I ended my prior installment asking a question, “Why is the esophagus inflamed if it’s not EoE?” Interestingly enough, this takes us back to the very beginning of this series. Remember how we discussed how chronic reflux, even when “silent”, could result in inflamed and enlarged adenoids, tonsils, and a sore and irritated throat? Well, the same thing is true for the esophagus. Chronic reflux can leave the esophagus very sore and “irritable” and as a consequence, certain foods and textures cause even more irritation and pain. The end result for our kids, is that they learn to avoid anything that makes their upper GI tract uncomfortable or painful when they eat and drink.
But what causes reflux? Interestingly, like lots of things in our bodies, there are a variety of reasons that people can have reflux. With that in mind, I’ll just touch on some of the more typical causes that we often see in our kids who are selective eaters.
As noted before, foods we are allergic to can cause reflux, and often the reflux is our first warning that we may have an undiagnosed allergy even if we have tested “negative” in prior tests. Why? Because not all foods will trigger as “allergic” with a typical skin-prick test, and instead require more extensive testing using a blood sample, so even though we have been told previously that our child is free from allergies, unless blood testing was done as well, we may not have the whole picture. For some children, the reason for the reflux has to do with their overall body “tone”. Muscle tone refers to the resting state of your muscles, ALL your muscles including those that are inside your body. This includes the muscle at the top of the opening to your stomach which allows food into your stomach and is then supposed to keep food and liquid there rather than allowing it to flow back out and up into the esophagus. Hence, for some “low tone kids” like those with Down’s syndrome, reflux is as a result of their specific physiology.
However, for many kiddos, the culprit is actually further downstream in the GI tract. Remember the pipe analogy I used earlier? Go back to visualizing your stomach and gut as a series of twisting pipes. What happens in your pipes at home when a big wad of hair and goo get stuck, blocking the passage? Depending on the age of your house, you may have things backing up in the toilet, in the basement (my parent’s downstairs shower was notorious for this!), or into the sink. Nothing gets through when the pipes are truly blocked, and if you pour something down or attempt to flush the toilet, often times things come back out in a nasty, explosive mess! Ultimately, it takes a plumber’s snake to finally get the clog cleared.
Now, apply that same concept to your child’s GI tract. If they are chronically constipated, then their “plumbing” is not emptying out regularly, resulting in gas, pressure, and overall discomfort. Sometimes with g-tube kids, parents will actually find that the stomach is not emptying between feedings, and this is specifically because quite frankly, the food has nowhere to go! But how do you know if and when a child is constipated? Google “Bristol stool chart” and take a look at the different forms in which poop can take. Yes, I know, it’s a bit gross, but if you’ve had any experience with your child’s diapers, you already recognize that their poop can range quite a bit in texture and color. One of the questions I often ask my families is, “Does your child’s poop look like rabbit pellets, or is it more like playdoh? Hard or soft? A lot or just a little smear?” All these questions help me to better understand whether or not the lower part of a child’s GI system may be negatively impacting what they are willing to put into the uppermost opening of their “plumbing”, their mouth! As adults, we know how bloated being constipated can be, and how it impacts our willingness to work out, move around, or eat a big meal, and it’s no different for our kids. No one wants to eat more than a little bit here and a little bit there when even eating the smallest amount leaves them feeling overstuffed and bloated. So how do we help?
Next up: our final installment or “Okay, so it may not be behavior but I now have absolutely no idea what to actually do with all of this new information! What are my next steps?”