My baby is always vomiting, but when I took her to the doctor, he said it was a reflux problem and not vomiting. In what way does reflux differ from vomiting in babies?

Some babies are unlucky enough to have a defect in the muscle ring at the bottom of the oesophagus (gullet). This muscle ring is normally contracted shut, and only opens when food is swallowed. This prevents the acid and food in the stomach from running up into the oesophagus when lying down or bending over.

If the muscle is weak or defective, the acid in the stomach can burn the oesophagus, which causes considerable pain to the infant. This is known as reflux oesophagitis.

Most children will grow out of the problem, but medication must be given in the meantime to prevent the burning and pain. This is usually in the form of a mixture which is given after every feed. More sophisticated treatments are available for intractable cases.

Why do babies vomit so much?

It is important to differentiate between vomiting, positing and reflux. Vomiting is not very common, and may be due to some disease process (eg. infection, food allergy). The vomitus is usually altered food and may be green in colour, indicating the presence of bile. It may occur several hours after a feed.

Positing occurs in most infants, and is the regurgitation of milk and food from the mouth, gullet and upper part of the stomach during or immediately after a feed. It is caused by over feeding, rapid feeding or burping, and it does not require any treatment.

Reflux is the regurgitation of the stomach contents immediately after a meal, and for some time afterwards. It is distressing to the child, as stomach acid is bought up, and this burns the gullet. This can be helped by posture feeding, slow feeding and mixtures (such as Infant Gaviscon) that may be given after a meal.

If you are unsure about the problem, have your child assessed by your GP.

Different doctors and naturopaths have told me different ways to deal with my asthma. What is the best treatment for asthma?

The best treatment is that which completely prevents the disease. It is far better to prevent asthma than to deal with acute attacks. If the asthma only occurs every month or two, intermittent treatment may be appropriate. Most patients are being under-medicated, rather than taking too much. This applies particularly to patients who obtain their medication over the counter from chemists rather than seeing a doctor. This habit could prove expensive to your health!

Prevention involves two classes of drugs:

— Intal or Tilade

— Steroids (eg. Becotide, Becloforte, Flixotide, Pulmicort, Aldecin etc.).

Both groups are designed to be used regularly on a long term basis to prevent asthma attacks.

If an attack does occur, treatment is usually by one of a number of sprays (eg. Ventolin, Respolin, Bricanyl, Serevent). These can also be given by a nebuliser (when they are even more effective) or in a tablet or mixture (when they are less effective than a spray).

Combination inhalers are now available (eg. Seretidc) that have both preventive and treatment medication in the one dose.

Tablets or mixtures of a group of drugs called theophyllines can also be given to treat an attack of asthma. These include medications such as Ausryn and Theo-Dur.

If these medications do not work adequately, there are a number of add-on sprays and tablets that can be used including Atrovent and Prednisone.

I must emphasise how important it is to be under the continued care of a doctor when using any of these medications. Asthma can be well controlled with the cooperation of the patient.