> Diagnosis


For a diagnosis to be made, a baby or child’s healthcare provider will usually carry out a physical exam and take a health history.


Other tests may include: •


A chest x-ray. This checks for signs that the contents of the stomach have moved into the lungs. • An upper gastrointestinal (GI) series or barium swallow checks the esophagus, the stomach, and the first part of the small intestine (duodenum). The test involves the child swallowing a metallic fluid called barium, which coats the organs so that they can be seen on an x-ray. Then x-rays are taken to check for signs of sores or ulcers, or abnormal blockages. •


An endoscopy involves a small, flexible tube called an endoscope, which has a light and a camera lens at the end, being inserted into the inside of part of the digestive tract. • An esophageal manometry is a test, which checks the strength of the esophagus muscles to see a baby or child has any problems with reflux or swallowing. The test – which involves a small tube being put firstly into the child’s nostril, then down the throat and into the esophagus - measures the pressure that the esophageal muscles make at rest. • pH monitoring checks the pH or acid level in the esophagus. Again, a thin, plastic tube with a sensor that measures the pH level is placed into the child’s nostril, down the throat, and into the esophagus. The other end of the tube outside the child’s body is attached to a small monitor and this records the child’s pH levels for 24 to 48 hours.


Treatment


The treatment of GERD depends on both a child’s symptoms, age, and general health and also on the severity of their condition. In many cases, diet and lifestyle changes can help to ease GERD in babies or young children.


It can help, for example, if a baby is held in an upright position for 30 minutes following feedings. It can also help if a baby’s bottle has a nipple that doesn’t allow the baby to swallow too much air while eating.


For children: • Watch your child's food intake. Limit fried and fatty foods, peppermint, chocolate, drinks with


38 - SCOTTISH PHARMACIST


caffeine such as sodas and tea, citrus fruit and juices, and tomato products. • Offer your child smaller portions at mealtimes. Add small snacks between meals if your child is hungry. Don’t let your child overeat. Let your child tell you when he or she is hungry or full. •


If your child is overweight, contact your child’s provider to set weight- loss goals. • Serve the evening meal early, at least three hours before bedtime. Medicines and other treatments Fortunately, there are a range of medicines that can help to reduce the amount of acid the stomach makes and consequently reduce the heartburn linked to reflux. These medicines may include: •


Common ailments in children Colic


H2-blockers reduce the amount of acid the stomach makes by blocking the hormone histamine, which helps to make acid. •


Proton pump inhibitors help keep the stomach from making acid by stopping the stomach's acid pump from working.


Tube feedings


For some babies tube feeding may be recommended. This involves formula or breastmilk given through a tube – called a nasogastric tube - that is placed in the nose. The tube is then put through the food pipe or esophagus and into the stomach.


Tube feeding can be done instead of bottle feeding or given in addition to bottle feeding. There are also tubes called nasoduodenal tubes that can be used to go around, or bypass, the stomach.


Surgery


In very severe cases of reflux, such as in cases where a child is not gaining weight because of vomiting, surgery called fundoplication may be carried out. This is often done as a laparoscopic surgery where small cuts or incisions are made in a child’s abdomen. A small tube with a camera on the end is then placed into one of the incisions to look inside and surgical tools are put through the other incisions. A surgeon will then look at a video screen to observe the stomach and other organs and will then wrap the top part of the stomach around the esophagus, creating a tight band, which strengthens the LES and greatly decreases reflux.


Colic is a very common condition, which tends to appear at around two to four weeks of age and can last for three months – or longer in some cases. The key symptoms of this distressing condition include loud crying, often for two or three hours, pulling feet up under the body and clenching fists. Babies with colic can sometimes be soothed by being rocked in a cradle, being taken for a drive in the car, wrapped up tightly in a blanket, or by having their stomachs gently massage. If these measures don't work, then anti-colic drops should be suggested.


Eczema


It’s estimated that up to a fifth of all children will suffer from eczema at some stage in their lives, In babies, atopic eczema first presents as a rash on the cheeks. In many cases it will then spread to the face, neck and nappy area, but can also appear on the arms and legs. In toddlers, the rash is usually concentrated in the skin folds on the backs of the knees and on the wrists and ankles. The skin in these areas then becomes dry, flaky and inflamed and, in very severe cases, will become raw and broken. For this reason, good hygiene and regular cleaning of the area is essential to ensure that it does not become infected.


Topical corticosteroids – also known as steroid creams – are commonly used to treat eczema. These are called ‘topical’ because they are applied directly to the affected area of the skin.


Doctors usually prescribe steroid creams to relieve inflammation, and anti- histamines and antibiotics to control the itching and possible infection.


Obviously one of the key factors in treating your child’s eczema is to keep his or her skin as moisturised as possible. An excellent range of aqueous creams and emollients, which are available from pharmacists, will help to fight the itch, replenish the oils in your child’s skin and provide a barrier against irritating substances.


Rosacea


While rosacea is relatively rare in children, it can occur if a child frequently has: • Red and/or irritated eyes • Styes or conjunctivitis • Red, swollen eyelids that itch and which may have a greasy or crusty appearance


• Long-lasting flushing on the face


If left untreated, the long-lasting flushing aspect of rosacea can lead to permanent redness in the middle of the face. When rosacea affects the eyes, a child may be regularly affected by styes and conjunctivitis. This is often a warning sign of ocular rosacea, a condition which is often missed in children.


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