The Best Australian Science Writing 2012 by Elizabeth Finkel Page B

lacy-white sensuality of the Lux mother: a brutal collision with reality lurks beneath the sentimental images of motherhood, shocking us early on, and it’s reasonable to expecta sensitive response from the GP. But parents came to believe that a failure to diagnose was a failure to care.
    In the A4 newsletter that arrived in my mailbox every couple of months I read a stream of heartbreaking testimonials, alongside hints on sterilising medicine cups and removing the smell of vomit from clothing, or recipes for blancmange to thicken expressed breast milk or formula. There were diagrams illustrating how to change nappies with a pillow under the baby’s shoulders and without lifting the baby’s legs, or how to breastor bottle-feed holding the baby vertical. There were ads for approved cot harnesses to secure the baby once the head of the cot was raised 30 degrees, or for slogan T-shirts, cheap and cute, for the discernible ‘reflux’ baby, alongside order forms for a fundraising drive. Contributions from paediatric gastroenterologists and GPs advised frequent burping, thickened breast milk, thickened formula, frequent breastfeeds, spaced breastfeeds, different bottles, different formula.
    It felt voyeuristic, peering into the newsletters like this, browsing families’ misery and their plucky attempts to keep each other’s spirits up, all written in homey prose. But it was also clear to me that Queensland babies, at least in the first few months of life, were in the grip of an imaginary disease. It’s true that premature infants, and infants with certain underlying health problems, for example, neurological abnormalities, are prone to GORD. But in otherwise healthy, full-term babies in the first few months of life, excessive crying, crying in a piercing shriek, back-arching, turning red in the face, flexing up the knees to the tummy, disrupted sleep, vomiting, and crying when put down are common behaviours, not caused by pain or reflux. I could see that using the diagnosis of GORD to explain these behaviours caused harm to mothers and babies.
    For a start, parents were desperately focused on performing the various odd, disruptive and time-consuming manoeuvressupposed to protect their baby’s imaginary oesophageal lesions. These preoccupations certainly didn’t help parents learn to read and respond to their infants’ cues. Yet learning to read and engage the baby’s communications (a difficult task in unsettled babies, one that may even require professional help) is a very important way of protecting the mother–infant relationship and the child’s long-term mental health.
    Multiple other problems were often not identified or addressed in the frenzy of activity surrounding GORD: for example, feeding difficulty, cow’s milk allergy, maternal anxiety or depression, or lack of familial and social support. Worse still, if correctable clinical problems weren’t diagnosed, mothers and babies were at risk of developing entrenched long-term problems, including ongoing feeding difficulties. The consequences of undetected and unmanaged feeding difficulties may be catastrophic for some, resulting in severely disrupted and anxious mother–infant relations, since it is not easy for a mother to remain calm at feed times if she believes her baby is starving.
    Some babies do develop true GORD down the track. Could it be that by over-diagnosing GORD in the first few months of life, we also predisposed some babies to oesophagitis later on? This is a sensible interpretation of what we know about the multiple factors that do predispose babies to GORD, and the effects of failing to identify them.
    Worst of all, cisapride (trade name Prepulsid) could fatally disrupt the beating of a tiny heart. This was recognised in 2000, after two children died. But the potential for disaster didn’t halt the GORD juggernaut: we simply substituted PPIs, even though they had not been trialled on a