It’s not big news that the incidence of children presenting with reflux is on the rise. I have yet to establish if it’s due to cases previously going undiagnosed or perhaps even environmental factors but almost one in every three parents I have met in the last number of years have had a diagnosis of reflux with their little ones, be it mild or severe cases. This is different to colic, which I previously posted about
Reflux
Reflux can rear its head a number of ways
- Baby who vomits and spews up regularly after feeds – and in many cases, in between feed times too. With reflux, the ‘vomit’ has a quite distinctive acidic smell. A baby with mild reflux may just spew up and be done with it. A more severe form of reflux will be accompanied by lots of tears and obvious pain.
- “Silent reflux”. In this case the baby will not normally be physically sick, but will scream in pain during and around feeds. This can be harder to diagnose as there is no ‘physical sign’ apart from the tears.
Not all forms will require medical intervention. In fact lots of young infants have some degree of reflux. This causes no problem and resolves spontaneously with time. However, some infants have more severe forms of reflux – gastro-oesophageal reflux disease or GERD. Put simply, these infants have a more complicated range of symptoms and a more complicated digestive system.
When we eat, food passes down the oesophagus into the stomach. Acid is made in the stomach which help to digest food. Stomach cells also produce mucus which protects them from damage from the acid. There is a band of muscle (a sphincter) at the junction between the oesophagus and stomach. This acts like a valve by relaxing to allow food down, but then normally tightens up and stops food and acid leaking up (refluxing) into the oesophagus, causing pain, burning and discomfort.
Many children with reflux disease will be referred to paediatricians for further tests and may require medication. It is not advised to stay on these medications for too long as they completely suppress acid production which is not a good idea long term. For many infants though, it allows their digestive system to calm down and recover before gradually reducing the medication. It also means that they are more likely to thrive as they will start to feed and keep their feeds down.
Advice for parents of children with acid reflux is initially to nurse or feed babies in an upright position to reduce the likelihood of feeds coming back up again. It would also be advisable to try and keep your hands away from their tummies while winding them, so as not to put too much pressure on their little bellies.
Symptoms of GERD
Pain, irritability, constant or sudden crying which doesn’t stop or can even get worse as the day goes on.
Frequent spitting-up or vomiting (where even the walls aren’t safe!)
Refusing feeds or having only really tiny feeds.
Poor sleep habits; inconsistent and frequent waking.
Baby halitosis! Stinky (acidic) breath and “wet” burps.
Sleep Tips to help with Reflux
- Elevate the head end of the cot. You can do this by either buying a wedge that sits under the mattress or blocks that go under the legs of the cot.
- Use a ‘sleep positioner’. The less babies with reflux move in their sleep, the better. The more they move, the more the contents of their stomach move, which is what you want to avoid.
- Swaddle your baby.
- Consider side-sleeping*
- Make sure you sit your baby upright after each feed, in particular the last feed before going to bed, for as long as thirty-five to forty minutes if possible. Baby doesn’t necessarily have to be awake, just upright.
- If you have things to do (and who doesn’t, right?), use a baby sling or a baby carrier after you have fed your baby to keep the little one upright. Avoid using a bouncy chair – this aggravates the issue, as your baby is more likely to throw up.
- If you are bottle-feeding, try to find an ‘anti-colic’ bottle. The less trapped wind your baby has, the better.
- Increase the frequency of feeds and give less milk. Babies are more likely to throw up if they are too full. So give less food in smaller quantities, more often.
Don’t just go straight to Dr Google though – seek real life medical advice. Always.
Note: *I am only too aware that safe sleep guidelines recommend putting babies flat on their backs to go to sleep. A baby with reflux will experience pain in this position. Many babies will be more comfortable sleeping on their sides. Yes, babies are at the lowest risk of SIDS sleeping on their backs and at most risk while sleeping on their tummies. Sleeping on their sides (although controversial) is the middle ground. There is not enough statistical evidence to state that side-sleeping poses a greater risk.