What to Expect the First Year (123 page)

What is it?
Also called celiac sprue or gluten-sensitive enteropathy, celiac disease is an autoimmune digestive disorder in which there is a sensitivity to gluten (found in wheat, rye, and barley). When the gluten comes in contact with the small bowel during digestion, it damages the small intestines and interferes with the absorption of nutrients from food. Celiac disease can begin anytime after foods containing gluten are introduced into a baby's diet, or anytime in childhood or adulthood.

There is a wide range of symptoms (and sometimes there aren't symptoms), but most infants and toddlers with celiac disease have stomach pain, diarrhealike stools (or less commonly, constipation) for more than a few weeks, a distended abdomen, and they fail to thrive. Occasionally, the only symptom is failure to thrive.

Some experts estimate that as many as 1 in 200 people have celiac disease, but many cases go undiagnosed. Since celiac disease is inherited, the odds are increased if either parent or any other siblings have the condition.

If you suspect your baby may be showing signs of celiac disease, ask the doctor about testing. A blood test can determine if your baby has increased levels of certain antibodies related to celiac disease. If the blood test is positive for the antibodies (or inconclusive), the doctor will likely want to take a biopsy of the small intestines via an endoscope through the mouth and stomach to check for damage to the villi, tiny fingerlike projections that line the wall of the intestines.

Management.
Once the diagnosis is confirmed, you'll have to keep your baby on a strict gluten-free diet. Foods with gluten include most grains, pasta, and cereal, and many processed foods. But baked goods and pasta made with rice, corn, soy, potato, or other gluten-free flours can easily replace the traditional grains. And happily, most supermarkets carry gluten-free products (check the label, and look for ones that are gluten-free but also whole grain). Plus, there are plenty of “regular” foods that easily fit into a gluten-free diet—like fruits and veggies, dairy, eggs, fish, meat, and poultry. There is some preliminary research that suggests probiotics could be beneficial in managing celiac disease.

You can get more information from the Children's Digestive Health and Nutrition Foundation (
cdhnf.org
), the Celiac Sprue Association (
csaceliacs.org
), and the Celiac Disease Foundation (
celiac.org
).

Prognosis.
The good news is that a gluten-free diet will keep your child symptom-free for life.

What is it?
First, here is what GERD isn't: GER. GER (gastroesophageal reflux) is just a fancy term for spitting up, something the majority of babies do during the first year. Most babies have some form of GER, and as long as it isn't associated with poor weight gain, pain, or other symptoms of GERD (see below), it's nothing to be concerned about.

GERD, on the other hand, is not normal, and it isn't nearly as common, though it's seen more often in premature infants. It is similar to heartburn (acid reflux) in adults. Normally during swallowing, the esophagus propels food or liquid down to the stomach by a series of squeezes. Once food has entered the stomach, it is mixed with acid to start digestion. When this mixing occurs, the circular band of muscles at the lower end of the esophagus becomes tight, keeping the food from backing up. In premature and some term infants, the junction between the stomach and esophagus is underdeveloped and sometimes relaxes when it should be tightening. This relaxation of the muscles allows the liquid and food to come back up. When the acid in the stomach backs up into the esophagus or even up to the back of the throat, it causes symptoms of GERD, which may include some or all of the following:

• Frequent spitting up or vomiting (sometimes forceful vomiting) and irritation of the esophagus

• Excessive drooling

• A gurgling, congested, or wheezing sound during feedings

• Sudden or inconsolable crying (usually due to severe pain) or more than usual fussiness

• Arching of the back during feeding (again, because of the pain)

• Erratic feeding patterns (baby refuses food, for instance, or eats or drinks constantly)

• Slow weight gain

GERD usually begins between 2 and 4 weeks of age and in some cases can last until age 1 or 2. Symptoms peak around 4 months and begin to subside around 7 months when the baby begins to sit upright and take more solid foods. GERD is usually much less severe in breastfed babies because breast milk is more easily and more quickly digested than formula.

Management.
Treatment is aimed not at curing the condition but at helping baby feel better until it's outgrown:

• Offer smaller amounts of breast milk, formula, or solid food more frequently, instead of feeding large amounts less often.

• If your baby is on formula, ask the doctor if a switch in formula might help.

• Give your little one probiotics. There are drops available, or mix powder into a bottle of breast milk, or if you're formula feeding, choose one with probiotics and/or mix probiotics in.

• Burp your baby frequently.

• If you can, prop your baby upright during feeding and for 1 to 2 hours after feedings. If your baby falls asleep after a feeding, be sure to prop up the crib mattress (put a pillow or two
under
the head of the mattress) so he or she can lie at an incline. Do not use any specially designed sleep positioners or wedges (even those designed for babies with GERD), since they are considered unsafe and a SIDS hazard.

• Avoid bouncing baby immediately after feedings.

• Try offering a pacifier after feedings since sucking often eases reflux.

Ask the doctor about medications that reduce stomach acid, that neutralize stomach acids, or that make digestion more efficient (such as Prevacid or Zantac). For cases that aren't helped with standard management, these meds are safe and are often helpful. Just keep in mind that because they may occasionally cause some side effects, they should be used only in diagnosed cases of GERD, not for ordinary spitting up (GER).

Prognosis.
The good news is that almost all babies with GERD will outgrow it. And once they do, it usually doesn't recur. Occasionally, reflux can continue into adulthood.

What is it?
There are many degrees of hearing impairment or hearing loss, and not all children with hearing loss are considered deaf. The child who is deaf has a profound hearing loss and cannot understand speech through hearing alone, even with the use of a hearing aid.

There are two main types of congenital hearing loss in young children:

• Conductive hearing loss. With this type of hearing loss, there may be an abnormality in the structure of the ear canal or there may be fluid in the middle ear (the space just beyond the eardrum). As a consequence, sound is not conducted efficiently through the ear canal and/or middle ear, making sound extremely low or inaudible.

• Sensorineural hearing loss. With this type of hearing loss, there is damage to the inner ear or to the nerve pathways from the inner ear to the brain. Usually present at birth, this type of hearing impairment is most often an inherited condition. It can also be caused by maternal infection before birth, or by certain medications taken by a mom-to-be.

Two to four out of 1,000 babies are born with some hearing loss each year. Some will have hearing loss in only one ear, some in both. Most newborns are given hearing tests in the hospital soon after birth. If your baby did not receive a hearing test as a newborn or if you suspect hearing loss now (even a child who “passed” the hearing test as an infant can develop hearing loss), speak to the pediatrician about getting a hearing test (see
box
). Since hearing deficits are more common among graduates of the neonatal intensive care unit (NICU), babies who were preemies should be screened more carefully.

Management.
It is important to diagnose a hearing loss early and to determine the level of impairment, which can range from mild to profound. Treatment of hearing loss, beginning as soon as a diagnosis is made, is very important to maximize your little one's future hearing and language development.

Treatment depends on the cause and may include:

• Hearing aids. If a hearing loss is due to a malformation of the middle or inner ear, hearing aids (which amplify sounds) may be able to restore hearing to normal (or almost normal) levels. Hearing aids can also help with some types of sensorineural hearing loss. There are many types of devices, and the type used will depend on your little one's age and the type of hearing loss.

• Surgery. Cochlear implants (electronic devices that are surgically placed in the bone behind the ear), possibly in conjunction with amplifying hearing aids, can make a huge difference by restoring hearing and vastly improving the ability of totally deaf children to learn spoken language. The earlier a child receives the cochlear implants (preferably between age 1 and age 3), the better.

• Education. An education program should be begun as soon as hearing loss is diagnosed, and may include teaching your little one to use devices that assist in learning to hear and/or
to speak; cued speech, in which a system of manual cues is used to supplement speech (or lip) reading; and a total communication program, which uses a combination of speech reading, signing, and finger spelling and may also emphasize listening skills and speech production. Speech and language therapy (as well as counseling and training for parents) will also be part of the education process. The pediatrician and hearing specialist can work together with you to help you find the program that best meets your child's needs. The doctor can also point you to state-administered Early Intervention programs that provide services free of charge.

Prognosis.
With proper proactive treatment, children with hearing impairments are likely to have completely fulfilling lives. Some may eventually hear and speak, while others (such as those with more profound impairment) will learn to communicate through signing. Whether a child with a hearing impairment is mainstreamed (that is, attends regular classes with hearing children) depends on the individual child, the programs that local schools offer, and the availability of special classes in speech and language development in the mainstream schools in your area.