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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 
It is also possible for babies to suffer from ‘silent’ reflux, whereby they experience reflux  symptoms but the stomach contents doesn’t get regurgitated into the mouth and therefore is re swallowed into the stomach.  Did you know? 40% of infants suffer from physiological reflux. When Do I Need to Worry about Reflux? In most cases simple physiological reflux will get better on it’s own without needing any  medication. As your baby grows their digestive system will become better developed and the  valve between the stomach and oesophagus stronger. However, that is not to diminish the  difficulty faced by families with a baby who suffers from reflux. Dealing with a refluxy baby,  especially if it causes baby distress, can be overwhelming, exhausting and often confusing. Don’t  be afraid to to reach out for help (health visitor, GP, other parents, friends, family, reflux support  groups) and ask any questions you need clarifying!  In a small number of cases the symptoms of physiological reflux can worsen and start to cause  other health complications. This is known as Gastro Oesophageal Reflux Disease (GORD) and  requires medical advice to be sort to assess whether reflux symptoms needs to be treated with  medication. This information can sometimes scare parents who are unsure whether their baby has  simple physiological reflux or GORD- my advice would be to go with your gut feeling. You know  your baby better than anyone else and if you believe them to be in distress or suffering the  symptoms below it is important to seek medical advice regardless of what others may suggest. 
  • Not gaining weight 
  • Extremely distressed 
  • Vomit is green or blood stained 
  • Experiencing breathing difficulties/wheezing 
  • Aversion to feeding 
As a general rule of thumb, if your baby is happy and gaining weight appropriately, there is no  need to sort medical advice and reflux symptoms can be managed through feeding and care  routine tweaks.

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 
which the stomach empties and relaxes the oesophagus. What Medication could my Baby be Prescribed to Deal with  Reflux? If you have tried these practical tips and found that baby is still increasingly distressed and  suffering adverse symptoms, you may find that your GP decides medication is the next option. 

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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