lot of screaming, seems uncomfortable, is spitting up and having pain, or has a lot of gas with discomfort, then following a four-step management plan will start your journey to alleviating your baby’s symptoms. I’ve listed the steps, and we’ll explore each in detail:
1. Solve feeding issues. The first step is to address any feeding problems that may contribute to your baby’s discomfort. This includes breastfeeding problems and other physical issues.
2. Stay close. Try comforting your baby with constant holding and carrying, perhaps aided by using a sling.
3. Address food sensitivities. Your baby may be sensitive to foods that she’s eating. Breastfed babies are often sensitive to the foods that their moms have eaten. Eliminating those foods may ease a lot of symptoms.
4. Get professional assistance. Seek holistic pediatric care and treatment with herbs and other nutritional supplements. Chiropractic care and acupuncture can also be helpful in establishing balance in your baby’s system and relieving discomfort.
The Problem with Drugs
Conventional medical treatment for reflux typically includes drugs that inhibit gastric-acid production. The theory is that if stomach-acid production is blocked, then acid will not irritate the stomach and esophagus. However, stomach acid is there for a reason-to help in digestion and to inhibit harmful bacteria. The drugs used to treat reflux fall into two categories: H2 blockers such as ranitidine (Zantac) or famotidine (Pepcid), and proton pump inhibitors such as omeprazole (Prilosec) or lansoprazole (Prevacid). Histamine 2 (H2) is a chemical that triggers the release of stomach acid. Blocking its action reduces the signal for acid production. Proton pump inhibitors block the enzyme that triggers the last step in stomach-acid production. They are much more potent drugs than H2 blockers.
Unfortunately, these drugs do not address the underlying problems of reflux (an impaired digestive tract), and they may cause other illnesses and digestive problems. Infants prescribed gastric-acid inhibitors of either category have an increased risk of pneumonia and digestive-system infections than healthy children, even after treatment is discontinued.
A study of children aged four to thirty-six months treated by gastroenterologists revealed that those children treated with Zantac or Prilosec had an increased risk of pneumonia and gastroenteritis during treatment and in the four-month period following drug treatment (Canani et al. 2006). The incidence of these diseases was attributed to the inhibition of white blood cell function as a direct result of these drugs and to the change in gastrointestinal microflora (the “good” bacteria that assist in digestion) induced by the drugs. For example, children given gastric-acid inhibitors have an increased number of beta- hemolytic strep, the bacteria that cause pneumonia.
Drugs in the proton pump inhibitor category, such as lanso¬prazole, have been shown to be ineffective and to cause similar side effects. In one study, there was no difference in symptoms attributed to reflux in infants as a result of taking Prevacid com¬pared to placebo, but the treatment group had a significantly higher incidence of respiratory-tract infections (Orenstein et al. 2009). In a systematic review of all studies evaluating the effect of proton pump inhibitor drugs on reflux, the authors concluded that studies show no effectiveness of these drugs compared to placebo (Karkos and Wilson 2006).
Simethicone (Mylicon) is a drug used to break up gas bubbles in the intestine and is often recommended for gassy, crying babies. Several studies have shown no effectiveness of simethicone in the treatment of colicky symptoms in infants compared to placebo (Metcalf et al. 1994).
The holistic treatment of reflux and digestive disturbances may involve one or more interventions. These can be put in place one at a time, in succession, or more than one can be started simul¬taneously. The most effective methods, discussed here, include probiotics, herbal treatment, acupuncture, chiropractic care, and homeopathy.
Establish a Healthy Gut Environment
Since reflux and other digestive symptoms such as gas and diarrhea manifest in the gut of sensitive babies, the first step in treatment is to create the healthiest digestive tract possible. Digestion requires adequate intestinal bacteria colonies that gradually develop in the newborn and infant. Your newborn has no intestinal bacteria prior to birth. After exposure to the birth canal, the mother’s skin, and breast milk, the gut is colonized with the normal flora necessary for digestion and maintenance of healthy intestinal function. If a healthy gut flora is not established or if babies are treated with antibiotics that destroy these valuable organisms, then digestion of milk will not go smoothly. Since we don’t know when and if a baby has developed healthy bacterial colonies, any baby with digestive symptoms should be given live bacteria as a supplement to ensure a healthy gut ecology.
A supplement containing Lactobacillus and Bifidobacterium species is indicated for distressed babies. Babies who are solely breastfed have colonies of Bifidobacterium species, but these bacteria may be deficient due to antibiotics given to mothers or babies or for other reasons. Special supplemental formulas of these bacteria are made for the breastfeeding baby to take on a daily basis. A study of crying (colicky) infants showed that 95 percent responded positively to a probiotic supplement containing Lactobacillus reuteri. The assumption of the study’s authors was that colic may be asso-ciated with an allergic component that would respond to this bacterium, since L. reuteri has been successful in the treatment of allergies (Savino et al. 2007). This study would suggest that Lactobacillus species including L. reuteri can be beneficial to solely breastfed crying babies in addition to Bifidobacterium strains. Of course, formula-fed infants will similarly benefit from this supple¬mentation. These supplements are all available in a powder form that can be dissolved in milk.
Professional Assistance to Relieve Symptoms
The mainstays for relief of these digestive symptoms in holistic pediatrics are herbal formulas and homeopathic medicines. Chinese medicine interprets reflux and colic as food stagnation and a weakness of the Stomach/Spleen energetic systems, which are responsible for digestion and assimilation of nutrients. The energy of the Stomach moves down. When a weakness or disturbance occurs, then Stomach Qi will move up, producing reflux and vomiting. The Spleen energy system is responsible for digestion and the movement of fluids in the body. The Spleen also generates Nutritive Qi, which nourishes and provides the energetic founda¬tion for other body systems, including the body’s defenses (Wei Qi) and immune function.
Chinese medicine provides tools for directly strengthening the digestive system (the Stomach/Spleen network) using herbs and acupuncture. The primary herbal formula for digestive disturbance in babies is Grow and Thrive (produced by Chinese Medicine Works), a nutritive tonic that promotes the assimilation of nutrients and the movement of food through the intestines. This formula was designed to strengthen and support proper digestive function. It is based on the classical formula Kang Ning Wan, or Curing Pill. Its primary ingredients, hyacinth bean, Chinese yam, lycium, and poria, support the Stomach/Spleen network and build Qi. A secondary herbal formula for reflux and colicky symptoms is Tummy Tamer (Chinese Medicine Works). This formula regulates the function of the digestive system, activating and dispersing the stomach and intestines to move food smoothly along. This formula is based on the fourteenth-century prescription Bao He Wan (Pill for Indigestion). Its primary ingredients, hawthorn, tangerine, radish, bitter orange, and fennel, aid digestion by activating the stomach and small intestine while dispersing and descending the Stomach Qi. Since discomfort and distress in infants is often due to stagnation of food and insufficient movement of food through the digestive tract, a dispersing formula will help to move things along. Other ingredients dispel the accumulation of toxins from food stuck in the stomach and intestines.
Several Western herbal formulas have also been used for the symptoms of reflux or colic. A popular tea containing chamomile, fennel, vervain, licorice, and balm mint was evaluated in a randomized, controlled clinical study and shown to significantly improve the symptoms associated with colic compared to placebo (Weizman et al. 1993). Gripe water is a generic name for several Western herb formulas that contain a combination of fennel, ginger, peppermint, and chamomile. I suggest using caution when purchasing the various gripe water preparations. Many have some form of sugar (sucrose or fructose), baking soda, and parabens or methylparaben. None of these are safe for infants. Parabens in particular have been shown to cause hormonal disruption, and they are potential carcinogens (Oishi 2002). Organic forms of gripe water do not contain these additives. These herbs do aid digestion and help calm fussy babies, but Chinese herbal formulas will also strengthen and build digestive function to provide a curative treat-ment that tends to prevent recurrences of symptoms.
Acupuncture is an extremely useful adjunct to other treatment modalities for babies with reflux. Stimulation of acupuncture points can be accomplished with needles or non-needle techniques including finger pressure, cold lasers, magnets, or massage of acupuncture channels. Acupuncture is an excellent tool for moving energy, and that is just what your baby needs. Acupuncture will help move energy down, readjust your baby’s energy balance, and strengthen Stomach Qi so that food moves downward. In the traditional understanding of energy systems, acupuncture relieves the stagnation of food and the upward surging energy of stomach contents, and calms the crampy discomfort of irritated intestines. Acupuncture is a unique and indispensable tool for readjusting the flow of food through your baby’s digestive tract while you’re using herbs to strengthen digestive function.
Typical acupuncture treatment will focus on the Spleen and Stomach channels and may include others, depending on the symptoms involved. The points Stomach 36 and 37 and Spleen 6 are standbys. But many other points on a variety of channels can be utilized depending on the presenting symptoms. Tui na acupressure massage and sho ni shin massage are especially valu¬able treatment options for infants, and they do not require the use of needles. Your acupuncturist can show you safe and effective methods of acupressure to use at home with your baby.
A baby with persistent crying, distress, and reflux symptoms should be evaluated for structural problems by a chiropractic or osteopathic physician who specializes in children. There are many possible causes of structural abnormalities that could contribute to reflux symptoms. Typically, birth trauma occurs from pulling on the head and rotating the neck. This can occur because of mothers lying on their backs during birth, mothers given drugs that slow the birth process, or cesarean sections that require pulling on the baby to extract her from the uterus. This brute force results in tension in and torsion (twisting) of the upper spine and neck. However, even babies born without these sorts of interventions can suffer physical stress during the birthing process that results in spinal injury. Spinal misalignment can be caused by birth trauma or an injury that occurs sometime after the birth.
These misalignments can also be caused by positioning problems initiated in utero, creating postural deviations, such as a baby persistently holding her head in one direction. Chiropractors often attribute the arching of the back seen in babies with reflux to these spinal-cord stress injuries. Chiropractic adjustments will release this tension. Babies may be tender and resistant to touch and pressure on their necks at first, but after a few treatments they become much more settled and relaxed. Taking tension out of the neck will result in relax¬ation in the spinal cord and fascia and relief of the nerve irritation that can trigger digestive symptoms and crying (Olafsdottir et al. 2001).
An interrelationship exists between the nervous system and the immune system. Problems in your baby’s spine and spinal cord can result in immune-system dysfunction as well as digestive disturbance. Alleviating this spinal stress can allow further healing and the re-establishment of balance in the immune system as well (Ohm 2009). Whatever the cause, having your baby checked and treated with gentle chiropractic adjustments will eliminate spinal structural problems as a possible contributing cause of her crying.
Homeopathy: Do It Yourself or See a practitioner
Whereas Chinese medicine and chiropractic require professional help, you can utilize homeopathy yourself-though seeing a qualified homeopath can help with more intransigent problems. I’ve seen homeopathy do wonders for reflux and crying babies. Never forget the magic of the correct homeopathic medicine, which can clear symptoms instantly. Of course, for many children the effect of homeopathy is gradual and gentle, though the curative ability of a homeopathic remedy is often marvelous. The synergistic effect of homeopathy in combination with herbs facilitates the healing process. Where chiropractic corrects structural problems and Chinese medicine corrects the energetic imbalance, homeopathy provides a profound energetic stimulus to healing. When you address the nutritional components of symptom production as well, the overall holistic effect covers all bases and produces a dramatic curative process.
To find the correct homeopathic medicine, compare your baby’s symptoms to the cluster of symptoms described for each medicine. Find the description that matches your baby the best, and try using that one. Start with a single dose of the homeopathic medicine in a 12C or 30C strength. If symptoms improve, then wait and observe. If symptoms return, then repeat the dose. For small babies, you can crush the tiny pellets and mix them with water or breast milk. You can consult appendix 1 at the end of this book for more detail about using homeopathic medicines at home. For persistent or prolonged symptoms, it would be best to consult a professional homeopath, who can treat the underly¬ing constitution and root causes of the energetic disturbance that causes colic and reflux.
The homeopathic medicine most often indicated on an acute level is Colocynth, especially if your baby seems better when you press on her abdomen. Jalapa is a colic medicine for babies who cry all night and sleep during the day. Lycopodium is used primarily when gas symptoms are prominent and when the late afternoon and evening (four to eight p.m.) are your baby’s worst time of day. Nux vomica corresponds to an exceedingly irritable baby who is worse in the mornings.
Following, I’ll offer more specifics about each of the homeopathic remedies you may find helpful.
The pains associated with Chamomilla are sharp and severe. Babies scream and flail. They must be carried and rocked in constant motion, but they are not satisfied by anything they demand. Older babies will indicate something they want and then throw it. They are beside themselves. The abdomen may be bloated and the loose stools are greenish.
Colocynth. The characteristic of the pain that indicates Colocynth as the correct medicine is amelioration from pressure. Babies will pull up their legs, doubling up in apparently excruciating pain. If you put pressure on their abdomen, holding them across your knees or over a shoulder, they will get some relief. They tense up their bloated abdomens in response to the sharp, cramping pain that often comes in waves. They will strain and cry before bowel movements and feel better after passing a stool.
Dioscorea. This remedy can be considered the opposite of Colocynth. Children who need Dioscorea are worse when bending forward and feel better when arching the back. They tend to have a lot of gas. Symptoms are worse in the morning and better when stretching out flat. They also like to be held upright.
Babies who need Jalapa cry all night with pain and discomfort but are fine during the daytime. Symptoms often include watery, sour-smelling diarrhea.
The symptoms that correspond to Lycopodium are worse during the hours between four and eight p.m. Look for lots of bloating and gas with a tendency to constipation. Any pressure on the abdomen aggravates the pain and discomfort.
Babies with symptoms indicating Nux vomica are irritable and worse after eating, but especially troubled in the morning. They are very sensitive to spices and other irritants in the mother’s diet.
Special Issues in Older Babies
When feeding problems and digestive symptoms persist beyond the first few months, if babies continue to spit up large amounts of milk, throw up solids, or continue to scream with abdominal pain that keeps them up at night, then they may require a different treatment regimen than infants. These children often suffer from a damaged intestinal lining in need of repair.
The first issue to consider is the type of solids that babies are eating. Grains fed at too early an age can cause significant prob¬lems. I recommend that you keep all grains, including rice cereal and oatmeal, out of your baby’s diet until at least twelve months (and longer if she is having any allergic or digestive symptoms). Wheat is especially difficult for babies to handle, and it should be avoided in any baby with symptoms. Similarly, dairy products can cause allergies and sensitivities and can damage the intestines of babies. Wait until ten to twelve months for any dairy products. Then you can try yogurt and cheese. Wait until eighteen to twenty-four months before giving whole cow’s milk unless your baby must have formula. Babies need the fat of whole dairy products and not reduced-fat preparations.
Older babies may benefit from having specific tests to pinpoint the issues that underlie digestive symptoms. A comprehensive stool test that examines digestive-enzyme production, inflammatory markers, intestinal bacteria, and yeast cultures can be informative and lead to appropriate treatment. Babies with an overgrowth of yeast (Candida albicans) may benefit from supplements including Saccharomyces boulardii (a strain of yeast that helps estab¬lish normal intestinal flora) and a medium-chain triglyceride oil supplement that contains caprylic acid, a potent antifungal fatty acid. Many babies need some additional digestive-enzyme support. If inflammation is a problem, then the amino acid glutamine in powder form has a potent regenerative effect on the intestinal lining. Glutamine benefits the growth of rapidly dividing cells, providing the nutrition required for the synthesis of new RNA and DNA so that cells can multiply. This is vital for maintaining a healthy lining within the digestive tract, where cells have a rapid turnover rate. When there is digestive inflammation, there is an increased need for glutamine for cell repair and replacement. Other anti-inflammatory supplements include the herbs boswellia and turmeric (curcumin), the enzyme bromelain (extracted from pineapple), and the flavonoid quercetin, which is found in many fruits and vegetables. It is important for children with digestive inflammation to also take adequate amounts of omega-3 fats for their anti-inflammatory effect (fish oil is the most accessible source of these fats). And older children with digestive problems need a broad-spectrum probiotic that includes a variety of Lactobacillus and Bifidobacterium species. Other nutritional supplements may be needed for healthy digestive function, including pantothenic acid, zinc, hydrochloric acid, and prebiotics, depending on the judgment of a holistic pediatric practitioner (see chapter 8).
These children may have food allergies and food sensitivities. Depending on the child’s symptoms, a range of food-sensitivity tests can be informative, including blood IgE, IgG, and stool IgA antibody studies. Often these children have a sensitivity to wheat products (including the proteins in gluten, primarily gliadin). Other grains contain gluten as well. Cow’s milk proteins are also irritating to many children’s digestive tracts. For these children, the protein molecules cause damage to the intestinal lining, disturbing the intestinal barrier and allowing potential allergens into the bloodstream. These foreign proteins then stimulate antibody production and allergic reactions in other parts of the body. This is the beginning of the process that leads to allergies in so many children. Approximately 70 percent of immune activity occurs in the intestinal lining (Brandtzaeg 1998). For this reason, healing the gut is essential to maintaining a healthy immune system. For a more thorough discussion of the relationship and treatment of digestive and immune-system imbalances see chapter 8.
Good health care begins at home with healthy food, a non-toxic environment, natural remedies to strengthen immunity, and mental, emotional nurturing. At Healthy Child, you will get in-depth information on all these topics and you will learn how to keep your child exceptionally healthy.
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I’ve been using babies magic tea for my colicky baby who wasn’t settling down with any other remedy. Thank God, it worked wonder and my baby got relieved from severe colic.
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