Irritable babies: how research findings can help and reflux and irritability

In Western societies, about 10-15 per cent of parents seek professional help because their baby cries repeatedly, for prolonged amounts of time, without apparent reason. As well as distressing parents, this phenomenon is expensive for health services. Morris and colleagues, for instance, estimated that professional support for infant crying and sleeping problems in 1-12 week-old babies cost the UK National Health Service almost £66 million in 1997. A recent review of the paediatric literature by Gormally and Barr concluded that organic disturbances, including cow’s milk protein intolerance, account for less than 10 per cent of cases where persistent crying in 1-3 month old babies is the presenting condition. In contrast, there is extensive evidence that babies in general peak in their crying in the first three months of age. As a consequence, the crying is increasingly being viewed as normative, perhaps due to a neurodevelopment ‘shift’ which occurs at this age, while babies who cry a lot are considered to be at the far end of the normal distribution. ------------------------ Persistent infant distress is often presumed to have a gut cause and interventions usually involve digestion and feeding, such as weaning, formula changes, gripe waters, and colic mixtures. Infant irritability is commonly attributed to oesophagitis presumed to be caused by pathological gastroesophageal reflux (including ‘silent reflux’) and treatment with anti reflux medications has become popular, despite the lack of evidence about its efficacy. All infants reflux to some extent. Frequent or prolonged episodes of acid reflux may cause irritation or inflammation of the lower oesophagus that may have a role in infant irritability. The lack of empirical knowledge about the role of reflux in infant distress prompted a prospective research study of otherwise healthy infants admitted to RCH for investigation of persistent irritability. One aim of the study was to identify clinical predictors of pathological reflux. The other aim was to evaluate the effectiveness of anti reflux medications in infants who had mild to moderate (but still within the normal range) gastroesophageal reflux.