This is a guest article by pediatric ENT specialist Dr. Russell A. Faust, who blogs at Ask the Boogor Doctor.

We adults with reflux know it as heartburn. Other symptoms include burping and sour taste. That sour taste is regurgitation of stomach contents to the back of the throat (yuk!).

It’s called gastro-esophageal reflux (GER), and more than 135 Million, or about 44% of Americans, have reflux at least every month.

Babies, Infants, Children

We know reflux in babies and infants as “spitting up,” and we can all recognize the spitty baby from the white curds on their chin.

Most of these babies will outgrow their reflux without harm, and without intervention. Most will never have symptoms.

A small minority of infants and children with reflux will experience symptoms. Symptoms of reflux in children can be stealthy. They almost never complain of heartburn. The symptoms that they experience are usually indirect – they cough, wheeze, have chronic throat-clearing, recurrent bronchitis, or chronic sinusitis.

This is when simple GER becomes GER Disease, or GERD.

What I wanted to review here today is a connection that does not seem intuitive – that between reflux and sinusitis.

How in the World Can Reflux Cause Sinusitis?

Similar to the link between reflux and ear infections, there are two schools of thought on this connection:

1. The first is based on a theory called the Unified Airway Model. This theory states that, because the upper aero-digestive tract is derived of the same lining, any inflammation occurring anywhere in that tract will stimulate the other areas also. Simply put, otitis can cause sinusitis, can cause asthma, etc. There is pretty good scientific support for this theory.
2. The second thought it that if reflux reaches the back of the throat and lining of the nose, the resulting inflammation and swelling can cause sinusitis. There is pretty good scientific support for this theory too:  studies have found gastric enzymes inside the middle ears (in cases of chronic otitis), or inside the sinuses (in cases of chronic sinusitis). This is pretty direct evidence that gastric contents has been regurgitated up to that level of the upper airway (not a pretty thought).

What is the Clinical Evidence for a Connection?

A study reported in 1999 (Bothwell) found that 89% of their pediatric candidates for sinus surgery were able to avoid surgery simply by treating for reflux.  89% avoided surgery!!

A study published one year later (Phipps) reported that 63% of children with chronic sinus disease had reflux, and that sinusitis improved in 79% of them when their reflux was treated.

That same year (2000), another group (Yellon) reported an even stronger correlation between reflux esophagitis and sinusitis:  When they looked at the esophagus (food swallowing tube leading to the stomach) they found inflammation of the esophagus (esophagitis) in 100% of the children with sinusitis. That is, in their study every child with sinusitis had reflux esophagitis.

These correlations do not prove that reflux causes these symptoms, but there is strong implication.

What Can You Do With This Information?

Other symptoms to raise suspicion for GERD include:

• Cough, worse at night
• Wheezing, worse at night
• Choking at night
• Stomach ache, worse in the morning
• Chronic throat-clearing, worse in the morning
• Recurrent bronchitis
• Recurrent and chronic sinusitis
• Failure to thrive (difficulty gaining weight)

If your little monkey has chronic sinusitis, or any of these other symptoms, reflux should be considered as a contributing factor. Improving, or even eliminating, the symptoms might simply be a matter of treating the reflux. It still amazes me that I “cure” asthma or sinusitis in my clinic when I recognize reflux as the major causative actor and treat it.

Ask your pediatrician or pediatric boogor doctor about it.

Finally, Jan Gambino’s book, Reflux 101, is a great place to start if you have questions reflux in your infant or child, and what you can to do about it.

Next month I am reviewing how we test for reflux, and treatment options for reflux (conventional and alternative), and I invite y’all to come visit.

Resources:

1. Nelson, Chen, Syniar, Christoffel. Prevalence of symptoms of gastroesophageal reflux in infancy. Archives of Pediatric and Adolescent Medicine 151: 569-72; 1997.
2. Stroh BC, Faust RA, Rimell FL: Results of Esophageal Biopsies Performed During Triple Endoscopy in the Pediatric Patient. Archives of Otolaryngology – Head and Neck Surgery, 124: 545-549; 1998.
3. Bothwell M, Parsons D, Talbot R, Barbero G, Wilder B. Outcome of reflux therapy on pediatric chronic sinusitis.  Otolaryngology-Head and Neck Surgery. Vol. 121(3): 255-262; 1999.
4. Phipps CD, Wood WE, Gibson WS, Cochran WJ. Gastroesophageal reflux contributing to chronic sinus disease in children. Archives of Otolaryngology-Head and Neck Surgery. Vol. 126: 831-836; 2000.
5. Yellon RF, Coticchia J, Dixit S. Esophageal biopsy for the diagnosis of gastroesophgeal reflux-associated otolaryngologic problems in children.  American Journal of Medicine. Vol. 108: 131s-138s; 2000.

©2010 Littlestomaks.com

This is a guest post by Jan Gambino, author of Reflux 101 and an expert in infant/toddler acid reflux, feeding disorders, special needs and parents education. She writes at RefluxMom.

Picky eating is common and often occurs during the toddler years. After the intense growth and the seemingly easy going attitude about eating and drinking during the first year, the average toddler will often have a slower rate of growth and become more opinionated about what she eats and when.

Picky Eating May Include

• Eating a limited variety of foods.
• Avoiding one or more food groups such as: dairy, vegetables or fruits.
• Craving Carbohydrates such as crackers, bread, pasta.
• Requesting a particular type of food (for example: a child who will only eat French Fries from the local fast food restaurant or Brand X frozen chicken nuggets from the food store).
• Showing displeasure or having a tantrum when a new food is presented.
• Crying or refusing to eat when the favored foods are not available.

For more information about this normal stage, read my previous post about coping with picky eating.

Beyond Picky

A few children have significant difficulty eating a variety of foods and these worrisome symptoms needs to be discussed with the doctor. If your child has many or all of the symptoms of picky eating plus any of the concerns listed below, it is time to schedule an appointment with the doctor.

Worrisome symptoms that need to be discussed with the doctor

• Slow weight gain.
• Weight loss.
• Extremely limited diet that may lack key nutrients.
• Tantrums, fussiness or crying at meals or when food is presented.
• Fearful about eating or when food is presented.
• Choking, coughing or gagging when food is presented or when eating.
• Immature feeding skills (for example: eating pureed food only beyond infancy).

A toddler may be picky or beyond picky like my daughter due to a medical condition such as gastroesophageal reflux disease (GERD). A food allergy, food intolerance or a digestive condition such as GERD, Celiac Disease, Lactose Intolerance or another condition may cause eating and digestion to feel uncomfortable or painful. A child may try to “fix” this problem by avoiding foods or food groups or even limiting intake. Other causes of extremely picky eating include: sensory issues (textures, temperatures and flavors cause discomfort) or an oral motor problem such as a swallowing disorder, aspiration or poor muscle tone. In addition, a learned pattern of eating or adapting to digestive discomfort may lead to behavioral issues. Sometimes a behavioral reaction to eating (turning away, crying) may occur due to an undiagnosed medical condition. It is always best to work with your child’s doctor to look at medical and behavioral causes of picky eating and developing a treatment plan together.

©2010 Littlestomaks.com

I got interested in reviewing this book by Jan Gambino when I connected with her on LinkedIn and she mentioned that some of the picky eating habits of toddlers may be due to gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD). This peeked my interest because in most cases we assume that picky eating is a behavioral problem. In some cases, the underlying reason may be physiological leading to a behavioral issue. Parents of infants and toddlers with GERD are probably already sensitized to that, but for a lot of other parents this may not be so obvious.

GER is defined as the backwashing of food from the stomach into the esophagus (food pipe) and throat during or after a meal. GERD, on the other hand, is considered to be symptoms or complications of gastroesophageal reflux. Clinical signs of GERD in children include vomiting, poor weight gain, dysphagia (difficulty swallowing), abdominal pain, esophagitis and respiratory disorders.

Overview

Jan has written this book out of a personal struggle with her youngest daughter’s severe asthma and reflux problem, which took a lot of time to diagnose, treat and control. She even calls herself a Reflux Mom! The wisdom of her personal experience and what she learned working with other parents can be clearly seen in this book. What I really liked about this book was the Question-Answer format in a lot of sections which directly addressed common concerns. It is full of practical tips and relevant comments from parents, yet it manages to cover a lot of ground on advanced medical topics and medications for GERD. Amazingly, Jan has been able to pack a lot of details in just over 250 pages!

10 things I learned from this book I did not know before

One way for me to evaluate a book is to step back and think about new actionable knowledge I gain by reading it. Luckily we did not face any major problems with reflux when our twins were still infants. There were a couple of incidents of forceful vomiting when we were introducing solids, but then we backed off, took it slow and avoided problem foods. In that way, this book gave me a lot of new information which I did not know before from personal experience. Here are 10 nuggets I gleaned from my reading:

1. Reflux (GER) is common in infants and babies and usually disappears in early toddler years. But GERD is a chronic condition which needs treatment.
2. There are several million children with GERD in the US.
3. Reflux can cause ear infections in babies.
4. Reflux can be triggered by food allergy.
5. Reflux is very common in children with autism.
6. Reflux during infancy can lead to picky eating in toddlers.
7. There is something called a silent reflux when food and acid from the stomach enters the esophagus but doesn’t come out as vomit. It can cause a lot of pain, irritation or discomfort to the child.
8. Some babies and children with reflux can even get overweight.
9. Colic and reflux can occur together but they are not the same.
10. Breast milk minimizes reflux since it is easy to digest.

What I wish this book had more of

Although this book is very well organized and there is a lot of useful information, it could use a few pictures or visuals to make its contents more appealing and not so dry. It is more of a personal preference as I am a very visual person. I like to see charts, graphs and tables to quickly understand the data. I also like pictures or photos to make it even more personal.

Recommendation

Here are a few reasons you may want to consider getting this book:

1. You would like to know more about reflux so you can be prepared to handle your baby’s needs and are not surprised by normal episodes of reflux.
2. You feel exhausted by excessive fussiness at feeding times, sleep issues and slower than expected weight gain and suspect that you need to see a doctor about these problems.
3. Your child has been diagnosed with GERD and you feel completely at a loss about how to care for him.
4. You feel isolated, constantly challenged, emotionally drained and feel you are not able to cope with the needs of your child with GERD.
5. You would like to learn more about tests, medications, surgery options and resources about GERD.

Overall, I give it a big thumbs up!

Visit RefluxMom.com for more information on GER, GERD and how to purchase this book.