Anyone who has suffered the pain of heartburn or indigestion can only imagine how hard it must be for a baby who is suffering with silent reflux, and is unable to tell anyone about it or find ways to relieve it independently. Having had a son myself with severe acid (silent) reflux as a result of initially undiagnosed food allergies, I know only too well the pain of watching your child suffer and feeling unable to help them. Not to mention the affect it has on everyone’s sleep!
Please note -
The information in this blog should not be a substitute for medical advice. Each baby is individual so please follow advice from your childs health professionals. This is a culmination of information I have gathered from personal experience and training, as well as from supporting other parents through support groups, and from working for many years with babies suffering with reflux.
What is normal?
It is worth bearing in mind that it is physiologically normal for babies up to around 18 months to regurgitate milk, and this type of reflux is usually nothing to be concerned about, though it can mean the inconvenience of even more washing and needing to always carry spare clothes for both baby and carer! These babies are often termed Happy Spitters - if its not bothering your baby (ie there's no pain when refluxing their milk) and their weight gain is good, it is usually just something they will eventually grow out of. You can of course use tactics to reduce the likelihood of regurgitation such as those listed below. Some babies will also always bring up a little milk after a feed, and this is normal.
What isn't?
Gastroeosophageal reflux disease (GORD) is less common, and is accompanied by persistent pain and feeding problems - often arching, bobbing on and off the breast/bottle and sometimes feed refusal. This condition needs to be diagnosed by a medical professional.
GORD can be accompanied by projectile vomiting, or it can be much harder to identify - especially if it is silent reflux. This is where the stomach contents (usually high in acid) rise up the oesophagus and don't actually come out of the mouth - though it can come squirting out of the nose at times. This can be very painful for the baby and not always easy to spot. Sometimes you will also hear gulping or choking whenever the baby is laid flat. Again, this can be physiologically normal for a baby, as their bodies are still growing and developing and the sphincter at the top of the stomach can take a while to strengthen, and the oesophagus is short, but it is of concern when it is accompanied by pain and feeding or weight gain issues.
Signs to look out for:
Bringing up milk (this won’t be seen if it is silent reflux but will come up and down the oesophagus, you may hear it as frequent gulping) and being excessively sick during or after feeding. This will be more than the usual ‘posset’ that is normal. Often this can happen some time after the feed has finished
Repeated projectile vomiting, accompanied by pain
Coughing, choking, excessive swallowing, gagging or gasping during, after or in between feeds
Arching back during or after feeds
Unsettledness during feeds, bobbing in and off the bottle or breast
Excessive drooling
'Wheezy' chest or constant blocked nose but without other cold/cough symptoms
Abdominal pain
Inability to maintain weight. However some babies feed for comfort so will continue to put weight on, and will constantly seem to be asking to be fed, however while feeding can soothe and temporarily reduce the feeling of the milk coming back up, it is a vicious cycle if they feed too much, as it increases the frequency of the reflux
Refusal to feed, babies can associate feeding with pain and feeling uncomfortable
Screaming out soon after falling asleep or during sleep, waking with a shrill, sudden cry of pain or sounding frightened
Only taking very short naps (often 20 mins or less), unable to fall into a deep sleep and complete a whole sleep cycle. This may not be down to reflux however - some babies are hypervigilant for other reasons
Preferring to be held upright, hating being laid down or unable to be laid flat without discomfort or fussing
Excessive crying with no obvious cause
My top tips for coping with reflux:
Try to hold baby as upright as possible for feeds
Keep baby upright after feeding for at least 20 minutes to keep the milk down - ideally 30-60 mins. You could seat them in a well supported baby chair/bouncer for this time if they are comfortable in this
Don't wind or jiggle them around too vigorously - handle them gently while their tummy is still full
Dummies can be useful, the extra saliva produced from sucking on a dummy can soothe the throat and reduce the feeling of reflux
Avoid tight waistbands and nappies
Try not to overfeed your baby, it can be helpful to give them a little break halfway through their feed or feed little and often - so rather than a 6-7oz bottle every 3-4hrs, a 3-4oz bottle every 2-3hrs (dependent on age and recommended milk intake of course) or small, short frequent breastfeeds.
Change your baby’s nappy before feeding - avoid laying them flat straight after, it may also be helpful to raise the head end of the changing mat but be very careful never to leave them unattended
Try to get into a sleep, feed, play routine to give them time to let their milk go down before they are laid flat to sleep, and also to avoid getting into the habit of falling asleep when held upright after a feed
Have your baby checked for a tongue tie - this can be easily missed and can cause problems latching onto the breast or bottle which can result in extra air being taken in and can cause colicky/refluxy symptoms
Consider the underlying cause of the reflux - is it just physiological (remember it is very normal for babies to bring some milk up after feeds if not accompanied by pain), or could it be a possible allergy - most likely a cows milk protein allergy (CMPA)? You should request a referral to a paediatrician or dietician to explore this further if you think this could be a possibility. Be mindful that not all allergies can be 'tested' for, and a delayed reaction allergy (non IgE reaction) can happen up to 20 hours after exposure and can only be diagnosed with removal of the offending food group from Mum/baby's diet. This type of allergy is notoriously difficult to spot/diagnose but is often seen in babies with reflux.
See your GP or health visitor if your baby is unable to feed well, lay flat or sleep for reasonable periods without waking in discomfort. You may require a referral to a paediatrican or gastroenterologist.
It may be useful to take a video of your baby to show your health professional what your baby does, as its common for them to act like the ‘perfect’ smiley baby in the consultation room as there are distractions and its somewhere new, just to return home and go back to the miserable, uncomfortable baby that you see the majority of the time!
Please note - If your baby is vomiting bile (green liquid) or blood, has black or bloody stools, a distended stomach, or is persistently refusing feeds and/or losing weight, then seek medical attention as soon as possible.
Possible treatments (under medical advice only)
Thickened feeds
Dietary management - removal of dairy, soy, eggs and other foods from mothers diet if breastfeeding, or baby’s diet if weaning or on cows milk formula
Trial of hypoallergenic formula
Medications that can relieve symptoms such as Gaviscon or Omeprazole
Further tests such as ph probe test or impedance study - though usually only in very severe or prolonged cases
If you're struggling with your child's sleep, suspect they may have reflux, are dealing with multiple night wakings, early morning wakings or resistance to bedtime, please contact me! Or please visit www.sweetdreamssleepcoaching.co.uk/book-online to book a consultation and bespoke sleep coaching package tailored specifically to your family's needs and parenting style.
Sweet Dreams!
Emily x
The UK’s only charity supporting families of children suffering with reflux, Living With Reflux www.livingwithreflux.org has lots of information and helpful resources if you think your baby or child may be suffering with reflux, and also has a great active Facebook support group and local support groups around the UK.