Allergy

Why babies spit up! (Pedcast)

Parents are often concerned about a common infant symptom, “spitting up”. In today’s podcast, Dr Smolen discusses some of the main reasons why babies spit up and older children and adults, don’t.  Take a few minutes to listen to this practical and informative discussion.

Transcript:

Welcome to another edition of DocSmo.com, the home of the pediatric pod cast,
-Where we help parent raise their children all the way from the diapers to the diploma, from the beginning of gestation to after graduation
I am your host, Dr Paul Smolen
-Before we get started with today’s pod cast, I want to remind my listeners that this pod cast is informational in nature, and not intended to give medical advice for any individual child… if you are looking for tailored advice for your child, visit the wonderful person you call your child’s pediatrician.

-After 30 years of practice, I guess I have been asked everything…it certainly seems that way.
-One of the more common questions I get is why babies spit up so much
-For older children and adults, spitting up stomach contents on a regular basis would be abnormal, a sign of disease, … but most of the time this is a normal symptom for infants.
-Actually, many of the digestive symptoms that babies experience on a regular basis would be very abnormal for an adult… spitting up, pooping 8 times a day, having watery stools regularly, and lots of gas… Sounds terrible if that were you or me, but for most babies… all in a day’s digestive work.
-I guess that is why parents are so taken aback by these symptoms in their young children and feel that something must be wrong.
-Lets break down the spit up part in today’s pedcast…shall we

-If you have a baby handy, take a good look at them. What do you notice?
-How are they different from your older children or even yourself?
-Right, they are smaller and they are usually either laying or at best in a semi erect position.
-A babies stomach is only about 2 inches below their mouth…it is practically in their mouth.
-The other thing that you can’t see from the outside is that their stomachs are almost always filled with liquid food and a lot of air.
It takes about 3 hours for most babies to empty their stomachs and as soon as their little stomachs begin to empty, they demand to fill them right up again… hence always full.

-Ok, so we have a baby with only about 2 inches from the top of their stomach to their mouths, who is almost always laying down with a tummy full of milk and gas… Can you see why stomach contents are constantly being regurgitated into their throats or worse, your nice clothes?
– The only thing holding stomach contents in your infant’s stomach is their LES (lower esophageal sphincter) which is constantly opening to vent excess air from our stomachs and allow it to escape. Getting rid of air from their tummies is a good thing but unfortunately, with the air frequently comes liquid stomach contents…milk
-The same process is happening in older children and adults all the time.
The venting process is letting air escape into our throats, but the stomach contents only make it into the lower esophagus …and unless we have an inflamed esophagus, older children and adults are unaware of this process.
-Older children, usually older than a year of age along with adults are therefore actually “silent spitters” since they are unaware of this venting and regurgitation processes going on inside them almost constantly.
-But for babies, it’s a different matter… with only 2 inches to travel from their stomachs to their mouth, liquid not solid food in the tummy, and laying down to boot…the result is spit up, over and over and over.
-Shakespeare talked about the pukng babies so this is certainly not a new thing…it has nothing to do with modern life…its part of the baby experience.

-For most infants, the entire spitting up ordeal is a much bigger deal to their parents than for the baby. Most babies tolerate the stomach contents in their esophagus and throat without much problem. Doctors refer to these healthy babies as “Happy Spitters”
-That’s not to say that spitting can’t cause problems for babies… it certainly can.
-Some babies spit up so much that they get serious heartburn… others fail to gain weight… and some even choke on their stomach contents and aspirate them into their little lungs…that can’t be good.
-Additionally, lots of spitting may be an indication of a serious digestive disorder such as cow’s milk allergy, malformations of the intestines, liver disease etc etc.
-Your child’s doctor is always on the lookout for children where spitting is not the benign symptom it is in most children.
-If you are worried about your child‘s spitting, talk to their pediatrician.

-To minimize spitting, don’t forget to burp your child as often as every ounce of intake and hold them upright for a while after feeding to help their stomach’s empty in the right direction.
-For children with serious spitting issues, thickening feeds with cereal can be very helpful. Thick food doesn’t regurgitate nearly as easily as thin milk.
-But But But…the main thing is if your child is a happy spitter without the serious symptoms I mentioned earlier, just relax and wait for it to go away… which it almost always does by 1 year of age..

-So the next time you ruminate on why babies spit up so much, hopefully you will be able to regurgitate some of the reasons they do.
-Thanks again for joining me today.
-If you enjoy the DocSmo experience and find them useful, please take the time to make a comment on itunes or shoot a comment to the blog.
-I try and answer all relevant comments.
-And while you are at it, send your favorite DocSmo mp3 to a friend or relative. Go ahead, share the experience
-And don’t forget you can follow us on face book or twitter
-This is Dr Paul Smolen, continuing your free pediatric education, hoping you stay smitten even if your little baby keeps on a spittin.

Until next time.

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Food Allergy in Children (Pedcast)

Allergy to food is much more common than in years past.  In this Pedcast, Dr Smolen reviews some of the new information and recommendations about the introduction of allergenic foods to children.  After listening to this Pedcast, you should have a better understanding and recognition of food allergy.  Dr Smolen also makes practical suggestions should you have a child that suffers from food allergy.  Kick back, listen, and learn.

SmoNotes:

 

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1. Food Allergy: What You Need to Know: The High and Increasing Prevalence of Food Allergy

2. Food Allergy: The Definitive Guide to Clinical Practice: What Do the Guidelines Mean to Practitioners and Patients?

3. Food Allergy: What You Need to Know: Final Perspective and Clinical Recommendations
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What’s Up with all the Children with Allergies? (Pedcast)

The news is full of articles about allergy in children.  What is happening?  Is allergy more common today and why? In today’s pedcast, Dr. Smolen gives you some of his and other physician’s thoughts on the increasing frequency of allergy in today’s world.

 

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To my new listeners, thank you.

To my seasoned listeners, welcome back.

 

I was reading the Wall Street Journal of all place and having coffee with the Mrs..

I came across a report about an article in New England Medical Journal, which points out that farm life exposes children to far more microbes and this early exposure significantly reduces a child’s chance of asthma or eczema.

This observation is a big help to researchers since they are struggling to explain the obvious increase incidence of all allergic disorders, especially in children.

The subject of allergy is a hot, hot issue in medicine and one of the important questions when it comes to children’s health: why so much allergic disease???

I am not an allergist but I am someone who deals with matters of children’s health on a daily basis and I have the perspective of time to observe changes.

I therefore feel that I may have something to contribute to the discussion.

I thought it is important to make parents aware of some research that might have practical implications to their day-to-day lives.

So, lets get started with a our discussion of allergy. Let’s review some research I found interesting, and give you The DocSmo view of the allergy epidemic of the 20th and 21st centuries in the western world.

 

Somehow our bodies know what is us, and what is foreign.

Somehow our bodies figure out how to sort out what foreign things to react to and which to ignore.

Reacting to germs is an essential part of that process.  Particularly important for children.

A strong immune system is paramount to a child’s existence.  Their very survival depends on a functioning immune response.

From the beginning of mankind, the children who survived were those who could mount a targeted, brisk immune response to invasion.  A strong and targeted immune function was essential to survival.

Fast forward to modern times, when immunizations, clean water and food etc. have eliminated most of these threats to survival.

Today most children grow up in a very clean world, very different from his or her parents just a few generations ago.

Just because the germs are mostly gone doesn’t mean their bodies have forgotten what to do!  Could the kid’s immune system simply be bored?

Maybe since children don’t have to defend against as many microbes, they are having responses to more minor irritants.

 

What we call allergy is an inappropriate immune responses to things that children should be tolerant!

These immune responses are so critical to a child’s survival 200 years ago, but are now targeting nonsense threats like peanuts and grass pollen.

 

With that as background, let’s look at the numbers when it comes to allergic diseases…food allergy,. Asthma, eczema, and allergic rhinitis (hay fever)  ESTIMATES vary widely.

Food allergy… up 400%

 

Asthma… up 1000%

Eczema ….up 300%

Hay fever …up 200 %

 

I was taught that these disorders are genetic, Either you get them or you don’t.

Certainly our genes haven’t changed radically in the past 100 years.

What is up?  Why is this happening?

Here are a few recent research studies that might shed some light on this question.

 

 

Lets go back in time a few decades when the Berlin wall in Germany was built.

One side Germans living the Western lifestyle, modern, wealthy, clean, artificial ventilation for both heat and cold, and all the other stuff that we enjoy today.

On the communist side were Germans living the lifestyle that existed in the late 19th century: dirty industry, primitive heating systems such as burning coal or wood, dirty air and water, and fairly ubiquitous poverty.

Fast-forward until the year 1989.  The wall comes down Mr. Gorbachov, tear this wall down.  Well, the people on both sides did just that.

Perfect natural experiment to look at the affect of environment on people.   Same genetic populations, living side-by-side…totally different environments.

What did researches find?  Rates of allergic disease (asthma, hay fever, eczema) were much higher on the clean side of the wall rather than the dirty.  The OPPOSITE of what you would have expected!  Maybe the West Germans were TOO clean.

 

Lets get back to that NEJM article this week. Children who are exposed to barns at an earlier age and more frequently have a significantly LOWER incidence of Asthma and eczema.

What’s going on in a barn: dirt, animal wastes and a lot of pollen, especially grass pollen.

Being exposed to dirt and germs , especially at a young age, seems to be protective when it comes to allergies.

The opposite of what was expected.

Again, maybe the city kids are too clean?

 

These observations and many others have led to what is called the Hygiene Hypothesis. A child’s immune responses and tolerance to the world are altered negatively by lack of exposure to dirt and germs early in life.

Could it be that western children are growing up in a world that is TOO clean and this is causing the rather precipitous rise in allergic disease seen especially in the past 50 years.

Maybe we are creating the problem of allergy by staying inside with artificial heat and cold so much, eating super clean water and food, sleeping on clean artificial bedding , constantly scrubbing dirt off as fast as it touches our children, our obsession with clean hands, not living with animals, and changing the natural grasses, trees and other vegetation in our constant quest to change the natural order around us.

Makes sense to me that if allergy shots can alter immune response and make us tolerant. So could natural exposure.

The answers are not in yet but we are beginning to get an understanding of the complexity of our immune system .

Stay tuned!

Question coming in;

 

Question:  Doc Smo, This is your friend Her Dieter from Germany. I have a question.  If I am hearing you right, you are saying that my little venarschnitzels are too clean, and that they need more time getting exposed to microbes, especially the kind found outside.  Is that right?

 

You got it.  Lot less allergic disease in those children who slop them pigs, shuck some corn, and spend time on the old farm.  The same is probably true for any child who spends a lot of time outside.

 

Question:  How do the experts feel about dogs and cats in the house.  Do they help or hurt allergic children?

 

Good question.  From my reading the answer is both.  Exposure to furry creatures like dogs and cats in the house in the first year of life seems to diminish the chance that a child will develop asthma.  On the other hand, exposure to animals such as dogs and cats in older, already allergic children often makes their allergic symptoms much worse.   I know that answer is as clear as mud but that’s the best I have.

 

Question:  Is the same thing true for food allergy?  I thought early exposure was bad! Is there a way to keep my little snitzels from being allergic to certain food?

 

That is a subject for an entirely different Pedcast but let’s just say that avoiding early exposure to very allergenic foods have not reduce the incidence of food allergy.

The truth is, We just don’t know the best age to introduce allergenic foods

We do know that breastfeeding reduces allergic disease especially eczema

(In fact, in another natural experiment with peanut exposure…conclusion was early exposure is preferable!)

 

Summary- “When it comes to Allergy”

Early experiences change the way our immune system develops.

New research indicates that early exposure to a variety and high quantity of germs lessens the chance of allergic disease, if the exposure is done early!

-Growing up in a too clean environment may harm a child’s health.

Her are some steps parents can take that might help reduce allergic disease in their children.

Breastfeeding as long as possible.

Get your children outside as often as you can.

Turn of the A/C and heat whenever possible and open those windows.

Hand hygiene is really important when your children are spending lots of indoor time with other kids but not when they are at the park. Outdoor dirt won’t hurt.  Calm down about outside dirt.

When it comes to allergy, furry pets in the house seem to be harmful to older already allergic children but may, and I emphasis may actually be of benefit to very young non-allergic children.

Allergies are probably similar to other biologic phenomena—a complex interaction of genetics and environment.  Back to that nature /nuture question-again

 

Hope you enjoyed that discussion

Please feel free to make comments on iTunes or Face book are welcome

Invite your friends to subscribe.

If you are a medical professional and would like to send comments-highlight on blog

More reading can be found in SmoNotes

 

Dr Paul Smolen, broadcasting from studio 1 E, Queen City, Charlotte, NC

Hoping your children get just the right amount of dirt on their toes and pollen in their nose

 

 

Until next time.

SmoNotes:

1.

NICOLAI, T.. “Epidemiology of Pollution-induced Airway Disease: Urban/rural Differences in East and West Germany.”
Allergy : European Journal of Allergy and Clinical Immunology 52.38 (1997): 26-29. Web. 10 Mar. 2011.
<http://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.1997.tb04866.x/abstract>.

2.

Ring, J. et al “Environmental Risk Factors for Respiratory and Skin Atopy: Results from Epidemiological Studies in Former East and West Germany.” International Archives of Allergy and Immunology 118.2-4 (1999): 403-407. Web. 10 Mar. 2011. <

3.

Bacharier, Leonard B., and Robert C. Strunk “Pets and Childhood Asthma—How Should the Pediatrician Respond to New Information That Pets May Prevent Asthma?” Official Journal of the American Academy of Pediatrics 112.4 (2003): 974-976. Web. 10 Mar. 2011. <http://pediatrics.aappublications.org/cgi/content/full/112/4/974>.

4.

Wang, Shirley S. “Greater Germ Exposure Cuts Asthma Risk.” Wall Street Journal 23 Feb. 2011: 1A. Web. 10 Mar. 2011 <

5.

Greer, Frank R., Scott H. Sicherer, and Wesley Burks “Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas.” American Academy of Pediatrics 121.1 (2008): 183-191. Web. 10 Mar. 2011. <

6.

Toit, G. et al “Different Prevalence of Peanut Allergy in Children in Israel and UK Is Not due to Differences in Atopy.” Allergy and Clinical Immunology 117.2 (2006): S33. Web. 10 Mar. 2011. <http://www.jacionline.org/article/S0091-6749(05)02857-5/fulltext>.

7.

Ege, Markus J. et al “Exposure to Environmental Microorganisms and Childhood Asthma.” New England Journal of Medicine364.1 (2011): 701-709. Web. 10 Mar. 2011. <http://www.nejm.org/doi/full/10.1056/NEJMoa1007302>.

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*By listening to this pedcast, you are agreeing to Doc Smo’s terms and conditions.

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