GERD ... Does that ring a bell in your mind?
No? you are lucky!
Yes? Heard it from a friend? You are still lucky!
Yes? You are experiencing it as a mom handling your toddler? ... So you are living through this nightmare.
For those of you who don’t know, GERD stands for Gastro Esophageal Reflux Disease. In simple terms, it is a condition in which the stomach cannot retain the content inside after a meal and throws it back upward in to the food pipe. This condition in adults can be managed easily as they are aware of their body and its needs, and treat themselves accordingly. However, in a toddler, the challenge is way high as the toddler is not mature enough to gauge what is going inside their body and, worst of all, they cannot express their discomfort or sensation verbally.
GERD can be caused due to various reasons. But mostly it is a combination of an immature digestive system and an allergy developed toward a specific food item, like CMPI (Cow Milk Protein Intolerance). The allergy could also be caused due to intolerance of wheat, nuts, etc.
The food habits of a toddler suffering from GERD are not at all like their peers. These kids are totally disinterested in food - of all kinds and at all times. Even if they go to birthday parties or made to eat with other kids their age, they don’t end up eating anything. The condition starts with vomiting sensation, the body’s inability to hold down food resulting in frequent episodes of throwing up, and gradually aggravates to a state in which the child can completely psyche out over the concept of food. In certain cases, the child may also develop eczema due to the body’s inability to absorb vital nutrients and may end up losing weight. The symptoms don’t show up together and set in one by one. So, often moms may confuse GERD with normal vomiting bouts of a child due to over-eating, coughing, jumping, reluctance to eat, dislike for the recipe, etc.
As a mom of such a child, you would always try your best to make different kinds of recipes and buy kid-friendly fancy cutlery. You might wake up with the thought if your child would be able to keep all their feeds down that day and go victorious to the bed if your child consumed almost all the meals successfully that day. You might feel embarrassed in gatherings when your kid’s total disinterest for food is but obvious to others especially when you are among women of your mother’s generation, who are ready to pour in advices in to your poor brain: "You don’t make good food,” “You should make it tasty,” "You should give the child variety,” "You are feeding him too much,” "Give him longer gaps in between meals"… Things that you are aware of already and have obviously tried out by this time.
The child with such a condition also goes through a very tough time. They become the victim of their mother’s wrath, who spends a lot of time preparing a healthy meal, only to end up cleaning the vomit of the child, left with no food in their belly. Being toddlers, they can’t express their feelings or the discomfort they go through during every meal time. They are the silent one going through the trauma of being made to sit down to eat, the food inserted in to their mouths, the distractions created by the parents so they don’t throw up, to the terrible sensations in their oesophagus followed by throwing up and then facing the frustration of the family members, which keeps growing day by day.
If GERD is detected at the outset, the condition can be managed in a much better way and the toddler can be helped to come out of it sooner. If you think your child is vomiting at least one meal a day either right after the meal time or after a physical activity followed by intensive coughing, you can become more vigilant toward them. If it persists and is not a matter of a few days, you may want to visit a paediatrician for consultation. For some kids, the doctor may advise an acid reflux test, in which a tube is inserted down the child’s mouth and a white fluid is pushed in to check the degree of the reflux. The test itself is a trauma for the kid as well as the parents and you can talk to your doctor if you can opt out of it. It is advisable to act on the remedy to help the child get over it. If you are the mother who doesn’t want to keep a small child on allopathy medicine, there are a few things you can actively do to help them pass through this phase.
--To begin with, stop all the variety and start all over again with a rice-based diet for the child, like curd-rice, rice with lentils/pulses, puffed rice, crisped rice, etc. Slowly re-introduce all the other items to be able to diagnose the cause of the allergy. Wheat, full cream milk/cow’s milk and oats should be removed first of all.
--Time your child’s meals well along with a specific menu for the next one week. Consulting a good paediatric dietician is advisable.
--Maintain a chart of their bouts of throwing up, including the time, the activity undertaken before that and the ingredients of the food taken
--Give your toddler plenty of water after every episode of vomit to help them flush their system and clear the unpleasant taste from their mouth
--Remove all the food items from the child’s meals that are consistently causing a reaction to puke
--Make routine changes in case any activity or exertion before a meal is causing the reaction
--Follow the golden rule of introducing a new food item after a gap of at least 4 days
--Continue to distract the child during meal time with animated conversations, stories, etc
--Don’t force the child to eat if they display firm reluctance after a few spoons … try to feed again after a gap of 30 mins
--Water intake should be consistent every day and should not be given immediately after a meal
--The child should never be engaged in any physical activity right after their meals, including playing indoors with other toddlers. Basically, they should not be excited for until about 30-40 mins after the meal
--For some time, it is advisable to stop citric food intake, including sweet lime juice, etc., as it aggravates the condition by causing acidity
--Help the child rest at night or nap times with the head high on a pillow so the food pipe is not parallel to the ground
--Help the child build their digestive system through toddler exercises/sports
--You can try out alternative medicines, like homeopathy, for a short duration
You can also bring about a few behavioural changes in the house to help your toddler go through this difficult phase comfortably. Show them colourful food-related kid’s videos or picture books to arouse interest in food. Don’t lose your mind when they throw up even if they end up doing so 4-5 times a day; rather train them to run to the bathroom when they have a sensation, so you don’t have to do all the dirty cleaning and your house doesn’t stink. When the child pukes, don’t serve them the same food again immediately. Please know that the child might have associated that taste with the trauma they went through just then.
To sum up, identification of the food item causing the reaction in the toddler is the most significant step toward the cure. Once that food item is completely removed and compensated by substitutes (for e.g., if it is CMPI, the toddler can be kept on soy milk and gradually moved over to toned milk), the child will start showing gradual improvements. If you are constantly in touch with a good paediatric dietician, your toddler will never develop any nutritional deficiencies. Along with these steps, it is extremely important to be a very empathetic and patient parent because you are dealing with your little one who is exhibiting a certain reaction out of their control and is as distressed as you are. Remember as Arnold H. Glasow said, “The key to everything is patience. You get the chicken by hatching the egg, not smashing it."
This article was published on mycity4kids.com on August 10, 2015
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