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.