Fighting through GERD: Bowie and Finley’s story

From the very beginning, Melissa and Kris knew their twins were fighters—they were also a surprise; the couple hadn’t been sure if they were going to be able to have more children.

“We knew these twins had a purpose and a reason. From the very beginning of their lives, they were a miracle all around.”

Melissa experienced hyperemesis gravidarum also known as HG, a rare condition characterized by extreme nausea and vomiting. Most pregnant women experience morning sickness, but less than 3% experience HG, which can lead to near-constant vomiting, dehydration, weight loss and malnutrition.

“From the second I was pregnant, I was extremely ill. The three of us shouldn’t have lived through my pregnancy, but we did,” Melissa says. “The twins are little fighters. From the womb until now, they’re just little fighters.”

Her body was so depleted that she was put on extended bedrest and hospitalized on and off throughout her pregnancy. She needed a PICC line, or peripherally inserted central catheter, for two-thirds of her pregnancy. PICC lines are sometimes needed when intravenous (IV) medications are required over a long period of time.

“The babies were getting all their nutrients from me, and I was so sick. It was really scary,” she says. “One night while on hospitalized bedrest I needed four blood transfusions. My body was shutting down. The babies were ok through everything—the blood transfusions, me getting IVs, copious amounts of potassium, medications, everything. They just kept going.”

Showing signs of gastroesophageal reflux disease (GERD) 

A few days after they were born, Bowie and Finley started showing signs of gastroesophageal reflux (GER). This occurs when a small amount of acidic stomach fluid or food in the stomach goes back up into the esophagus or swallowing tube. Two-thirds of healthy infants experience gastroesophageal reflux.

When the reflux causes intolerable discomfort or complications, children may be experiencing gastroesophageal reflux disease (GERD). Nurses at the delivery hospital told the parents the babies were spitting up and throwing up more than they should be. By the time they went home a couple days after they were born, they had lost a bit more of their birth weight than they were supposed to. Melissa and Kris’ older children Scotlynd and Kingston had GER when they were younger, so they thought they knew what to expect.

Bowie and Finley Lyman’s first photo with their parents.

Most cases of GER resolve without medication. In rare cases, treatment of GERD requires surgery.

“The older kids just got through it and was never life-threatening,” Melissa said. “With the twins, it went from ‘all babies spit up, they will be ok like their siblings’ to failure to thrive and life-threatening episodes.”

Each twin had life-threatening episodes of GERD. Melissa recalls an especially frightening night with Finley.

“After one middle of the night feeding, Finley threw up and that time, I wasn’t sure if she was ok. I went back in her nursery to check on her and she wasn’t breathing. It was the most terrifying moment. She was limp. I screamed for my husband. We tried everything to wake her up.”

Their pediatrician referred them to CHOC pediatric gastroenterologist Dr. Greg Wong. The two physicians worked together to improve GERD symptoms. Despite trying to change feeding times, amount and type of formula, and medication, the symptoms just weren’t going away. 

For Bowie and Finley, pictured here, GER runs in the family. Their older siblings had experienced GER but unlike the twins, they didn’t suffer from GERD or require surgery.

“We wanted to stay within the CHOC network. That was important to me because our older son had been treated at CHOC, and we fell in love with the CHOC family,” Melissa says. “We know how not only wonderful and caring they are, but from a medical perspective too. We wanted the best for them and we felt CHOC was the best.”

Bowie and Finley’s path to surgery

The family hadn’t wanted to prematurely jump to surgery as an option, but in the end, it was the right decision. They were referred to Dr. Peter Yu, a pediatric general and thoracic surgeon at CHOC.

“Dr. Yu made us feel so comfortable. He really knew what he was doing,” Melissa said. “The CHOC team felt that we had exhausted all other options, and that surgery was the best option for the twins.”

Bowie and Finley underwent surgery when they were about 6 months old. Dr. Yu performed a minimally invasive procedure known as laparoscopic Nissen fundoplication to repair the twins’ GERD. At the same time, he repaired their hernias.

“They are not identical babies, but they had identical surgeries,” Melissa says.

Surgery was performed on one baby at a time. Afterwards, they were brought to recovery rooms right next to each other, so one parent could be with each twin, and they could be close by.

“Before surgery, the babies were so sickly,” Melissa said. “After surgery, they are completely different babies.”

The twins are now feeding, growing and thriving. One of many benefits of this surgery has been less laundry. Melissa and Kris used to have a full hamper of laundry every day because the twins went through clothes and sheets so often.

Celebrating holidays in the hospital

Melissa’s birthday was the day after surgery.

“It was another birthday spent in the hospital, but it put things in perspective,” she said. “The best gift I could’ve gotten was for them to be healthy and thrive again. You think about the important things, and everything else fades away.”

Helmet therapy and physical therapy

Part of the family’s efforts to control the twins’ side effects of GERD had been to keep them in one position to limit their acid reflux. Because of this, they weren’t able to do tummy time which helps prevent flat spots on the back of the head.

After surgery, Finley and Bowie wore helmets for three months that helped correct the growth and shape of their skull.

Because of GERD, the twins’ backs were strong, but their cores and trunks were weak. They are in physical therapy to strengthen their bodies and help them roll and move around using the correct muscles.

A message to other moms

Melissa’s advice for other moms taking care of babies with GERD is to just keep asking questions and remember that every baby is unique.

“There are a lot of levels of GERD, and I didn’t know how severe it could be until it happened to us,” she said. “I learned not to compare my babies to anyone else’s. Every kid is different.”

She added that this experience taught her that trials are temporary, and things will get better.

“Even in the heart of it when you can’t get through another day, and you have to take it minute by minute,” she said. “I always say it’s only temporary. It might not get better right away, but it will.

Celebrating milestones

Last Mother’s Day, Melissa was on bedrest in the hospital, days away from giving birth to her twins. This year, she’s looking forward to celebrating her family being complete—and healthy.

The Lyman family

“You have to look back and see where you’ve come from to see how wonderful it is. Last year wasn’t this way. I spent last Mother’s Day with them in the hospital preparing to give birth,” she recalls. “It’s amazing to see how far we have come in a year. We are moving forward, and we can truly enjoy them and enjoy our time as a whole family.”

The twins’ first birthday falls right after Mother’s Day. The family is planning a big celebration in their neighborhood.

“We want to include everybody that was there for them from my pregnancy through the first year of life,” Melissa says. “We want to celebrate that they made it and thank everyone for their help. Everything has been so up and down and up and down, and now were in the clear.”

VIDEO: CHOC Docs answer common questions about surgery

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I’m a Pediatric Gastroenterologist. Here’s What I Want You to Know About a Gluten-Free Diet

By Dr. Bassam Younes, pediatric gastroenterologist at CHOC Children’s

In recent years, gluten-free diets have risen in popularity and gluten-free products become more readily available—but not everyone who puts themselves or their children on a gluten-free diet has a medical reason for doing so. About 30 percent of the US population is on a gluten-free diet, but all patients requiring this diet (celiac, gluten-free sensitivity, etc.) combined are less than 30 percent of the US population.

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Dr. Bassam Younes, pediatric gastroenterologist at CHOC Children’s

Shouldn’t everyone just go gluten free?

Many people assume that since gluten can have such strong negative effects on some of us, that it would be safer if we all just avoided gluten. Wrong.

Gluten-free foods may be safe to eat, but they’re not calorie-free. Many gluten-free foods and snacks are higher in fat and calories. Also, very few gluten-free products are enriched with essential vitamins and minerals that most gluten-containing products contain. This means if you’re on a gluten-free diet not managed by a registered dietitian, you could be missing out on essential nutrients your body needs. At CHOC, our team of pediatric gastroenterologists work in tandem with registered dietitians to care for children who require a gluten-free diet.

What is gluten?

Gluten is a general name for the proteins found in wheat, rye, and barley and triticale (a cross between wheat and rye). It can be found in many types of foods, but is primarily made up of two different types of proteins:

  • Gliadin- gives bread the ability to rise
  • Glutenin- responsible for dough’s elasticity, acting as a glue to hold the food together, affecting the chewiness and maintaining the shape of baked products

Here’s a few cases where I would recommend a gluten-free diet to my patients:

Celiac disease

If you are diagnosed with celiac disease, it means you have an autoimmune reaction to gluten. Whenever you eat something containing gluten, your small intestine is hyper sensitive to that gluten, which leads to difficulty digesting food. Some common symptoms of celiac disease are diarrhea, decreased appetite, stomachache and bloating, poor growth, and weight loss.

Many kids are diagnosed with celiac disease when they’re between 6 months and 2 years old, which is when most kids get their first taste of gluten in foods. Girls are twice as likely to have this disorder than boys.

For some people, the problems start slowly and the symptoms may be terrible one week and not as bad the next. Because of this, some people aren’t diagnosed with celiac disease until they’re older. The problem is chronic, which means that although symptoms may come and go, people who have celiac disease will always have it.

If celiac disease is not treated, patients will develop weight loss and malabsorption (a condition that prevents the absorption of nutrients through the small intestine).

No one is sure why celiac disease happens, but it appears to run in families. You have a five percent to 10 percent chance of getting celiac disease if someone in your family has it. Others at higher risk for celiac disease include those with Type I diabetes, an autoimmune thyroid or liver disease, Trisomy 21 (Down syndrome), Williams syndrome, Turner syndrome, IGA deficiency or juvenile chronic arthritis. If your child falls into this at-risk group, they should be tested for celiac disease even if they don’t currently show symptoms. Celiac disease can harm the digestive system if no obvious symptoms are present.

Some children with celiac disease do not respond to the Hepatitis B vaccine. They will respond to the vaccine once they are on a gluten free diet. If your child was vaccinated for Hepatitis B prior to their celiac disease diagnosis and starting their gluten-free diet, they may need to be revaccinated for Hepatitis B. Consult your pediatrician about your child’s vaccination history.

In addition to a complete medical history and physical examination, diagnostic procedures for celiac disease may include blood work or a biopsy.

The only treatment for celiac disease is a lifelong adherence to a strict gluten-free diet.

Wheat allergy

You might be hypersensitive to wheat proteins without having celiac disease. People living with a wheat allergy have an immune reaction to the proteins found in wheat. A type of white blood cell attacks the wheat, alerting the body that there is a problem. Reactions can occur within a few minutes to a few hours, and can include nausea, abdominal pain, itching, swelling of the lips and tongue, trouble breathing or anaphylaxis. People with wheat allergies cannot ingest wheat, but they have no trouble ingesting gluten from non-wheat sources.

Children with a wheat allergy may eventually outgrow it, but the only treatment is eating a wheat-free diet.

Non-celiac gluten sensitivity

Non-celiac gluten sensitivity is not well-defined, but it is not an autoimmune response (like Celiac disease) or immune response (like a wheat allergy). There are no tests to diagnose a gluten sensitivity, but your doctor can do a biopsy or allergy test to rule out Celiac disease and wheat allergy. If a child’s symptoms improve by following a gluten-free diet, then gluten sensitivity may be diagnosed.

The only treatment for non-celiac gluten sensitivity is adhering to a gluten-free diet.

Learn more about pediatric gastroenterology at CHOC

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The Appendix: 5 Common Questions

More than 700 kids are treated for appendicitis at CHOC Children’s every year. The appendectomy is one of the most commonly performed surgeries in the world. But just what is the appendix, and why does it send so many people to the emergency room with stomach pain?

Dr. Peter Yu, CHOC Children’s pediatric general and thoracic surgeon, explains everything you’ve ever wondered about the appendix, and more.

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Dr. Peter Yu, pediatric general and thoracic surgeon at CHOC Children’s

 

  1. What does the appendix do?

The appendix is a small, finger-like projection that sticks out of the large intestine, located in the right side of the abdomen. It weighs about as much as an earthworm. In fact, its old-fashioned name is vermiform appendix, which means worm-like, Dr. Yu explains.

Everyone’s appendix is different. Some are long, some are short and stubby. But one thing they all have in common is that they are not necessary for a happy, healthy life.

“We are not sure if the appendix has a purpose. Some doctors don’t believe it does anything,” Dr. Yu says. “Some think it plays a role in the development of the immune system, and some believe it harbors ‘good bacteria’ that helps intestinal health. The bottom line, though, is that appendicitis is common, and patients do extremely well after removal of their appendix.”

  1. What causes appendicitis?

Bacteria naturally live in the large intestine and flow in and out of the appendix. Sometimes, the opening to the appendix gets blocked. Either constipation, a hard piece of stool called a “fecalith,” or enlarged lymph nodes cause these blockages.

The blockage traps the bacteria inside where it festers and multiplies. This leads to inflammation of the organ. If left untreated, the appendix can burst, releasing the infectious bacteria into the body.

Symptoms of a Burst or Inflamed Appendix

What are signs of appendicitis?

  • sudden severe pain
  • pain that starts near the belly button and moves to the lower abdomen on the right side
  • fever, nausea or vomiting

To diagnose appendicitis, the Julia and George Argyros Emergency Department at CHOC Children’s Hospital will check your child’s blood for signs of an infection and will do an ultrasound of the abdomen. While many hospitals use a CT scan to diagnose appendicitis, CHOC radiologists and sonographers have the training and experience to make a diagnosis using ultrasound, in order to minimize your child’s exposure to radiation. If the ultrasound is inconclusive, the radiologist may conduct a CT scan.

  1. How does the surgeon remove the appendix?

The surgeon will perform a procedure called a laparoscopic appendectomy to remove the appendix. A pediatric anesthesiologist will put your child to sleep using general anesthesia. The procedure takes about 30 minutes, though CHOC’s pediatric general surgeons can remove the organ in less than 10 minutes if needed.

During surgery, three tiny incisions are made on the abdomen. Carbon dioxide is blown into the belly to create a dome, giving the surgeon room to work. Small surgical tools are inserted in two of the incisions and a laparoscopic camera is inserted in the third. The appendix is identified, stapled or tied off, and removed.

The surgeon closes the incisions with surgical glue and dissolvable strips. In most cases, children will stay in the hospital for one day before the doctor discharges them. They should have no heavy activity or sports for two weeks after surgery and can usually return to school quickly, often even the next day.

  1. What do you do with the appendix after you take it out?

Pathologists then inspect the removed appendix in the pathology department under a microscope. This inspection is important because it will confirm the diagnosis of appendicitis and rule out other conditions such as ulcerative colitis, Crohn’s disease and carcinoid. Your surgeon will update you with the results during your follow-up appointment.

  1. What if my appendix bursts?

“Fortunately, perforated appendicitis is less common than non-perforated appendicitis, but it can happen,” Dr. Yu says. “For some, the appendix can burst quickly, and for others it does not burst at all. There are many factors that a surgeon will consider before deciding whether to operate immediately, or to wait.”

If your surgeon decides to wait, then treatment can include antibiotics, placement of a drain in the abdomen, and nutrition through an IV if needed. Most patients improve in several days, after which the doctor discharges them. Your surgeon will then schedule your child for an interval appendectomy, which is removal of the appendix 8-12 weeks later. This gives the body time to recover from the infection and inflammation, making surgery safer and less complicated.

The CHOC Emergency Department, equipped to treat appendicitis 24 hours a day, with pediatric surgeons ready for all situations is mainly for kids and teens.

Learn more about appendicitis in kids and teens

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Do’s and Don’ts for Parents of Picky Eaters

Why won’t you eat the apple? You love applesauce!

 Try the roasted chicken! It’s the same thing as the chicken nuggets you love.

 Taste the tomato! It’s what spaghetti sauce is made of and you like that. 

When it comes to children and picky eating, logic can go right down the garbage disposal. A quarter of all children experience minor feeding problems, and many parents fret about their kids’ eating habits.

The good news is that most children outgrow fussy eating habits. In the meantime though, Dr. Mitchell Katz, a pediatric gastroenterologist and medical director of CHOC Children’s Multidisciplinary Feeding Program, has some Do’s and Don’ts for parents of picky eaters.

  • Don’t try to trick children into putting food in their mouths. This tactic doesn’t help them learn about the new food. Exploring foods by touching, licking, smelling, poking and rolling are important ways that children can learn about food before they put it in their mouths and eat it.
  • Do consider how food looks. Like on cooking shows, plating and presentation matter for picky eaters. Try making food look like fun shapes, play up colors, or create scenes to help capture kids’ interest in new or unappealing foods.
  • Don’t worry about fluctuating eating habits. Just like adults eat more on some days than others, it’s normal for children to be inconsistent with how much and what foods they eat.
  • Do focus more on variety than quantity. It’s more important for children to eat a small amount of food from a broader number of food groups than to eat a large quantity at one meal.

While many children will outgrow the habit, some kids’ picky eating can be a sign of a more serious problem. Dr. Katz offers some warning signs that parents should look for when evaluating their children’s eating habits:

  • A child is delayed in meeting feeding milestones but not in other milestones. Children’s eating skills should mirror their other physical and cognitive developmental skills, like sitting, walking, talking and paying attention.
  • The child cannot transition or advance to the next level of eating. Are children progressing from bottle to sippy cup, from smooth purees to lumpy foods, or from familiar to new foods?
  • The child eats only a certain brand or type of preparation for all or most of their food.
  • The child has minimal intake or outright refuses to eat for several days, unrelated to an illness.
  • Extreme measures are taken to nourish a child. Force feeding, feeding when children are asleep or distracted, or abiding by intense routines are cause for concern.

Parents who recognize these signs in their children should seek medical attention, Dr. Katz says.

A severe feeding issue – like what Dr. Katz and his team treat at CHOC – involves physical, psychological, behavioral, nutritional, and familial obstacles to eating.

Addressing all a child’s medical problems is important to start to make positive associations with food and eating, which may require the help of multiple specialists.

Learn more about CHOC's feeding program

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3 Surprising Causes of Stomach Pain in Kids

Children complaining of stomach pain is common, and some sources – like constipation, food allergies or even appendicitis – are obvious.

But a few illnesses might not come to mind first when considering the source of a child’s stomachache. Here is information from the American Academy of Pediatrics (AAP) about some causes of stomach aches that might surprise parents.

Strep throat
Even though this diagnosis is tied to another relatively distant body part, strep throat can also cause stomach pain.

An infection caused by a bacterium called streptococci, strep throat’s more obvious symptoms are a sore throat and fever, and sometimes vomiting or headaches.

Parents who suspect their child has strep throat should visit the pediatrician, who will swab the child’s throat to test for bacteria. If positive, the physician will prescribe antibiotics.


Urinary tract infection (UTI)
Though the tell-tale sign of a UTI is pain and burning during urination, these infections can also cause discomfort in the abdomen.

UTIs are a common ailment in children, with more than 1.3 million children treated annually for the condition. Girls ages 1 to 5 are more likely than other children to experience a UTI.

Parents who suspect their child has such an infection should visit the pediatrician, who will prescribe an antibiotic following a positive diagnosis.

Learn how to prevent UTIs in children.

Emotional upset
Stomach pain can also be the result of sadness, stress or anxiety. Though this type of pain is more common in school-age children, children younger than 5 under unusual stress may also experience it.

Parents should carefully assess the child for other symptoms that might indicate an illness such as fever, vomiting, weakness, pain while urinating, sore throat or diarrhea. If none of those are present, consider other aspects, like timing: Does it wax and wane over a period of more than a week, and surface around activities that are unpleasant or stressful?

A lack of other physical symptoms and pain with curious timing could point to emotional upset. In this case, talk to the child about what’s bothering them. A pediatrician can also suggest ways to help, and, if necessary, refer the child to a therapist, psychologist or psychiatrist.

When to call the doctor

No matter the source, stomachaches should be taken seriously. Not all aches require a doctor’s appointment, but here are some signs from the AAP that medical attention is necessary:

  • Abdominal pain that comes on suddenly or persists
  • The child has other symptoms, such as a change in his bowel pattern, vomiting, fever (temperature of 100.4°F or higher), sore throat or headache
  • A baby younger than 1 year shows signs of stomach pain such as legs pulled up toward the abdomen or unusual crying
  • A child aged 4 or younger has recurrent stomachache
  • If abdominal pain awakes a child or stops him from sleeping

Looking for a pediatrician? Find one near you.

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