Babies with reflux (GORD) are really difficult to put down to sleep in the cot and usually hate tummy time with a passion.
Is your baby waking at the 20 minute-mark day and night?
Many babies with reflux wake at the 20-minute mark in the day. Gastro-oesophageal reflux is a common problem caused by an immature gastric sphincter. Basically, the valve at the top of the baby's tummy is a bit loose and this allows milk to come back up the food pipe (oesophagus) and either be spilt out like a vomit or silent reflux where it comes up and is immediately swallowed. If it comes out of their mouth it is spitting or vomiting which can happen up to 30 times a day. The peak age of reflux is 4 months and most stop spitting up by 18 months of age.
It's important to also note that approximately 40% of babies with reflux will have cows milk protein allergy or intolerance (CMPA or CMPI).
Here's some background reading ON my blog: Milk protein allergy and intolerance
The babies who have reflux but it isn't causing any problems are called 'happy chuckers' as their vomiting is not causing any behaviour or emotional issues. It is the other babies, the really unhappy chuckers that we really need to concentrate on. We need to recognise it, treat it and manage it appropriately.
How do you recognise it?
- These babies cry more than the average baby. They are extremely hard to soothe.
- When feeding they may arch their backs a lot.
- They want to feed but then don't want to feed. This is probably because they are learning that feeding causes pain.
- Babies with reflux vomit a lot, whereas babies with silent reflux may look like they have a funny taste in their mouth and be swallowing more than usual.
- They may cough. This is the acid coming up into their throat and mouth.
- I have heard of babies being startled by the acid reflux and having a slight b episode.
- They hiccup a lot, is more than the average baby hiccups.
- Sometimes they may have poor weight gain but often, they thrive. It depends on the severity.
- They often have sleep problems in the day and a history of cat-napping. Sleeping for less than the usual 40-minute sleep cycle. If the reflux is very severe, they may sleep poorly at night too.
- A mum I helped shares her story in her own words here: CASE STUDY: A case of severe catnapping, Emily
- They cry a lot and are hard to lay down on the floor for tummy time or in the cot for sleep. They want to be held a lot.
- They may have recurrent chest infections, bronchiolitis, croup or ear, throat or sinus infections
- Have they got a lip or tongue tie?
- Is there a family history of reflux, food intolerances and atopic disease such as asthma and eczema in particular?
- Is their poo mucousy/slimy or is their blood in it? See my blog on baby poo here: What's normal for baby poo?
- It may be worth doing a dairy free elimination diet for 2-4 weeks and this includes chocolate!
And treat it?
- SIDS recommends not elevating the cot or crib as it's a safety issue. If they're on the correct medication the cot or crib should not need elevating.
- The Cocoonababy may be very helpful. A mum I know used this with her reflux baby and it changed her life.
- Watch a video of it here: https://youtu.be/ufqMzHNCu8Q
- Dummies can be useful to help digestion.
- Read my blog on the correct use of a dummy or pacifier here: Dummies: When to use and when to remove
- Go and see your doctor, GP or Paediatrician.
- Space feeds out during the day and night. If breastfeeding aim for 3-4 hourly feeds and formula bottle feeds, try for 4 hourly in the day and demand feed at night. Too frequent feeds may make the reflux worse and smaller feeds given more often can help.
- Baby massage may help digestion and soothe a fractious baby. Also placing baby in a lazy lion hold/tiger in the tree or across your knee may help relieve wind and pain.
- My eBook on baby massage with embedded video to show you how to do it: https://nurtureparenting.com.au/product/baby-massage-e-book/
- I also demonstrate this technique towards the end of my Youtube video here: Video: How to manage wind, gas and colic in your baby
- When your baby is formula-fed, an anti-reflux formula (AR) can help. The bottle may need a faster flow teat as the feed is thickened. AR formula can cause constipation in some babies because of the thickener. However, most babies with reflux will have a naturally sluggish gut.
- Breastfed babies may benefit from being fed lying down on the bed or straddled upright. The mother leaning back slightly in the chair. This can slow the flow if the flow is too fast. it may help to express a small amount before a breastfeed. This position is also known as a straddle position.
- Read more here: http://www.breastfeeding-babies.com/breastfeeding-positions.html
- If there is a cow milk protein intolerance then mum may need to go on an elimination diet if she is breastfeeding: https://www.nurtureparenting.com.au/cows-milk-protein-allergy-and-intolerance/
- If the baby is formula fed he may need an extensively hydrolysed formula such as Neonate or Elecare only available on prescription via a paediatric gastroenterologist.
- Check out this mum's recommendations on moving babies onto extensively hydrolysed feeds: https://www.preciouslittlesleep.com/what-to-do-about-infant-reflux/
- Often babies will need medication if the reflux is severe. Consult your GP or paediatrician for advice on this. Some medications that are prescribed include Mylanta, Zantac, Somac and Losec.
Try these home remedies from Dr Sears to help alleviate your baby's spit-up tendencies:
- Feed your baby twice as often and half as much. This is my general rule for any digestive disturbance. Naturally, if the stomach is less full, the milk will be digested sooner, reducing spit-up.
Burp your baby well during and after a feeding. Breastfeeding moms: Burp before you switch breasts. Formula-feeding moms: Burp halfway through the bottle.
- Keep your baby upright and quiet for 20 to 30 minutes after a feeding. Gravity will hold the food down. Jostling or laying your baby flat right after a feeding encourages spit-up.
Keep a diary
One of the best ways to monitor a health concern and to differentiate between a nuisance and a medical problem is to keep a running diary.
List the frequency and amount of spit-up, and whether it's associated with any symptoms, such as abdominal pain or poor weight gain.
If your diary reveals the occurrence of these or other worrying clues, report these to your baby's doctor. If, on the other than, your diary shows that her spit-up episodes gradually decrease in frequency and volume, you have reason to relax.
Fortunately, there is an end in sight. You can expect the last spate of spit-up between 6 and 8 months when the baby spends most of her time upright and her digestive system has matured.
Work on getting the reflux under control first before you start any sleep training. If the reflux is poorly controlled sleep training is not going to work very well and will put you and your baby through the wringer.
It is important to seek medical advice and/or your Child & Family Health Nurse for help and support.
Here is my new ebook all about reflux, eczema and food allergy which has more in depth information than this blog.https://nurtureparenting.com.au/collections/e-books/products/reflux-eczema-food-allergy-ebook