November 2023 Pediatrics Newsletter

“As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them” – John Fitzgerald Kennedy

Hi all! For those that are new to the newsletter, my name is Ashley Stone. I am the Pediatric Program Manager and a Speech Language Pathologist at DiagnosTEX. Our outpatient Modified Barium Swallow Study clinic is now open for pediatric patients of all ages! We have supported seating devices for those in need and have the capability to also complete studies in a side-lying position. We accept most insurances. Contact me for more information on how to make a referral. My contact information is at the bottom of this newsletter.

Insurance

We have gotten notification that we will be presented to the board at Cook Children’s to become in in-network provider with their Medicaid program. This is the last step before approval. Pray that all goes well, as we started the process of becoming an in-network provider in June 2022. We have had several families with Cook Medicaid go ahead and schedule with us in hopes we become in-network. If your families are open to that, please continue sending the referrals. Stay
tuned for an update!

Let’s talk about Spit Up

This is such a hot topic amongst parents & physicians. Let’s start with the ‘WHY’ behind it all ...

Anatomy – We all have 1 sphincter at the top of our esophagus (Upper Esophageal Sphincter, UES) & one at the bottom of our esophagus (Lower Esophageal Sphincter, LES). These sphincters relax (open) briefly to allow food to pass through but should contract (close), and remained closed until the next swallow. The LES is responsible for closing off the stomach from the esophagus to prevent food from coming back up the esophagus. However, if there is enough pressure within the esophagus from the stomach contents, the UES will relax & allow the stomach contents to be expelled from the oral cavity.
Movement - Babies are on the move, whether in a bouncer, on the floor, or being passed around the room to those that want to hold the baby. The Upper & Lower Esophageal Sphincters may relax with any sort of physical stimulation, which causes the contents of the stomach to “reflux” back up the esophagus & out the mouth, especially right after a feeding. This is normal as their sphincters are not fully developed yet. We all know that sometimes babies spit up even without movement following a feed. This is also still typical for babies, as long as it is not frequently large in volume.

What to do about it ...

First and foremost, the parents should always speak to their child’s physician prior to changing anything and to voice their concerns.
Do not alter their sleeping position. Sleeping on their back is still the recommendation by the American Academy of Pediatrics, even when there is reflux present. However, if the parent is able to keep eyes on the baby following their feeding, the research has proven that left side-lying or prone position decrease the amount of “spit up”. If the parent is going to be pre-occupied, then always place the baby in a safe resting position (i.e. bouncer, on their back, etc).
Limit activity 20-30 minutes following each feeding.
Burp frequently during feeding.Consider altering formula/breastmilk. Again, a parent should always consult a physician first, but the baby may have a sensitivity or allergy towards something in the formula or their mom’s breast milk.
Oatmeal - Some physicians are still recommending oatmeal to thicken their formula in attempt to decrease reflux. However, oatmeal may make the baby feel “full” faster, which may lead to a decrease in volume intake. They may not necessarily lose weight if their volume decreases because the oatmeal is adding extra calories. Parents do have to make sure the baby is still consuming enough to maintain hydration, which may become a concern if volume decreases. Another thing to consider here is that oatmeal does not mix well with breastmilk. The enzymes in the breast milk will break down the oatmeal, which makes it ineffective in thickening. Some physicians will also recommend a ‘cross-cut’ or ‘y-cut’ nipple, which drastically increases the flow rate of the formula/breastmilk. This could lead to aspiration as the baby’s swallowing mechanisms are not mature enough for that fast of a flow. For these reasons, I am not a fan of this method to combat reflux. However, I also recognize that each family and physician are making an informed decision together and may have exhausted all other options.
Medications – The research and data surrounding reflux medications for babies is mixed. It is best for each family to discuss this option with the physician and do their own research.

Dysphagia Needs “Closet”

Do you have new feeding supplies that you no longer need? Would you like to donate new, unopened thickener? Do you know a family that gets an excess of supplies from insurance? I am hoping to help families with the financial burden of taking care of all the needs that come with a child who has dysphagia. The most costly need for families is thickener, which insurance does not often cover. I have already been able to provide tubs of GelMix to families following their MBSS thanks to a family who donated their unopened thickener. If you are interested in donating supplies or thickener, please reach out to me.

Contribution

Do you have an interesting topic that you would like to share in a newsletter, whether it be a research article you have read or a patient you have treated? Email me if you are interested! I, and the rest of the DiagnosTEX staff, look forward to helping you serve your patients and ensure a safe diet for ALL children.

Keep an eye out for a newsletter each month & feel free to share with your colleagues and friends!

I cannot end without saying ... LET’S GO RANGERS!!

Dates to Remember
November 5 – Daylight Savings Time Ends
November 11 – Veterans Day
November 17 – World Prematurity Day
November 23 – Thanksgiving Day