Maternal Care Practices for Infants with Gastroesophageal Reflux Disease
Background. Frequent regurgitation, heightened irritability, and feeding difficulties, are the primary symptoms of GERD in infants less than 6 months of age. These symptoms can be extremely stressful and taxing to infants and parents. Mothers report feelings of worry, anxiety, frustration, and anger. The maternal-infant dyad displays poor feeding interactions. Treatment, such as anti-reflux medication, relieves acid reflux, but does not decrease primary symptoms more than placebo. Examining various maternal activities to alleviate infant symptoms will increase understanding of the daily living experience of these dyads during the early months.
Methods. Infants (n=36) were 6 to 10 weeks of age at enrollment in a randomized trial examining benefits of massage therapy for infants with GERD symptoms. Care providers in 11 offices referred eligible infants. Infants were born at term, diagnosed by their care provider with GERD, and had no other medical conditions. All infants scored above the recommended cut-off of 16 for GERD diagnosis on the Infant Gastroesophageal Reflux Questionnaire-Revised (Kleinman,et al., 2004). Mothers were over 18 years of age and spoke English. Mothers completed weekly diaries for 6 weeks that included administration of anti-reflux medication, type of feeding, formula used, and any interventions mothers used to relieve infant symptoms.
Results. The most common intervention was anti-reflux medication given by 91% of mothers. In addition to massage and nonmassage treatments provided in the study, 2 mothers consulted a chiropractor. Twenty mothers (57%) held the baby upright after feedings for 20 minutes and kept the baby’s upper body elevated in an infant seat or in bed. Five mothers (14%) gave gripe water, and five administered probiotics (14%). Other remedies were increased holding time, prone positioning, drops to alleviate gas, nightly baths, slower and/or smaller feedings, more frequent burping, car rides, a commercially made swaddling blanket, an electrolye formula for dehydration, co-sleeping, mint tea, and praying. Nineteen (53%) mothers exclusively breast fed their infants. Of these, 8 (42%) changed their diet to avoid dairy or spicy foods. Six mothers (32%) stopped exclusive breast feeding to add special formula to the infant’s diet. Mothers who fed their infants formula used hypoallergenic, soy, or commercially made thickened formulas. Formulas were changed at least once by 35% of these mothers. 16 mothers (44.5%) used 1-3 interventions; 16 mothers (44.5%) used 4-6 interventions and 4 mothers (11%) used 7 -11 interventions to alleviate symptoms of their infants.
Implications. Although GERD is considered a self-limiting condition, the efforts made by mothers in this study add to the literature suggesting that GERD is quite disruptive to family life and a pleasant mother-infant relationship during the first 6 months postpartum. The volume of interventions used demonstrate the how hard mothers strive to try to make their infants comfortable. Research to find an effective conservative treatment that would ease symptoms, has the potential to improve the lives of mothers and infants with GERD symptoms during the early months of life.