Early in my career as a medical writer, a few years after I returned from the United States, I began to answer letters sent to the magazine Io e il mio Bambino [My baby and me]. These letters were often written by despairing mothers asking for advice. After a couple of years doing this job, I analysed the hundreds of requests I had received by that time and realized that the great majority concerned one specific problem:

 “My child won’t sleep”

My second finding was that the period when all these children were unable to sleep was usually limited to the first two and a half years of life. I rarely received letters from the parents of older children with the same problem. My subsequent experience allowed me to get to the bottom of the statistics. I realized that 90 per cent of sleep disorders in younger children are linked to gastroesophageal reflux and the problem tails off after two years of age because the reflux also diminishes significantly at this age. However, a good proportion of children continue to exhibit reflux symptoms well beyond this limit and some are even destined to have the problem into adulthood. After the age of two, the situation nevertheless changes in such a way that the problem risks going undetected and untreated even though the circumstances mean it continues to cause great discomfort. Let’s look at why this happens.

Halitosis

Because reflux was little-known at the beginning of my career, I didn’t realize that my daughter’s bad breath was one of its most telling signs. So, I forced her to clean her teeth three times a day, but to little avail.

Recurrent stomach-ache

After two years of age, children begin to be able to describe the pain they experience from time to time as “stomach-ache”. They touch themselves in the epigastric area, immediately below the ribs. The pain mainly makes itself felt early in the morning or a couple of hours after breakfast and then comes and goes without following any particular pattern.

Refusal to eat breakfast

This habit is due to nausea and a sensation that the stomach entrance is closed. This is linked to the fact that reflux gets worse at night when gastric acid can come back up more easily due to lying horizontally.  

Poor appetite

I have found that poor appetite coincides with periods when the condition is more active.  A word of caution:  this will not cause malnutrition or stunted growth because children always make up for it on days (or at the times of day) when they feel better.

Vagal hyperstimulation episodes

These are spells when the child almost seems to faint. They occur in direct proportion to the number of episodes experienced previously. One day, a five-year old patient of mine named Pietro scared his parents so much with one of these near-fainting episodes that he ended up in hospital and underwent a round of testing by cardiologists and neurologists, who found nothing abnormal. In this case too, as I regularly see happen, his parents had underestimated his reflux and stopped treating him for a few months, thinking (or hoping) that the condition had permanently cleared up.

Cough and laryngospasm and/or bronchospasm

Remember that, as with younger children, once children have passed their second birthday, there is a close relationship between coughing caused by respiratory infections and exacerbation of the reflux. Many children with reflux may experience episodes of bronchospasm, when they struggle to breath and make a wheezy sound on the out-breath as though they were having an asthma attack, or laryngospasm, when their cough sounds like a seal bark and their breathing is very raucous.

Vomiting with blood

If the esophagitis has been neglected for a long time, ulceration may develop. This may bleed and cause vomiting with blood. Fortunately, the symptom is so rare in children that I’ve never even seen one case.

Constipation 

The problem of constipation culminates at around the age of two and often leads children to retain their stools to avoid the pain of straining. Children can go for several days without going to the toilet and from time to time they twist around trying as best they can to resist the stimulus for fear of causing the pain they felt while moving their bowels. The anus may be affected by small tears known as fissures due to passing hard, bulky stools and these only add to the problem. The resulting vicious cycle risks going on indefinitely. As I already explained in the case of younger children, effective treatment of reflux usually puts paid to this problem as well. Otherwise, I advise administering lactulose or macrogol (two or three desertspoonfuls daily) for a few months. These substances soften the stools and make them much easier to pass. As time goes on, the vicious cycle described is permanently broken.

Quality of sleep and dreams

The most evident sleep disturbances, when children wake up crying and calling for their parents to pick them up and comfort them, tend to disappear at this stage. However, if the child still has significant reflux after this age, bedtime may be somewhat disturbed by acid coming up and interrupting sleep patterns.

Example: at about three years of age, my daughter began to experience episodes when she sat up in bed, often with her eyes open, but in a state of sleeping wakefulness during which it was clear that she was in the grip of a nightmare. She sometimes even sleepwalked. All these effects are referred to as parasomnias and attributed to psychological disorders that are not properly identified. In my experience, these very distressing experiences are usually linked with the sensation of choking caused by acid coming back up. Children who experience such nightmares frequently are often scared of going to bed in the evening and suffer from anxiety and melancholia.

This video will help you understand the meaning of the baby’s symptoms and reactions

https://youtu.be/NDXoHvVVHRE