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).