A Guide To Reflux
Although it is estimated that 4 in 10 babies suffer from reflux, I am still shocked to hear stories almost daily of misdiagnosed babies, under supported parents and months of distress for both baby and parents which could have been avoided if dealt with correctly. Although I work 1:1 with families dealing with reflux, I want to widen the support I offer and therefore I have written this post to help demystify, clarify and offer practical advise on reflux for those families working through their reflux journey.So, What Exactly is Reflux?
Gastro-Oesophageal Reflux (also known as physiological reflux) occurs when contents the stomach comes back up into the oesophagus, resulting in baby either posseting/vomiting their feed or re-swallowing the regurgitated stomach contents. Physiological reflux is very common in infants due to their underdeveloped digestive system and the amount of time they spend lying down, a position which can cause increased physiological reflux. Other symptoms of simple physiological reflux include;- Frequent coughing and/or hiccups
- Irritability/episodes of upset
- Frequent ear infections
- Frequent night waking
- Not gaining weight
- Extremely distressed
- Vomit is green or blood stained
- Experiencing breathing difficulties/wheezing
- Aversion to feeding
Allergy as a Cause of Reflux
Research shows that 25% of infants who suffer from moderate to severe reflux symptoms have cows milk protein allergy induced reflux. When addressing whether your baby may be suffering from CMPA it is important to look at the full picture and identify any other symptoms such as diarrhoea, constipation, eczema, rashes, swelling of the face and wheezing. If you notice any of these symptoms, your baby’s reflux may be caused by allergy and therefore medical advice should be sort.Practical Advice for Dealing with a Refluxy Baby
- Always respond to baby’s hunger cues swiftly. If your baby becomes hungry and begins to cry before a feed they will take in more air which can then lead to trapped wind and excess gas in the stomach, exacerbating reflux symptoms.
- If you are formula feeding ensure that you do not shake the bottle too much whilst preparing the feed/leave it to settle before offering the feed. Shaking the bottle will incorporate air into the milk so try gently swirling the bottle rather than furiously shaking.
- Over feeding can often cause/exacerbate reflux. Trial smaller feeds more frequently (ensure baby is still getting the total daily recommended amount of milk) to help ease discomfort after large feeds.
- If breast feeding, ensure that baby is latching correctly and feeding effectively. If in doubt seek the advice of an lactation consultant to review feeding. International Board Certified Lactation Consultants in your area can be found here https://lcgb.org/find-an-ibclc/
- Pause whilst feeding baby to ensure that they are being properly winded. Top Tip- A baby’s stomach is not a simple circular shape, part of it is in fact above the intake pipe (oesophagus) when a baby is held straight upright. In order to allow any trapped wind in this area of the stomach out you will need to hold baby so that the input pipe is above all areas of the stomach. The sweet position that allows this to happen is to hold baby with their head on your right shoulder, with their bottom in the middle of your chest/stomach.
- Aim to keep baby upright for 30 minutes after their feed. This can be done using a sling but avoid placing baby in a baby bouncer where they may slump.
- Avoid putting pressure on the tummy for 30 minutes after a feed. Baby will likely not thank you for choosing post feed as an opportunity for tummy time!
- DO NOT give up breastfeeding!! I have worked with many mummies who have been told to stop breastfeeding and replace with an anti reflux thickened formula to help stop their baby's reflux. This is terrible advice! Breastmilk is the best form of nutrition for your baby, reflux or no reflux. There is also uncertainty over whether these formulas make much of a difference and concern that these formulas require a lower temperature to prepare which does not kill harmful bacteria in the formula powder. I advise that breastfed or formula fed, always seek professional advice before trying these anti reflux thickened formulas.
- Struggling with a nap routine because baby is irritated by reflux? Aim to feed baby when they wake from a feed so that they have a period of time upright before being put down for their next sleep. In accordance to the Lullaby Trust Guidelines for safer sleep, always place baby on their back to sleep. However, placing something underneath the mattress that raises it slightly so that the whole mattress is still flat but sloping slightly can help to ease reflux symptoms. If all else fails, take the pressure of yourself and try a sling nap where baby is held upright.
- Consider whether introducing a dummy could help ease reflux symptoms. Not only does sucking have a soothing affect on babies, sucking on a dummy can also speed up the time in
Here is a brief summary of the medications used to treat reflux for you to refer back to:
Alginate Therapy E.g Gavison or Carobel These type of medications work by forming a gel when combined with gastric acid which then prevents the stomach contents from moving back up the oesophagus. Caution should be taken whilst using this medication as it can cause constipation, leading to further distressing symptoms if not addressed. Alginate therapy is usually the first medication prescribed for physiological reflux when adaptations to feeding routine have not worked. However, alginate therapy shouldn’t be used long term without consideration and should be be stopped periodically to ascertain whether the child still needs this medication to manage reflux symptoms. Proton Pump Inhibitors E.g Omeprazole Proton pump inhibitors suppress stomach acid by blocking the proton pump within the gastric parietal cell. However, this type of medication can come with a number of unpleasant side affects such as vomiting, diarrhoea, constipation and headaches. In particular, proton pump inhibitors can also increase the risk of gastro-intestinal infections due to the lowered level of stomach acid which allows bacteria to grown within the stomach and intestine. Research has also begun highlighting the long term effects of taking omeprazole, one of which is the increased risk of bone density and osteoporosis, however this still needs further research to become conclusive evidence. (Tags: Reflux, Allergy, Intolerance, Baby, Fourth trimester, Newborn, Feeding, Breastfeeding, Bottle feeding, Colic).
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