Reflux Look Alikes.
A pattern of symptoms often suggests a diagnosis or disease. Vomiting and crying after feeding are often associated with pediatric gastroesophageal reflux disease (GERD). On the other hand, vomiting and crying are also symptoms of some food allergies, Milk Soy Protein Intolerance (MSPI), Pyloric Stenosis and Eosinophilic Esophagitis. Vomiting and crying are also associated with an acute illness or infection such as an ear infection. While a list of common symptoms may be helpful in identifying a disease, there are many other factors to consider too.
A concerned mom contacted me recently about her toddler Maddie. During infancy, Maddie was treated for GERD and struggled with feeding during the first year of life. Things were really looking up as she progressed to toddler foods and the reflux medication was no longer needed. Just recently, at 2.5 years of age, she suddenly stopped eating food and only wanted to take sips of liquids. She would sometimes hold food in her mouth and then spit it out rather than swallow it. Of course the mother and I were both concerned about a possible reoccurrence of the reflux. I encouraged the mother to contact the doctor for a diagnosis.
The mother sent me an update a few days later, “[The day before the doctor’s appointment], my daughter told me her mouth hurt. I looked and found that she had what looked like a cold sore so I called the doctor's office and explained the symptoms. After speaking with the nurse, we assume she has been fighting off a virus and that is why she hasn't been eating...due to the sores in her mouth and possibly not feeling well. Today was a new day for her. I gave her the (medication) mix to help coat her throat on Saturday and Sunday and since then she has begun eating better. Let's hope her bout with the virus is over. I cannot imagine going back to the reflux days of crying, tantrums, and meltdowns and I truly thought that's where I was headed.” Mystery solved. While her symptoms of feeding difficulties were suggestive of GERD, a common virus caused her food refusal.
Another mom was distressed that her toddler was making slow progress in a feeding clinic despite intensive work and the use of several types of GERD medication. At a routine follow up appointment with the Pediatric Gastroenterologist, the doctor determined that her son did not have GERD and instructed the mother to stop attending the clinic, take her son off all medication and let him explore food and enjoy eating. Of course the mother was skeptical that this would work but she agreed to try it. She wrote to me a few weeks later to report that her son exhibits no signs of GERD and it eating more and more each week. She gives him a nutritional drink and lets him select typical toddler table foods.
Heartburn and chest pain are often associated with adult GERD but these symptoms are also associated with a heart attack. Many adults go to the emergency department of the local hospital due to severe chest pain and discomfort. After having a cardiac work up and finding no evidence of a heart attack, the typical treatment is a prescription for acid suppression medication for GERD.
While it may be tempting for patients and their families to use the internet to self diagnose a medical condition, it is still vital to go to the doctor for a medical exam, review of the symptoms and testing if needed. Patients play a vital role in observing patterns at home, recording symptoms to help the doctor diagnose and treat the problem.