Hello I'm Dr. Robert Bastian of Laryngopedia and Bastian Voice Institute. I want to talk
about babies who can't burp and because they can't burp they are miserable. They have colic,
they spit up, some have projectile vomiting, and they're incredibly gassy. Sometimes they
cry for hours every night. Well why would I, a laryngologist who deals with adults,
I deal with voice, swallowing, airway, non-burping, and a special kind of cough
in adult populations, so why would I be talking about babies who can't burp? Well I'm having a
little bit of a public service kind of a feeling here, and the reason is that I have a very large
population of adult patients who can't burp and those adult patients also are miserable. They
have gurgling noises, they talk about bloating, some have abdominal distension, chest pressure,
they get painful hiccups, they get nausea after eating, and they have tremendous flatulence. So
those adult patients often know about their own infancy through their parents or sometimes their
parents accompany them and not all of them but a significant subset maybe 20-30%. There is a
history that when these adult patients that I'm dealing with were infants, they were miserable
then too. The parents say we couldn't get him to burp and they say they describe again those
issues of the colic, the projectile vomiting, the gassiness, the refusal to eat,
that kind of thing. And so my thought is, that maybe there are parents out there in the world
who's, who are dealing with babies right now who aren't burping and having all of
these kinds of symptoms, and just to hear this simple description might give them
a direction that they can pursue with their pediatricians. Well what do parents describe,
parents with these babies who can't burp? They (I'm being a little repetitive) but they'll say
things like, one mother said my son burped normally for about two weeks
and then stopped burping, and then she said i've never seen a baby as gassy as he became.
Another set of parents sitting with their teenage daughter, who was seeing me because of her adult
troubles, inability to burp, the father said to me, "Doctor, this is our third child. She is our
third child. If she had been our first child, she would have been our only child." Signifying how
extraordinarily distressing it was to deal with this baby who couldn't burp. I had a
father who said, "We got very concerned that my daughter (wasn't—a different
child) my daughter wasn't getting enough nutrition because every time we'd feed her,
20—30 minutes later she would throw up this huge amount of her formula or her milk."
And so he said we took to measuring carefully what she ate (I suppose they used a bottle and measured
carefully) and then he said, "We would wait with a cup or a bowl and try to catch what she then threw
up, and then we'd measure the difference to see was she keeping anything or was she throwing up
everything?" Well you can imagine how stressful that would be for parents. What would I do if I
were you and a parent of a little baby who can't burp and as having all of this other GI distress?
Well I might go to the internet, type into your browser two words, BASTIAN BELCH. Up comes an
article, my original article, describing in detail this discovery. This is a discovery about
Retrograde Cricopharyngeus Dysfunction, a disorder of the upper esophageal sphincter. It's like a
gate right here that won't let go. Let's go fine in the anterior direction, so when babies swallow
and adults swallow, the sphincter lets go and then it clamps shut on the back side. But it won't
let go in the reverse direction, and therein is the problem so it's a retrograde—reverse
direction—cricopharyngis muscle —that's the name of the sphincter here —dysfunction. So go to your
browser, type in BASTIAN BELCH. That will bring up my original article on 51 patients where I
proposed the discovery and fully described the scenario in adults. So get to understand it
in adults, and then kind of extrapolate backwards to your infant.Then I might take
that article into your pediatrician and say, "Is this a potential explanation for why our
child is in such terrible distress?" Now you will read in that article that the solution in adults
is to place a small amount of botox into that sphincter muscle, and it's remarkably helpful.
It basically resolves this terrible problem in adults. A very high level of success.
So you think, as I do, how horrifying to think of putting botox into that sphincter in a tiny
baby. Well, it's horrifying at first thought, but hold over against that sort of horrifying
feeling the parent who is kind of on the ledge and they're just beside themselves,
with this tiny baby. You put those two things together and my prediction is that someday,
somewhere, there will be a pediatric otolaryngologist who will,
with much input from pediatricians and parents and all sorts of preparation and all kinds of
thought and all kinds of monitoring, there would be a lot of monitoring afterwards,
but there's somewhere somebody is going to do this because of the terrible distress. It's hard to
exaggerate the extreme distress both baby and parents can be in with this sort of disorder. So
I'll wait to see if that kind of thing happens, and in the meantime,
please be encouraged if you have one of these very difficult babies
and talk it over with your pediatrician and talk it over with a second pediatrician and, you know,
raising babies is strenuous, so we're not talking about the normal issues lots of babies are,
you know, it's a struggle it's a lot of work as I know from having raised babies, but
I'm talking about that special circumstance of extreme difficulty. Well thank you for
listening and all the best as you work towards a solution to your baby's problem!