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Behaviors associated with onset of gastroesophageal reflux episodes in infants. Prospective study using split-screen
A P Feranchak1, S R Orenstein, J F Cohn
1Department of Pediatrics, Children's Hospital of Pittsburgh, PA 15213.
Insights
Infant behaviors like crying, regurgitation, yawning, and stretching are linked to gastroesophageal reflux episodes. These behaviors may trigger or result from reflux, suggesting complex infant reflux mechanisms.
Area of Science:
- Pediatric Gastroenterology
- Infant Health
- Clinical Observation
Background:
- Gastroesophageal reflux (GER) is common in infants.
- Identifying triggers and associated behaviors of GER episodes is crucial for understanding infant discomfort and developing management strategies.
Purpose of the Study:
- To systematically and prospectively identify behaviors associated with the onset of gastroesophageal reflux (GER) episodes in infants.
- To explore the temporal relationship between specific infant behaviors and GER events.
Main Methods:
- Prospective study of 10 infants (2-32 weeks old) using 2-hour intraluminal esophageal pH probe monitoring.
- Split-screen audiovisual recording and videotape analysis to correlate behaviors with reflux events.
- Statistical analysis to determine temporal associations between behaviors and reflux onset (P < .001 to < .05).
Main Results:
- Six behaviors significantly associated with reflux onset: discomfort (crying/frowning), emission (regurgitation/drooling/burping), yawning, stridor, stretching, and mouthing.
- Hiccuping, sneezing, and thumb-sucking were infrequent but associated in some infants.
- Coughing/gagging showed association in two patients.
- Temporal analysis suggested behaviors might cause reflux, and reflux might cause behaviors.
- A preceding 'quiet period' was observed in six infants.
Conclusions:
- Specific infant behaviors are closely linked to the onset of gastroesophageal reflux episodes.
- The bidirectional temporal relationship suggests complex pathophysiologic mechanisms requiring further investigation.
- Findings provide insights into infant reflux triggers and consequences.
Abstract:
To identify behaviors associated with the onset of gastroesophageal reflux episodes in infants both systematically and prospectively, each of 10 patients (aged 2 to 32 weeks) was studied during 2 hours of intraluminal esophageal pH probe monitoring, using a split-screen audiovisual recording technique. Videotape analysis of eight infants who had scoreable reflux events revealed six discrete behaviors closely associated temporally (P < .001 to < .05) with the onset of reflux events: "discomfort" (crying or frowning), "emission" (of liquid or gas, i.e., regurgitation, drooling, or burping), yawning, stridor, stretching, and mouthing. Three behaviors (hiccuping, sneezing, and thumb-sucking) were infrequent but were significantly associated with onset of reflux events in one or two patients each. A tenth behavior, coughing or gagging, was significantly associated with onset of reflux events in two patients, but not in the rest, despite relatively frequent occurrence. Exploration of temporal relations between reflux and each behavior suggested that discomfort, emission, mouthing, and cough-gag may have caused reflux episodes, and that all 10 of the behaviors may have been caused by reflux episodes. These findings and a "quiet period" immediately preceding episodes in six of the infants suggest interesting pathophysiologic mechanisms in infants which require further evaluation.