Rhuger is best given before feeds and in small frequent doses. It is most effective when the dose is warmed to body temperature. This can be done by warming a teaspoon with hot water, or by using a little expressed breastmilk, before administering directly to baby. Rhuger can be added to formula or given during feeds. Give Rhuger separately to Gaviscon, thickeners or Losec and Ranitidine.
3. WHAT DOSE SHOULD I GIVE TO MY BABY?
Rhuger works mostly on the surface of the gut wall, so it may require you to give doses before every feed for several days in order to begin to see improvements.
Newborn Babies - (2-weeks) :0.5ml up to 6 times a day.
Babies - (6-weeks to 12-weeks) :1ml up to 6 times a day.
Infants - (3-months & over) :2mls up to 6 times a day.
Maintain for at least 2 weeks before increasing (not decreasing) doses. Rhuger may be helpful in older infants when solids are introduced or at weaning if constipation occurs.
4. HOW LONG SHOULD I CONTINUE WITH RHUGER?
It may take several days to see any improvement in unsettled behaviour after feeding. Winding should become easier and signs of discomfort reduce such as, tight tummy, arching of the back or pulling up of legs. In infants from two weeks old it is safe to maintain a dose 1ml six times a day for as long as it may be necessary to treat these symptoms. You may continue with Rhuger as long as baby grows and bigger and longer feeds are required.
5. HELPFUL HINTS
To help ease the build up of trapped air in the stomach.
• Try turning your baby around to burp, before changing to feed on the other breast. This may release wind and your baby will settle better to continue feeding.
• Avoid rigorous up and down movements, trapped wind will find a way out.
• Air may well get in earlier in the feed, when suckling is more forceful and the foremilk let down more prone to baby allowing air to be swallowed. It is important for you to have your baby get a good amount of hindmilk in the feed.
• Burping to release wind before a feed. Use Rhuger before the feed.
• Aim to complete breastfeeds from one side before going to the other side.
MEDICINAL USES OF:
The plant from which Zingiber Officinale is derived from is a herbaceous, perennial, monocotyledon, called ginger, and grows to about 1 metre from a tuberous rhizome. Typically found in tropical Asia, but cultivated in Queensland and it is from Australia that our ginger liquid extract is sourced. The active extracts contain around 2% volatile oils, phenols ie, zingerones, gingerols and shogaols, and a resin oleoresin. The preparation extracted is then dried under controlled conditions, as the active isomers evolve before made stable in a solvent up to 25% ethanol. The liquid extract preparation contains:
Vitamins: A, B-complex and C
Minerals: Calcium, phosphorous, iron, sodium, potassium and magnesium.
Action Carminative - gingerol, shogaol
Anti-emetic - shogaol
Peripheral circulatory stimulant
The overall pharmacology is complex, and can be isolated into specific groups. This may lead to some claims of medicinal use with zingiber officinale to suit the practitioner in vitro, where in situ may produce a range of effects.
The gingerols display mostly a cholagogue action. This gives them the ability to stimulate peristalsis and gastric secretion. This together with the shogaol fractions which have a broader pharmacology, resulting in actions such as: sedative, antipyretic, analgesic, antipyretic, antitussive, antispasmodic, suppression of gastric contractions, inhibition of prostaglandin PGF2a synthesis. ( this prostaglandin is a potent stimulator of smooth muscle.)
The phenol fraction is mildly irritating to the gut mucosa, this provokes circulatory stimulation, it may also .explain how the surface of the gut may release trapped air, partially digested food, and relieve the discomfort of wind in neonates.
The ability to act as an anti-emetic has been well known for centuries through herbal medicine in the East and Ancient societies. Many studies have proven this to be as effective as the use of first generation antihistamines, ie, diphenhydramine 100mg, and similar to cyclizine 50mg. In treating nausea, or stopping vomiting. This may be useful in treating vertigo or motion sickness, or prove effective in the control of nausea and vomiting following operations or morning sickness associated with pregnancy. The whole extract has the ability to be used for these specific tasks, but it has the ability to be generally useful in easing those symptoms for which it is prescribed for in treating symptoms of winding and reflux in infants.
Has a long history of herbal usage. The primary result of rhubarb root as a herbal medicine is a positive and balancing effect upon the digestive system.
The root is used as an anticholesterolemic, antiseptic, antispasmodic, astringent, laxative, purgative tonic. Rhubarb roots contain anthraquinones which have a purgative effect, and the tannins and bitters have an effect that is opposite that of an astringent.
When taken internally in small doses, rhubarb acts as an astringent tonic to the digestive system, when taken larger doses rhubarb acts as a very mild laxative.
The cause and treatment of infant, newborn and baby wind (gas) problems
All babies have gas but some babies have an easier time passing gas, which may stem from a learned or innate ability. While a certain amount of gassiness is completely normal, it may be causing your baby discomfort if you notice tell-tale symptoms such as; abdominal bloating, hard distended belly, frequent burping, spit-ups, hiccups, flatulence and excessive fussiness or restlessness.
6. WHERE DOES GAS COME FROM IN INFANTS AND NEWBORNS
Newborn gas is a natural by-product of digesting lactose, gas producing foods, such as cruciferous vegetables and legumes. Citris fruits and juices, strawberries and tomatoes are high in acidity. Dairy “intolerances”, soy and peanut intolerance is hyper-lactation syndrome. Foremilk is higher in water content, higher in lactose and usually delivered with greater force during letdown. An excess, foremilk can make baby’s stomach cramp, creating more fussiness. Over stimulation can also lead to increased gassiness. The more activity the higher the chances of gassiness and fussiness in baby’s evening and night.
The introduction of solid foods in older babies creates changes that may take baby some time getting used to since enzymes and probiotics must build up to digest and absorb nutrients.
7. WHY DOES INFANT WIND CAUSE PAINS AND DISCOMFORT
Normally gas is not a problem and causes not pain or discomfort because it is quickly pushed through the digestive system just learning to function.
8. WHAT TREATMENT IS AVAILABLE FOR BABY'S WIND PROBLEMS
Burping the baby thoroughly will reduce air in the stomach, so that it does not pass on to the intestinal tract. Unfortunately, burping is not 100% effective at eliminating gas, since is has absolutely no effect on the gas created in the intestines during normal digestion. Simply applying light pressure on the tummy can soothe and help. Place baby, straddled on your right elbow facing your upper arm with baby’s chin on your right shoulder. Gently lower and raise, bending at your elbow. Do not allow excessive up and down movements as this tends to mix milk and air before burping. If this does not work, there are several treatments available for infant gas.
This product joins the gas bubbles in the stomach so that it can be more easily burped away. Larger gas bubble clusters can be more painful on distension in cramping. This can cause more intense pain. Since Simethicone works by joining gas bubbles, if gas has been created by feeding, then this will have no effect. Simethicone only works near the top of the stomach as it has not effect on intestinal gas.
• Sodium Bicarbonate (commonly known as baking soda used in some gripe water brands).
This product is an alkali which counteracts the acid in the stomach. This can temporarily relieve acid reflux discomfort. Unfortunately Sodium Bicarbonate is absorbed into the blood and may pass through the kidney. This can have unwanted side effects and, according to some doctors, Sodium Bicarbonate may cause an imbalance in baby’s electrolytes, which may lead to serious health issues.
• Essential Oils (Dill, Fennel and Peppermint etc used in some gripe water brands).
There are known safety issues with essential oils as they are absorbed into the body fats when taken internally leading to possible side effects.
• Homeopathic Formulas.
These may be low in side effects and useful in treating mild symptoms of winding and colic pain
• Herbal Extracts (Rhubarb and Ginger etc).
Rhuger is a product used in New Zealand for treating winding and symptoms as a result of feeding issues in babies for over 25 years. Rhuger has a gentle effect on the gut wall in the intestines where gas can be created through the digestion of lactose in the baby’s milk. The Rhubarb extract in Rhuger is able to release the gas and relieve the symptoms of colic. The ginger extract in Rhuger can help dispel trapped air in the stomach and relax the smooth muscle controlling the Lower Oesophageal Sphincter, thereby controlling winding without the problem of refluxing partly digested milk contents into the oesophagus causing pain and discomfort for the baby.
Rhuger is a commercial product available from your community pharmacy and other health stores throughout New Zealand.
• The cause and treatment of neonatal reflux. This is a condition called GORD (Gastro-oesophageal Reflux Disease)
• GOR is simply defined as the upward movement of stomach contents into the oesophagus (the tube connecting the stomach to the mouth). This is common, from time to time, particularly after meals and where babies may regurgitate or spill up after feeding. Between 1 to 4 months of age bottle or breastfed, spitting can happen in up to two-thirds of healthy infants. This usually resolves by one year of age. In contrast, however, GORD is less common and is the serious complication of uncontrolled GOR.
• Babies with GORD have persistent regurgitation with complication such as poor growth rates and failure to thrive, may have feeding, stomach pain, and more complicated symptoms such as airway irritations, wheezing, chronic sinusitis or more serious pneumonia as a result of GORD.
• What is “Silent GORD”? It is where the stomach contents reflux up without any noticeable signs or symptoms. However this is where the refluxed contents may make their way up and down, or part the way, passed the lower gastro-oesophageal sphincter and is more difficult to diagnosis but can be more damaging as the acid goes up and down without control.
Less commonly is the condition called Laryngopharyngeal Reflux. This is where stomach contents, with acid, may make its way up to the back of the throat or airway area and back of the nasal passages.
Another condition, which is related to GOR, is referred GOR where the stomach smooth muscle around the sphincter goes into spasm, which may block the sphincter or, alternatively, keep it open allowing food from the stomach to be trapped.
Other causes of reflux may be related to food allergies, metabolic disorders, systemic infections or other physical abnormalities of the stomach and nasal gastric incubations may also result in this problem.
The Benefits of Breastfeeding
The breastfed baby has fewer reflux episodes as maternal milk is more easily digested than formula. Maternal milk contains hormones, which helps to promote relaxation of baby. If unsure of your technique when breastfeeding baby ask your mid-wife, plunked nurse or your general practitioner, to alleviate any concerns you may have. Your general practitioner can advise you on any prescription medicines to reduce stomach acid and, thereby, suppressing the symptoms of GORD.
Antiemetic use in Pregnancy and Lactation
Antiemetic properties of ginger in non pregnant patients, oral dose from 1-2g/day dried ginger powered root or rhizome. Exact mechanism is unknown, but appears to be a local effect in the git rather than a central action. This effect may be mediated by antagonism of git 5-hydroxytryptamice (Serotonin) to prevent stimulation of the vagus nerve and, thus, the vomiting centre. Ginger has long been used in Chinese herbal folk lore medicine for the treatment of pregnancy induced nausea and vomiting.
Research Ref: From drugs in pregnancy and lactation, Natural therapies and medicines , March 2013
Ginger has demonstrated anti-emetic activity in both experimental models and human studies. It appears that several key constituents are responsible which exert several different mechanisms. In vivo studies have demonstrated (6),(8) and (10) – gingerol isomers as well as (6) – shogaol exert anti-emetic activity ( Kawai et al 1994, Abdel-Aziz et al 2006), most likely by acting on the 5-HT(3) receptor ion-channel comples either by binding directly to a modulatory site distinct from the serotonin binding site or indirectly via underlying muscarinic receptors. Specific constituents of ginger volatile oil including terpinolene, beta-pinene and alpha-phellandrene were also found to induce an antispasmodic effect via interaction with the 5-HT(3) receptor channel system in rat ileum ( Riyazi et al 207). Galactone has also been identified as a serotonin receptor antagonist(Huang et al 1991, Mustafa et al 1993, Yamahara et al 1990). Such mechanisms of action also explain the inhibitory effect of ginger on serotonin induced diarrhoea and antispasmodic effect on visceral and vascular smooth muscle.
Ginger has been shown to blunt gastric dysrhythmias and nausea evoked by acute hyperglycaemia in humans. The anti-arrhythmic and anti-emetic effects are thought to be due to a blockade of prostaglandins rather than inhibition of their release (Gonlachanvit 2001.) Ginger has also been shown to reduce radiation induced gastrointestinal distress and emesis in rat models, which is thought to be due at least in part to it’s radicals and inhibit lipid peroxidation (Sharma et al 2005).
Ginger extract displayed comparable radioprotection against radiation induced taste aversion (CTA) when compared to dexamethasone and ondansetron in male and female rats. The most effective concentration was 1000mcg/ml of ginger extract, which exerted free radical scavenging of hydroxyl ions and nitric oxide and modulation of CTA (Haksar et al 2006).
Ginger exerts several effects in the gastrointestinal tract which lead to an improvement in gastrointestinal symptoms. It stumlates the flow of saliva, bile and gastric secretions. (Platel & Srinivasan 1996, 2001 Yamahara et al 1985) and has been shown to increase gastrointestinal motility in several animal models and human studies (Mysta & Sharma 2001, Micklefield et al 1999, Phillips et al 1993). In a recent randomised double blind study involving 24 healthy volunteers, ginger was found to accelerate gastric emptying and stimulate antral contractions (Wu et al 2008).
Ginger has also been observed to have prokinetic activity in mice in vivo and antispasmodic activity in vitro (Ghayur & Gilani 2005). These findings appear to support the traditional use of ginger in the treatment of gastrointestinal discomfort, colic, diarrhoea and bloating and its use as a carminative agent. Further in vitro studies confirm cholinergic agonistic activity on postsynaptic M3 receptors, as well as suggesting an inhibitory effect on presynaptic muscarinic auto receptors (Ghayur et al 2007). The (6)-gingerol constituent displayed the strongest antispasmodic activity (Ghayur et al 2008).
Is traditional evidence available about the substance in general? YES
Does traditional evidence caution or contraindicate against use in pregnancy? YES
Is the reason for the traditional caution or contraindication biologically plausible? NO
Is scientific evidence available in general about the substance? YES
Does scientific evidence (from human or animal studies) provide information about pharmacological effects that may be of concern in pregnany? YES
Are there any studies suggesting that the substance may be safe in pregnany? YES
Ginger has traditionally used as an antiemetic, ginger has encouraging research to support its use during pregnany for nausea and vomiting (Borelli et al 2005). No adverse effects have been reported in several studies examining ginger in the treatment of nausea and vomiting in pregnancy. A systematic review of four double blind RCTs (n=499) and one prospective observational cohort study(n=87) evaluated the effects of ginger on pregnancy outcomes. The preparation used in the trials was a ginger root powder or extract, taken 3-4times daily (total dose ranged from 1.0-1.5g) from 8 to 20 weeks gestation. No dose was provided in the prospective study. No difference in the occurrence of spontaneous abortions, stillbirth, term delivery and caesarean deliveries, neonatal death, gestational age or congenital abnormalities was found between women who took ginger compared to those who took vitamin B6 or a placebo, or to the general population (Borelli et al 2005). Unfortunatley there is a lack of consensus regarding the safety of ginger during pregnancy. Soudamini et al 1995. Suggest ginger contains possible mutiagenic properties, but this effect appears to be counteracted by zingeroone, another constituent present in the whole rhizome (Nakamua & Yamamoto 1982).
Ginger has been contraindicated in labour due to the possibility of increased postpartum haemorrhage, and in large doses ginger is tradionally thought to act as an emmenagogue (Grieve 1971). German commission E suggests that ginger is contraindicated in preganancy, while more recent research suggests that doses up to 2g/day of dried ginger root have been used safely. When considered in a comparison of recent research, the proposed notion of haemorrhage is unlikely (Lumb 1994). Even in very large doses (ginger tea up to 50g/L), ginger had no impact on maternal toxicity or fetal malformations in an animal model, but embryo losses were double compared to the controls. No evidence of maternal toxicity was found for a patented extract of ginger (EV.EXT 33) given in doses of up to 1000mg/kg/body weight daily to pregnant rats during the period of organogenesis (Weidner & Sigwat 2001).