A breastfeeding mom's guide to a reflux baby
Updated: Feb 23, 2019
Sharing all I have learnt about how to help a reflux baby, from elimination diets to medication.
Let me start by saying that I am not a medical professional, just a mum who has been learning all she can from other mums in order to help my little girl with silent reflux, and I’m sharing what I have learnt here. You can read our story so far here.
Although dealing with Lexi’s reflux has been awful, the one upside has been being able to help other mums out there navigate this horrible journey with a little more ease. I have already been able to help other reflux mamas and so my hope is that this blog post will help many more. This blog is written from a South African perspective, I can’t be sure what happens in other countries or what meds are generally prescribed.
WHAT IS REFLUX OR SILENT REFLUX?
Most babies spit up some of their milk at some point (which is known as reflux) but those that spit up a lot can be:
Happy spitters: Lots of vomit but baby is happy and it doesn’t really bother them or affect their weight gain
GERD babies with reflux: Lots of vomit and a very unhappy baby, normally because of the continuous acidic vomit is burning their throat – known as Gastroesophageal Reflux Disease (GERD). They often struggle to gain weight.
GERD babies with silent reflux: Not much vomit or spit-up but lots of discomfort as acidic stomach content comes up into their throats and they swallow it back down. This can be diagnosed by examining the throat and oesophagus or by observing the symptoms.
SIGNS AND SYMPTOMS OF SILENT REFLUX
Does your baby have reflux? This list of signs and symptoms from www.infantreflux.org is pretty comprehensive:
Screaming with pain
Frequent screaming episodes with eyes shut and brows furrowed
Sudden Screaming during Sleep and Wakes up Frequently,
Turning deep red/purple while arching
Startles easily; very irritable and easy to agitate (by knocks on doors, ringing, etc.)
No sleep or only short naps
Sleeps better with upright or with movement
Sleep better at night
Restless nights, thrashing and rubbing face
Stiffening of body
‘Glerking’ noises – like an internal hiccup – “Glunk! Glerk!”
Other noises associated with ruminating ( ruminating = the voluntary or involuntary regurgitation and re-chewing of partially digested food that is either re-swallowed or expelled)
Loud and persistent grunting
Moaning, groaning, and straining during and after feedings, as if trying to pass gas or a bowel movement
“Sour Look”Sour breath/bad breath
Acidic (clear) spit up
Hands in mouth a lot
Pulls away from bottle or breast while feeding and is obviously still hungry
Constantly hungry and still feeds even after being overfed
Very tense during feeding with fists clenched tightly and legs drawn up
Continuous cycle of: eating, spitting/vomit, eating, spitting, eating (feels good going down, but burns coming back up so infant eats more to soothe only to burn again)
Hard to burp
Spit up with pain
Chronic ear or respiratory infections (bronchitis, bronchiolitis, pneumonia)
Constant runny nose
Contant congestion (thick mucus)
Straining to poop and then, when it comes out, it’s soft
Constipation; Going a substantial amount of time without bowel movements
Of course this doesn’t cover everything, and just because your baby has some of these symptoms, doesn’t necessarily mean they have reflux. But personally I found it really helpful to understand that Lexi’s constant congestion, difficulty burping, feeding aversion and problems pooping were all reflux related, not just the sleep issues.
If you or your doctor still aren’t sure if your baby has silent reflux, you can ask your doctor for a pH scope. This is quite an invasive procedure as it entails a catheter down the baby’s nose and into their oesophagus for 24 hours but it give a much clear picture of what is going on. We only did this at 8 months but you can read more about it here.
MY BABY HAS REFLUX, NOW WHAT?
Keep calm and keep breastfeeding. There are cases where babies really do have to switch to a reflux formula or hypoallergenic formula but these cases are very rare. People talk about babies being lactose intolerant (and breastmilk contains lactose), but lactose intolerance is rare, it is much more common for babies to be allergic to cows milk protein. Before thinking about giving up on breastfeeding, there are lots of other steps you can consider first:
1. Write down your reflux story
Write down all the symptoms so that when you are talking to a health care professional, you have a record. I felt like a real chop because I was really vague and no-one really took me seriously when I was convinced there was a problem.It can also be helpful to find other moms dealing with babies with reflux. This could be a coffee date, a Whatsapp group or a Facebook group (there are a number of amazing groups). These moms get what you are going through, have lots of experience and give amazing support. Being on these groups can give you the moral support you need to get answers and solutions from medical professionals.
2. Eliminate possible physical causes
Some reflux babies just have an immature tummy and the pain just needs to be managed until the tummy matures, but other babies have physical problems that can be worked on and greatly improve the reflux.
– A tongue or lip tie can cause major issues with a bad latch and air getting in while baby feeds. This can lead to trapped air, burps and digestive problems. Posterior tongue ties are often missed so try and get a really good lactation consultant to examine your baby and have the tie revised if needs be. Some peads deny the link between a tongue tie and reflux but there are many people who have seen dramatic results.
– Eliminating foods that your baby may be allergic too. A lot of people say that breastfeeding moms can eat anything in moderation and this is true IF it doesn’t seem to affect your baby. If your baby is clearly battling (they have reflux), you should definitely consider changing your diet. Dairy and soy are the biggest culprits, and if this doesn’t help, you can look at more drastic measures.
The top 8 allergens which you should cut out next are dairy, eggs, soy, nuts, peanuts, wheat, corn, fish, shellfish. There are also reflux ‘trigger’ foods; cooked tomato (so spaghetti bolognese was a huge one for Lexi), pineapple, citrus, onion and garlic, spinach.
If this doesn’t help and you know that you definitely don’t want to compromise on breastfeeding your baby, you can try the Dr Sears Total Elimination Diet. The basic idea is to pick the least allergenic food from each food group (lamb, olive oil, pears, courgettes, squash and rice) and just eat those. If this helps reach a baseline, you can slowly add in more foods and watch for trigger foods.Signs that your baby may have a food allergy are:– eczema– cradle cap– bad gas– blood and/or mucous in nappies– very restless nightsKeeping a food journal can also help you pinpoint certain meals or foods that your baby seems to react to.There are also blood and skin prick tests that can be done to determine whether the baby has allergies, but often these are not conclusive. Even though Lexi’s blood work showed that she didn’t have a Cow’s Milk Protein Intolerance, the paed still said that she could have an allergy.
3. ‘Natural' methods of treatment & prevention:
- Visit a chiropractor, especially if your baby was born via c-section
- Visit a homeopath or naturopath
- Boost gut health with probiotics
- Natural meds – some people have had great results from Colic Calm and other homeopathic meds. Stay away from alcohol based meds, gripe waters and tinctures.
- Feed upright and hold upright after feeds
- Burp oftenFeed on demand; smaller more frequent feeds are better
- Oversupply & a forceful let down can aggravate things. Learn how to manage it here.
- Dream feed if your baby is fighting feeds
- Limit time on back
- Tilt bed upright as much as possible
- Use a carrier or wrap for daytime naps
- Tummy sleeping made a huge difference for us (please note that health professionals will not recommend this as it is said to increase the risk of SIDS. I knew that Lexi was strong enough and it was a risk I was happy to take. I’m not recommending this, just sharing that it worked well for us)
Again, I need to emphasis that I am not a medical professional, I am just sharing what other moms have told me, what we did and what worked for us. Most paediatricians will be quick to prescribe Gaviscon and Nexium, although often they are quite conservative with the dosing (in South Africa).If you are anything like me, you might be quite hesitant to give your baby medication, especially serious meds like Nexium. I eventually came to terms with this because I realised that if you don’t medicate, it is likely to get a lot worse before getting better. Not only will you likely have a miserable baby and very little sleep, it can eventually lead to lots more complications like ear/nose/throat infections, feeding aversions, terrible sleep habits and long term damage to the oesophagus. Having said that, some parents choose to just grit their teeth and get through it and it works for them too.
So what’s the deal with the meds? As far as I understand, the Gaviscon is meant to coat the stomach and keep the milk down. It didn’t really work for us but has done wonders for some babies, especially those who actually vomit. If your baby takes a bottle, you can mix the Gaviscon with the milk which is really helpful. If not, you will need to administer it via a syringe. There is mixed opinion about whether to give it before, half way through, or after a feed.
Nexium is a proton pump inhibitor (PPI). Proton pumps produce acid in the stomach, so the Nexium reduces the amount of acid produced. The Nexium needs to be mixed with water (not milk!) and left a few minutes to thicken up and then administered on an empty tummy. This means waiting two hours from when your baby last fed. Once the meds are in, it’s best to wait 30 – 45 minutes before feeding.
This can be tricky if you are breastfeeding on demand but here’s why you do it: the Nexium gets absorbed and goes into the blood stream where it gets ready to work on the acid pumps but it can only shut them down once they are activated by a tummy full of milk. So when your baby feeds 30 -45 minutes after the meds, their tummy fills with milk, the acid pumps try and get going and the PPI is ready and waiting to shut the acid pumps down. They stay shut down for about 12 hours which is why it is best to give a morning and an evening dose. Remember though that the body’s acid pumps start shutting down naturally at about 7pm so it’s best to give evening meds well before then. For a more detailed explanation of how PPIs work, check out this site.
It is also important to make sure that your baby is getting the right dosage of meds. There is no point in going to all the effort of giving meds if it isn’t effective because it isn’t enough. South African doctors are often pretty conservative with meds, but it is quite safe to give babies PPIs up to three times a day. Check out this dosing chart. However obviously if you are giving a smaller dosage and that is working then that is awesome!One last thing to remember about PPIs is that you shouldn’t just stop giving them, you need to wean your baby off them slowly. A good way to do it is to reduce one of the doses in half for a week or two and see if the symptoms return. If they don’t then give this half dose every second day. If there are still no symptoms then try dropping the does all together. Wait at least 5 days to see if the symptoms return.
So here’s a Nexium recap:mix with water and wait to thicken upadminister at least 1.5 – 2 hours after a feed and then wait 30 – 45 minutes before feedingtry to administer before 7pm at night when the body starts shutting down acid productionmake sure your baby is getting enough to make a real difference
Other medication options:
Although doctors tend to automatically describe Nexium, there are other options such as Zantac (an H-2 blocker), or other generic (and cheaper) forms of PPIs (we have used Lancap and Omez, administered in pear puree). Omez worked far better than the other options for us. Check out www.infantreflux.org for more detail on other meds and check with your doctor.
5. Look after yourself Mama!
Whether it is diagnosed or not, moms with reflux babies will often suffer from post-natal depression, and some even suffer from post-traumatic stress disorder. Months and months of sleep deprivation while dealing with a screaming, unhappy baby who needs you all the time can wreak havoc on your mental health. The walls of your home feel so so small but you are also too afraid to go out with your baby in case they have a melt down or need a feed in public.See a psychologist, take an anti-depressant, find other reflux mamas who understand, even if they are online. Your baby has already had a really challenging start to life, they really need a mom who has got it together and is able to keep her chin up and stay positive. Reflux can be hell, but there is light at the end of the tunnel and it does get better, we just might need a little help focussing on the light and believing that we will get there.
Note: This is also not an extensive guide to reflux, there are many other possible gut and digestive issues, medication options, test and potential allergies but I have tried to keep this simple. I need to emphasise again that this post is just my experience, and is very much a work in progress, please feel free to leave comments with questions, corrections or suggestions.