Reflux is a tough one!!! Severe reflux is a parents’ worst nightmare, as it is always there, and needs to be managed constantly. I see this a lot in my practice. Here are a few facts that you need to know about reflux, as knowledge is power:
- All babies have reflux. Anatomically, there is a valve at the top of the stomach that is meant to close off and prevent backflow of stomach contents/acid up the oesophagus. In small babies this is never closed as it is not yet a mature muscle. Therefore, when babies are put in a lying down position, they get reflux. If babies take in too much milk and their stomachs become over inflated, their reflux symptoms worsen. This is why reflux starts to become an issue at about 3 weeks of age, as volumes of milk are increasing. Makes sense right?
- If mum had a history of reflux in pregnancy and needed medication to manage this, then baby is at a higher risk of developing reflux.
- Usually by 4 months, babies start to “grow out of” reflux and it improves (which is a light at the end of the tunnel for many parents).
So, your baby is showing signs of reflux such as:
- crying in their sleep, crying when being put into a lying down position, and only settling over your shoulder in an upright position.
- Bringing up milk or being sick during or shortly after a feed.
- Swallowing or gulping after winding (swallowing down content that has risen up the oesophagus)
- Not gaining weight as not keeping feeds down.
So what can you do?
The following is a list of things for you to try. Some will work for you and your baby and not for others. As with everything its trial and error.
Examine your diet
Generally, you can eat everything in moderation when breastfeeding, but if your baby has reflux symptoms and is unsettled, it may be worthwhile keeping a food diary and noting if a food you are eating is causing your baby to be upset. If you cannot identify a possible cause, try eliminating dairy products from your diet, including any foods including cows milk protein (butter, yoghurts, milk and cheese, but don’t forget the hidden dairy in some of those foods such as milk solids).
Cows Milk Protein Allergy
Cows Milk Protein Allergy occurs in 3 out of every 100 babies in the 1st year of life. It is an allergic reaction to the protein in cows milk and symptoms include problems with the skin (eczema type rashes or hives), digestion (diarrhoea, vomiting, constipation or reflux) and respiratory system (wheezy after feeding, or coughing). CMPA usually occurs before a baby’s first birthday. If you think your baby may have CMPA, eliminate all dairy foods from your diet for 3 weeks (it takes 3 weeks for all dairy to be eliminated from your system). If there is no improvement in symptoms and you are 100% dairy free, then it is not CMPA.
Lactose intolerance is not an allergy, and it is very rare in children under the age of 5. Lactose is a milk sugar, and is the most important carbohydrate in breastmilk. It has many health benefits to baby including protecting gut flora and aiding calcium absorption. All babies are born with the enzyme lactase in their tummies, which help to breakdown the lactose in milk. If for any reason there is insufficient lactase, symptoms of lactose intolerance will develop. Symptoms of lactose intolerance include intense crying post feed, and profuse green, frothy diarrhoea. If lactose intolerance is suspected, contact your GP. Do not stop breastfeeding unless you have been advised to by a Paediatrician (Porto 2016).
Laid back breastfeeding keeps the baby semi-upright so that the milk cannot flow back up the food-pipe. See https://latchingon.ie/postnatal/laid-back-breastfeeding/. When you put your baby down to sleep, tilt the head of the mattress so that the baby’s head is higher than his/her stomach. You can also wear your baby in a sling, so that you are hands-free, until you can put your baby lying down.
If your baby is in pain/distress, try the colic hold, which applies gentle pressure to the baby’s abdomen, and may help to free some of the gas and increase movement of air in the tummy. You can do this by lying your baby face down over your forearm and rubbing their back:
Gentle rocking motions and slow dancing with your baby also helps to comfort them.
Analyse how breastfeeding is going
Do you have a large supply? Is baby struggling to cope with the volume of milk? Signs of this are choking on the milk, latching off to catch breath, gaining huge volumes of weight every week (150-200g/5-7oz a week is normal, but all babies have growth spurts and dips so never read too deeply into just one weeks weight). If this is the case, your baby could be getting a large volume of milk that his/her tummy just can’t handle. The following are strategies to try if you think this is the case:
- Make sure you are not swapping too frequently between breasts, as this gives baby a lot of the foremilk, which is thirst-quenching, but not filling. Instead, try to keep each breastfeed to one side only.
- If you are already doing this, try block feeding for 2 consecutive feeds on one side only. In this way, baby is getting more hindmilk, which is rich in fat and keeps baby fuller for longer. This also reduces your oversupply (if that is what you have). If you do not wish to reduce your supply, then hand express/pump on the side you are not feeding baby on and you can put this aside and build a freezer stash.
Bear in mind, that you should always consult with a breastfeeding specialist like a Lactation Consultant if you are experiencing problems such as oversupply/reflux, as there could be other things going on, and a Lactation Consultant is a specialist in infant feeding.
The power of a bath
Bathing your baby is a lovely soothing time, but also if you can get the baths that are “hands-free”, your baby can kick and splash, and this really helps to distract the baby from the wind and it also helps to get the wind moving in their tummies.
Probiotics are live microorganisms (in most cases bacteria) that are similar to beneficial microorganisms found naturally in the human gut, namely Lactobacillus and Bifidobacterium. They are often added to yoghurt/milk drinks or supplements. Some studies have found that certain probiotics resulted in much shorter crying episodes, less spitting up, and less constipation (Healthline 2018). Check out https://www.healthline.com/health-news/children-probiotic-may-prevent-colic-in-infants-011314 for further information. Breastfeeding mothers should not need to take probiotics as breastmilk is naturally probiotic. If however, you are combination feeding or formula feeding, or have been on antibiotics yourself lately, probiotics may help you to rebuild you and your baby’s healthy gut flora. Please seek medical advice before taking probiotics or giving them to your baby.
Bodywork is an all-encompassing term for various hands-on alternative therapies such as Cranio-Sacral Therapy, Chiropractors, Osteopath’s, Bio-Energy Healers and Acupuncturists. At present in Ireland Cranio-Sacral Therapy is the most well known and widely used alternative therapy, but like anything else, it depends on what practice is set up closest to you and the reputation of the practitioner. These therapies are ‘natural’ and usually work in someway with the body’s energy. They are indicated for babies born through traumatic and instrumental births, C-section babies, breech babies, babies post tongue-tie reversal, babies with torticollis, and in the treatment of reflux and colic. Before you try medication it is worth trying some bodywork first, in my opinion.
Over the counter remedies
There are several over the counter remedies that your GP or pharmacist will be happy to advise you on.
Ok, so you have tried all of the above, but your baby is getting worse, losing weight, or you feel that your ability to cope is dwindling. You may be beginning to doubt yourself, or your ability to feed or comfort your baby. Your baby is very upset most of the time, and you are exhausted. Its time to get your baby reviewed by your GP, if you haven’t already. Your GP will assess your baby from top to toe, and ensure there is no other cause for baby’s unsettledness, such as infection, constipation etc.
Your GP can also prescribe some medication to help your baby, but if this is necessary you should see a Paediatrician and your GP can organise this if they feel it is necessary. Most often, reflux gets better with time. By about 4 months most parents will notice an improvement, as this is the age babies are better able to sit up straighter and their stomachs are more mature. However when your baby is upset, getting to 4 months old can seem like a lifetime away, and nobody wants to wish that time away.
Make sure you take all the help you can get and take regular breaks from your baby. A short regular break from your baby makes the reunion all the sweeter and helps us cope with the difficult times. Also, seek family help with cooking, laundry, collections of other kids from school or activities, and order your food shopping online. Remember: A dirty house builds extra immunities. So sit down and relax with your baby.
Healthline (2018). Probiotic May Prevent Acid Reflux, Constipation, and Colic in Infants (Online). https://www.healthline.com/health-news/children-probiotic-may-prevent-colic-in-infants-011314 [Accessed on 02/01/2021]
Porto A. (2016) Lactose Intolerance in Infants and Children: Parent FAQ’s (Online). ttps://www.healthychildren.org/English/healthy-living/nutrition/Pages/Lactose-Intolerance-in-Children.aspx#:~:text=Can%20infants%20be%20lactose%20intolerant,older%2C%20the%20lactase%20enzyme%20decreases. [Accessed on 31/12/2020].