Parenting is not for the faint- hearted. It is assumed to be a natural instinctual response, but babies do not come with a manual and no two babies are the same.
Nothing frustrates a mother more than failure of her baby to gain weight. This is evident in the em- phasis put on weight gain during well baby clinics. Mothers have told horror stories of nurses scolding them when the baby’s weight does not increase as expected.
For Caren*, the heartbreak was real. She immensely enjoyed her pregnancy and together with her husband, they were more than ready to meet their princess. Caren gave birth and they took their 3kg bundle of joy home. Baby Carlie* was a joy. She fed well and slept long hours, allowing mommy to get the much-needed rest. Caren was grateful for the excessive milk she was producing. Things went smoothly and Carlie started her well baby clinics.
The baby did well in the initial visits, with her weight increasing as ex- pected. At around the third month of life, Caren noted that baby Carlie would spit up a whole lot more milk after feeds than she thought was normal. This seemed to become more frequent and the volumes regurgitated seemingly increased. At the next visit, she noted Baby Carlie’s weight had increased by a mere 300g from the previous clinic’s 750g. The nurse frowned at this and asked whether Caren had resumed work. Caren raised the issue with her paediatrician, but was reassured and asked to feed Carlie with smaller potions, but more frequently. Caren dutifully did everything as recommended by the paediatrician, but things did not improve.
Over the next two visits, the weight gain remained slow, but she achieved her milestones as expected. At six months, Carlie was weaned and though she seemed to love the new additions to her diet, she had pro- gressed to obvious vomiting. The vomiting would occur about an hour after the feeds and some- times the vomit would smell ac- rid, like it was rotten. Thus began Caren’s journey from doctor to doctor seeking a solution.
By the time Carlie was 11 months old, she weighed a measly seven kilogrammes, a weight that had stag- nated for three months. One afternoon as I was settling into office where I worked part time for a paediatrician, Caren and her husband walked in looking des- perate. They were seeking the fifth opinion and were exhausted. I listened to Caren with sympathy. She was completely robbed of the joy of motherhood.
She had put up with questions about the suitability of the foods she prepared for her baby, the feeding methods, having to deny her baby the pleasure of breastfeeding so as to “sufficiently starve her” into eating solid foods and putting up with the feeling of being blamed for her baby’s failure to thrive. Her husband was dis- tressed at not being able to help. Throughout the conversation, Carlie was bright and lively, curi- ously touching the medical paraphernalia with no inhibition. But, the sight of a spoon turned the cheerful babble into shrieks of protest.
Despite being underweight, she walked around the room by supporting herself on chairs and ut- tered monosyllabic words with ease. Carlie went home with a prescription that turned her life around. She came to the clinic weekly for the next one month and each time she recorded a drastic improvement. Within three months, Carlie was on a steady path to normalcy and her visits were back to routine care. Carlie’s monster has a name: paediatric gastro-oesophageal reflux disease (Gerd), a condition that afflicts 60 to 70 per cent of infants by the age of three to four months.
Three in five children will outgrow it by six months and by 10 months. Only about 10 per cent of babies will be needing intervention as severe symptoms will affect their health, growth and development. In the digestive system, the food pipe (oesophagus) enters the stomach at the oesophago-gastric junction. This junction has a muscular sphincter whose job is to relax and let food into the stomach and then shut tightly to prevent the food from going back up where it came from. For some people, the sphincter has moments of transient relaxation that permits food to flow back up the food pipe, with frank vomiting. This leads to irritation of the food pipe by stomach acid, resulting in poor appetite, undue irritation of the airways causing chronic cough and sometimes even hoarseness of voice. It may trigger asthma or worsen it. The condition is more common in premature babies and is generally worse in babies with chronic conditions that have nerve or muscular problems such as cerebral palsy and Down’s syndrome.
Treatment depends on severity and sometimes minor adjustments such as ensuring the baby is never
allowed to lie flat, but rather inclined on a pillow, reducing the meal potions and compensating by making the meals more frequent and thicker as liquid feeds are more likely to reflux. For those babies where these simple interventions do not work, they are given drugs that suppress acid production in the stomach. The treatment duration varies from child to child, but is generally long-term. Most babies will get better as they get older because age improves movement of food within the gut, causing the stomach to empty faster and reduce the chance of reflux.
For babies who develop complications, these may be life-threatening and may require surgery that aims to improve the function of the sphincter. This is extremely rare and is done as a last resort. The next time you want to ask a mother why her baby is so small for age, hold your tongue, for you may not know her daily struggle.
Dr Bosire is an obstetrician/gynaecologist