Parents are often advised to burp their babies after feeding them. Some people think burping after feeding is important to reduce or prevent discomfort crying, or to reduce how much a baby regurgitates milk after a feed.

It is true babies, like adults, swallow air when they eat. Burping releases this air from the top part of our digestive tracts. So when a baby cries after a feed, many assume it’s because the child needs to “be burped”. However, this is not necessarily true.

Why do babies cry or ‘spit up’ after a feed?

Babies cry for a whole host of reasons that have nothing to do with “trapped air”.

They cry when they are hungry, cold, hot, scared, tired, lonely, overwhelmed, needing adult help to calm, in discomfort or pain, or for no identifiable reason. In fact, we have a name for crying with no known cause; it’s called “colic”.

“Spitting up” – where a baby gently regurgitates a bit of milk after a feed – is common because the muscle at the top of a newborn baby’s stomach is not fully mature. This means what goes down can all too easily go back up.

Spitting up frequently happens when a baby’s stomach is very full, there is pressure on their tummy or they are picked up after lying down.

Spitting up after feeding decreases as babies get older. Three-quarters of babies one month old spit up after feeding at least once a day. Only half of babies still spit up at five months and almost all (96%) stop by their first birthdays.

Does burping help reduce crying or spitting up?

Despite parents being advised to burp their babies, there’s not much research evidence on the topic.

One study conducted in India encouraged caregivers of 35 newborns to burp their babies, while caregivers of 36 newborns were not given any information about burping.

For the next three months, mothers and caregivers recorded whether their baby would spit up after feeding and whether they showed signs of intense crying.

This study found burping did not reduce crying and actually increased spitting up.

When should I be concerned about spitting up or crying?

Most crying and spitting up is normal. However, these behaviours are not:

• refusing to feed
• vomiting so much milk weight gain is slow
• coughing or wheezing distress while feeding
• bloody vomit.

If your baby has any of these symptoms, see a doctor or child health nurse.

If your baby seems unbothered by vomiting and does not have any other symptoms it is a laundry problem rather than something that needs medical attention.

It is also normal for babies to cry and fuss quite a lot; two hours a day, for about the first six weeks is the average.

This has usually reduced to about one hour a day by the time they are three months of age.

Crying more than this doesn’t necessarily mean there is something wrong. The intense, inconsolable crying of colic is experienced by up to one-quarter of young babies but goes away with time on its own .

If your baby is crying more than average or if you are worried there might be something wrong, you should see your doctor or child health nurse.

Not everyone burps their baby

Burping babies seems to be traditional practice in some parts of the world and not in others.

For example, research in Indonesia found most breastfeeding mothers rarely or never burped their babies after feeding.

One factor that may influence whether a culture encourages burping babies may be related to another aspect of infant care: how much babies are carried.

Carrying a baby in a sling or baby carrier can reduce the amount of time babies cry.

Babies who are carried upright on their mother or another caregiver’s front undoubtedly find comfort in that closeness and movement.

Babies in slings are also being held firmly and upright, which would help any swallowed air to rise up and escape via a burp if needed.

Using slings can make caring for a baby easier. Studies (including randomised controlled trials) have also shown women have lower rates of post-natal depression and breastfeed for longer when they use a baby sling.

It is important baby carriers and slings are used safely, so make sure you’re up to date on the latest advice on how to do it.

So, should I burp my baby?

The bottom line is: it’s up to you.

Gently burping a baby is not harmful. If you feel burping is helpful to your baby, then keep doing what you’re doing.

If trying to burp your baby after every feed is stressing you or your baby out, then you don’t have to keep doing it.

Karleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney University and Nina Jane Chad, Research Fellow, University of Sydney School of Public Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

For women diagnosed with endometriosis it is often a long sentence of chronic pain and cramping that impacts their daily life. It is a condition that is both difficult to diagnose and treat, with many women needing either surgery or regular medication.

A medicine called Ryeqo has just been approved for marketing specifically for endometriosis, although it was already available in Australia to treat a different condition.

Women who want the drug will need to consult their local doctor and, as it is not yet on the Pharmaceutical Benefits Scheme, they will need to pay the full cost of the script.

What does Ryeqo do?

Endometriosis affects 14% of women of reproductive age. While we don’t have a full understanding of the cause, the evidence suggests it’s due to body tissue that is similar to the lining of the uterus (called the endometrium) growing outside the uterus. This causes pain and inflammation, which reduces quality of life and can also affect fertility.

Ryeqo is a tablet containing three different active ingredients: relugolix, estradiol and norethisterone.

Relugolix is a drug that blocks a particular peptide from releasing other hormones. It is also used in the treatment of prostate cancer. Estradiol is a naturally occurring oestrogen hormone in women that helps regulate the menstrual cycle and is used in menopausal hormone therapy. Norethisterone is a synthetic hormone commonly used in birth control medications and to delay menstruation and help with heavy menstrual bleeding.

All three components work together to regulate the levels of oestrogen and progesterone in the body that contribute to endometriosis, alleviating its symptoms.

Relugolix reduces the overall levels of oestrogen and progesterone in the body. The estradiol compensates for the loss of oestrogen because low oestrogen levels can cause hot flushes (also called hot flashes) and bone density loss. And norethisterone blocks the effects of estradiol on the uterus (where too much tissue growth is unwanted).

Is it really new?

The maker of Ryeqo claims it is the first new drug for endometriosis in Australia in 13 years.

But individually, all three active ingredients in Ryeqo have been in use since 2019 or earlier.

Ryeqo has been available in Australia since 2022, but until now was not specifically indicated for endometriosis. It was originally approved for the treatment of uterine fibroids, which share some common symptoms with endometriosis and have related causes.

In addition to Ryeqo, current medical guidance lists other drugs that are suitable for endometriosis and some reformulations of these have also only been recently approved.

The oral medicine Dienogest was approved in 2021, and there have been a number of injectable drugs for endometriosis recently approved, such as Sayana Press which was approved in a smaller dose form for self-injection in 2023.

How to take it and what not to do

Ryeqo is a once-a-day tablet. You can take it with, or without food, but it should be taken about the same time each day.

It is recommended you start taking Ryeqo within the first five days after the start of your next period. If you start at another time during your period, you may experience initial irregular or heavier bleeding.

Because it contains both synthetic and natural hormones, you can’t use the contraceptive pill and Ryeqo together. However, because Ryeqo does contain norethisterone it can be used as your contraception, although it will take at least one month of use to be effective. So, if you are on Ryeqo, you should use a non-hormonal contraceptive – such as condoms – for a month when starting the medicine.

Ryeqo may be incompatible with other medicines. It might not be suitable for you if you take medicines for epilepsy, HIV and AIDS, hepatitis C, fungal or bacterial infections, high blood pressure, irregular heartbeat, angina (chest pain), or organ rejection. You should also not take Ryeqo if you have a liver tumour or liver disease.

The possible side effects of Ryeqo are similar to those of oral contraceptives. Blood clots are a risk with any medicine that contains an oestrogen or a progestogen, which Ryeqo does. Other potential side effects include bone loss, a reduction in menstrual blood loss or loss of your period.

It’s costly for now

Ryeqo can now be prescribed in Australia, so you should discuss whether Ryeqo is right for you with the doctor you usually consult for your endometriosis.

While the maker has made a submission to the Pharmaceutical Benefits Advisory Committee, it is not yet subsidised by the Australian government. This means that rather than paying the normal PBS price of up to A$31.60, it has been reported it may cost as much as $135 for a one-month supply. The committee will make a decision on whether to subsidise Ryeqo at its meeting next month.

Correction: this article has been updated to clarify the recent approval of specific formulations of drugs for endometriosis.

Nial Wheate, Associate Professor of the School of Pharmacy, University of Sydney and Jasmine Lee, Pharmacist and PhD Candidate, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

When British TV doctor Michael Mosley died last year in Greece after walking in extreme heat, local police said “heat exhaustion” was a contributing factor.

Since than a coroner could not find a definitive cause of death but said this was most likely due to an un-identified medical reason or heat stroke.

Heat exhaustion and heat stroke are two illnesses that relate to heat.

So what’s the difference?

A spectrum of conditions

Heat-related illnesses range from mild to severe. They’re caused by exposure to excessive heat, whether from hot conditions, physical exertion, or both. The most common ones include:

• heat oedema: swelling of the hands, feet and ankles
• heat cramps: painful, involuntary muscle spasms usually after exercise
• heat syncope: fainting due to overheating
• heat exhaustion: when the body loses water due to excessive sweating, leading to a rise in core body temperature (but still under 40°C). Symptoms include lethargy, weakness and dizziness, but there’s no change to consciousness or mental clarity
• heat stroke: a medical emergency when the core body temperature is over 40°C. This can lead to serious problems related to the nervous system, such as confusion, seizures and unconsciousness including coma, leading to death.

As you can see from the diagram below, some symptoms of heat stroke and heat exhaustion overlap. This makes it hard to recognise the difference, even for medical professionals.

How does this happen?

The human body is an incredibly efficient and adaptable machine, equipped with several in-built mechanisms to keep our core temperature at an optimal 37°C.

But in healthy people, regulation of body temperature begins to break down when it’s hotter than about 31°C with 100% humidity (think Darwin or Cairns) or about 38°C with 60% humidity (typical of other parts of Australia in summer).

This is because humid air makes it harder for sweat to evaporate and take heat with it. Without that cooling effect, the body starts to overheat.

Once the core temperature rises above 37°C, heat exhaustion can set in, which can cause intense thirst, weakness, nausea and dizziness.

If the body heat continues to build and the core body temperature rises above 40°C, a much more severe heat stroke could begin. At this point, it’s a life-threatening emergency requiring immediate medical attention.

At this temperature, our proteins start to denature (like an egg on a hotplate) and blood flow to the intestines stops. This makes the gut very leaky, allowing harmful substances such as endotoxins (toxic substances in some bacteria) and pathogens (disease causing microbes) to leak into the bloodstream.

The liver can’t detoxify these fast enough, leading to the whole body becoming inflamed, organs failing, and in the worst-case scenario, death.

Who’s most at risk?

People doing strenuous exercise, especially if they’re not in great shape, are among those at risk of heat exhaustion or heat stroke. Others at risk include those exposed to high temperatures and humidity, particularly when wearing heavy clothing or protective gear.

Outdoor workers such as farmers, firefighters and construction workers are at higher risk too. Certain health conditions, such as diabetes, heart disease, or lung conditions (such as COPD or chronic obstructive pulmonary disease), and people taking blood pressure medications, can also be more vulnerable.

Adults over 65, infants and young children are especially sensitive to heat as they are less able to physically cope with fluctuations in heat and humidity.

How are these conditions managed?

The risk of serious illness or death from heat-related conditions is very low if treatment starts early.

For heat exhaustion, have the individual lie down in a cool, shady area, loosen or remove excess clothing, and cool them by fanning, moistening their skin, or immersing their hands and feet in cold water.

As people with heat exhaustion almost always are dehydrated and have low electrolytes (certain minerals in the blood), they will usually need to drink fluids.

However, emergency hospital care is essential for heat stroke. In hospital, health professionals will focus on stabilising the patient’s:

• airway (ensure no obstructions, for instance, vomit)
• breathing (look for signs of respiratory distress or oxygen deprivation)
• circulation (check pulse, blood pressure and signs of shock).

Meanwhile, they will use rapid-cooling techniques including immersing the whole body in cold water, or applying wet ice packs covering the whole body.

Take home points

Heat-related illnesses, such as heat stroke and heat exhaustion, are serious health conditions that can lead to severe illness, or even death.

With climate change, heat-related illness will become more common and more severe. So recognising the early signs and responding promptly are crucial to prevent serious complications.

Matthew Barton, Senior lecturer, School of Nursing and Midwifery, Griffith University and Michael Todorovic, Associate Professor of Medicine, Bond University

This article is republished from The Conversation under a Creative Commons license. Read the original article.