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Reflux: An interview with Pediatrician Tina Feeley

Hi, today we’re talking
to Dr. Tina Feeley. She’s a Board Certified Pediatrician for the American Board of Pediatrics. Currently, she is practicing as a General Pediatrician in Virginia. She did her undergraduate
degree at Boston College and then went on to
Dartmouth where she received a Master’s in Public Health
from the Dartmouth Institute for Health Policy and Clinical Practice. She then went on to medical
school at Rutgers University at the Robert Wood Johnson Medical School where she graduated with honors. She completed her pediatrics residency at the Children’s Hospital
of The King’s Daughters in Norfolk in Virginia,
and she lives in Virginia with her husband and her daughter. Today’s topic that we’re talking
to Dr. Tina Feeley about, is reflux. Welcome Tina. First of all, can you just walk us through your motherhood journey. Was it easy for you, or was it difficult? Can you tell us a little bit about that? Tina: Oh yeah, absolutely. So, in terms of my motherhood journey, I was a Pediatrician and
I graduated residency prior to becoming a mom,
and my husband and I are actually both Pediatricians. So, I think we both knew what
we were getting ourselves into in terms of, you know, babies
waking up every two hours to feed, and that our life
was gonna change a lot. But I think that even being
two people who arguably, are more qualified to have
children than you could imagine, I don’t think anything truly
prepares you to become a mom. Or a dad in that case for him. But especially the sleep
thing was honestly, the biggest kind of struggle,
because our daughter did not sleep for more
than 45 minutes at a time for about two months, and
it really got to be draining and feeling like am I really
gonna be able to do this? Even as a Pediatrician, so… But you know, the joys of motherhood have just been something that
I could’ve never imagined being this happy or having so
many highs at the same time. But it definitely was not as
easy as I thought it would be, even being someone who
knew that it was gonna be kind of difficult to begin with, too. Amanda: Yeah, I agree,
I don’t think anything can really prepare you
for what you’re in for after the birth, I think. Even, as you said, you’d
seen all of the things that can happen, but still,
nothing quite prepares yourself. Tina: You know in theory what
waking up every two hours is going to be like, or that someone, another human you’re solely responsible for all of their care, but I don’t think you truly understand what it
is until you’re living it. It’s been a great experience overall. Despite the initial shock. Amanda: Yeah, that’s right. So being a Pediatrician, what are the most commonly dealt-with issues
that you come across? Tina: So I’d say, the biggest questions that parents have when
they come in to see me, one is definitely involving sleep. How much sleep should
their baby be sleeping? How strategies to get them to
sleep, and things like that. Then other one is definitely feeding? So in terms of what to
feed, how much to feed, how much the baby should be taking or a child should be eating? And then, also about
growth and development. So, what should the child
be doing at that age versus what they are doing. Is what they’re doing
normal, is it not normal? So, I think those are probably
the three major things. And then obviously, I
see the everyday colds and asthma and things like that. But in terms of the
questions that parents have, it’s usually regarding sleep, feeding, and growth and development. Amanda: Right, so
talking about reflux now. We know some babies can
be maybe misdiagnosed or diagnosed with
reflux, when potentially, they’re actually overtired
or maybe undertired. Can you talk me a little bit through that, and do you see this yourself? Tina: I think so, I don’t know necessarily that it’s that they’re
overtired or undertired, but I think the main things
with children with reflux, and babies who are overtired
and babies who are undertired, is they all are kind of a little fussy. And reflux is one of those
things that almost all babies do, especially in the first
three months of life. Just the nature of how the baby’s anatomy is. So, the esophagus, which brings the food from your mouth to your
stomach, and your stomach has, in adults, a sphincter
which is like a valve which keeps food in your stomach and
keeps it from coming back up. But babies, it’s not really
developed until later. So almost all babies, it’s
just kind of an open tube between their mouth and their
stomach and they’ll reflux. So a lot of fussy
babies, because they are, their parents will notice
that they’re refluxing, or notice that they’re spitting up a lot, they kind of associate
that with the reflux, even though it might not
actually be the reflux. It might be that they are
fussy for another reason. It might be that they’re overtired. It might be that they’re undertired. But because this is something
that’s happening all day, every day, for the majority of babies, I think that’s something that people often attribute to a fussy child. Amanda:I guess it’s also whether the reflux itself, is actually causing… After the spitting up,
is actually causing pain, or if they’re just spitting
up and then they’re going on about their life as a
happy, little baby, as well. Tina: Exactly, exactly, so I
think sometimes parents will attribute what they’re seeing,
and what they’re seeing is the act of them spitting
up, even though that’s actually not what’s causing them
to be fussy at all. It could be something
else that’s going on, such as being overtired,
undertired or something else. Amanda: Exactly, that’s really good. So, what are the key symptoms that people or parents should be
looking out for with reflux? And when should they seek
some professional help, or when should they come and see you? Tina: Yeah, I mean, I
would say in general, if you ever have a
concern about your baby, go to your doctor. So, there’s never
anything that I would say is not worthy to come to
me and ask a question. We get all sorts of questions. And even if I tell you
that everything is normal, that’s okay, that’s worth my time. But in terms of reflux that
would be causing an issue for the baby, so it is causing pains, some of the signs of
that, it’s an emergency if the reflux or spit
up is ever red or green. So that means there’s either
blood in it or bile in it and that is always an emergency, you should go straight
to the emergency room. If the spit up is projectile
after every single feed, so what I mean by that is
it’s literally shooting across the room with every single feed, then that’s a concern that
you should definitely go straight to the emergency room for too, ’cause you don’t want your
baby to get dehydrated or see if other things are going on. And then in terms of the spit
up that’s not necessarily an emergency, but you
need to talk to your, you should talk to your
pediatrician or your doctor about are things where you’re
noticing that your baby isn’t feeding well, or they’re
refusing their bottles, or they’re spitting up and
seeming like they’re in pain while they spit up at the
same time, that would all be something that is a sign that
it’s more than just spit up. Amanda: Yeah, definitely. Myself, I was a projectile baby and I used to apparently, hit
the other side of the room. Tina: Oh gosh. It could be disconcerting,
especially for parents. A lot of times parents
will come in and say, “Oh my goodness, but it’s
coming out of their nose!” And I’d say, well it’s actually normal. Everything is connected back there. So if it’s coming out of their nose, that’s not necessarily abnormal. But if it’s forceful
after every feed, it is. One thing that babies do,
especially when they’re in pain, is not only will they
cry when they spit up, but they’ll kind of do something,
they’ll arch their back, sometimes get really stiff. And it’s really concerning
to see ’cause sometimes it’ll even cause them to take up hollow breathing, and things like that. So if you ever see that,
then that’s definitely a reason to go to your
doctor and just seek help. But if your baby is spitting
up and what we call reflux, but it’s not reflux disease. But if they’re just spitting up, and you didn’t even
notice, they didn’t cry. You just happened to
look in their bassinet, and they have some spit up on their sheet, or something like that, that
they’re just living their life and totally happy, and
they’re feeding well and gaining weight and growing,
then it’s not something, generally, you need to worry about. But again, always talk to your
doctor or your pediatrician if you’re ever concerned about
anything your baby is doing. Amanda: Yep, definitely. So, how does reflux affect a baby’s sleep? Tina: So, reflux can affect
a baby’s sleep in that generally it’s going to be
worse when the baby’s laying flat on their back, so with that said, we always want a baby to
be flat on their back, on a separate firm sleep
surface for safe sleep, but when a baby has
reflux, that’s always going to be a position where
they can make the actual spit up worse, in that it’s coming up from the stomach to the
mouth because they’re laying flat on their back and
they’re not having gravity help keep it in their stomach. So, one thing that we always recommend that parents do is, after
they feed their baby, if they do have a baby with reflux and the spit up is hurting them, to make sure they burp their baby in between their feeds,
so if they’re nursing, between each breast to burp their baby, or if they’re bottle feeding,
after ever ounce or two to burp them, and then
to actually sit them up and hold them up for about
30 minutes after the feed, and that can oftentimes help. So that way by the time
you put the baby back on their back on their
firm, flat sleep surface for their safe sleep, that
at least they’ve kind of digested some of the milk a little more so it won’t be coming right back up. But we still always emphasize safe sleep so that they’re sleeping, you know, on their back on a separate sleep surface, ’cause we don’t want
them sleeping inclined or in an unsafe position,
for the reflux itself. Amanda: Right. And so if a baby is diagnosed with reflux, that is needs to be medicated, how does the medication
work and what should parents expect to see as a result? Tina: In terms of the
medicine, there’s two different types of medicine, but they both act against the acid part of the reflux. So, it is not going to stop the reflux from happening because reflux is really just spit up, and you still don’t have that valve between the
esophagus and the stomach to keep the food in the stomach. The food’s still gonna come up, the milk’s still gonna
come up and go down, and come up, and go down, but, what the medicines do
is they prevent the acid so that it make it less painful. Ideally they turn from
being a fussy infant with reflux to an infant with reflux that it doesn’t really bother them, is the goal. But the goal is not that
it will actually stop the reflux itself or the spit up, the goal is that it’ll actually just stop the pain associated with
it, so that they won’t be waking up and things like that. In terms of sleep I know
that a lot of parents it can be concerning
when their baby spits up because they say, “Well,
they’re gonna choke on it,” because they’re lying on their back, and then they spit up,
but actually it is safer for them to be on their
back then on their stomach because your food pipe
is behind your wind pipe, so your esophagus is behind your trachea, so actually when you’re
laying on your back you’re more likely to just re-swallow it, then going on their tummy. So that’s another thing for
parents to keep in mind, that it is actually still safer for them to be on their back,
even though they’re still going to be kind of spitting up throughout the night and everything. Amanda: Excellent. Well thank you so much, it’s
been really informative, and I hope that everyone’s
learnt something about reflux and head
to your doctor or GP, your pediatrician if
you have any questions. Thank you so much, Tina. Tina: Absolutely, thanks for having me.

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