10 Tips for reducing reflux in your infant
Does My Baby have Reflux?
By Lisa Lawmaster Hess
When you dreamed of getting back into your pre-pregnancy clothes, did you envision accessorizing with a cloth diaper worn perpetually over your shoulder? Spit happens, as the drool bib proclaims; it’s as much a part of infant development as naps and 2 a.m. feedings. So, how are parents to know if their baby is spitting up too much?
“Reflux is kind of controversial,” says Dr. Brenda Singal, a pediatrician with York Pediatric Medicine. “Is reflux a normal part of being an infant, or is it a disease?”
Gastroesophageal reflux (GER) occurs when the ring of muscle at the bottom of the esophagus (the lower esophageal sphincter) allows food to re-enter the esophagus from the stomach. It is normal for this muscle to open and close; it opens to allow food to pass from the esophagus into the stomach and to release gas after we have eaten. In infants, however, the muscle that keeps food from re-entering the esophagus may not be fully developed until a baby is at least 6 months old, causing babies to cough, spit up, or even throw up.
“There are a number of children who develop difficulties with reflux at very, very young ages. As young as a month,” says Dr. Michelle Klinek of the Family Center for Allergy and Asthma in York. “Reflux in young children is often due to immature anatomy. As they get older, the reflux resolves.”
Babies are especially prone to reflux not only because of their immature anatomy, but also because their diets are primarily liquid, and liquids are more easily regurgitated than solids. In addition, babies spend most of their day lying down, a position that may make it easier for food to reflux. More than half of all infants experience reflux during their first three month. For most babies, reflux is more of an inconvenience than a medical issue.
“For kids that are happy spitters, that are growing well and happy feeders, we talk about positioning,” says Singal. Because reflux usually occurs an hour to an hour and a half after eating, Singal suggests that parents not lay a baby flat on his back right after a feeding. Instead, she suggests propping the baby at a 30-to 45-degree angle, which mimics the positioning of a car seat.
“Gravity’s your friend,” says Singal.
Burp your baby after he’s consumed one or two ounces of formula. For breast-fed infants, burp after feeding on each side. Do not overfeed. Talk with your infant’s doctor or nurse about the amount of formula or breast milk that your baby is consuming.
Not all babies are “happy spitters.” An infant with reflux may refuse food, be fussy or irritable after feedings or arch her back while eating.
“They arch is to extend the neck to make the distance between the airway and the stomach longer,” says Klinek.
If you are struggling to feed your baby, or she is consistently fussy during or after feedings, or appears not to be gaining weight, it’s time to consult the doctor. Many babies with reflux will feel better with simple changes in positioning after feedings; others may respond to a different formula (or changes in the diet of their nursing mother) or less food at one time. For a small number of babies, medication may be recommended.
“Most pediatricians and family doctors are familiar with reflux,” says Klinek. “If it’s reflux and you treat it, your baby should be much, much better.”
10 Tips to Help Reflux
It’s important to realize that not all babies with reflux will require medication or have difficulties with their reflux. Many infants will benefit greatly from some simple steps that you can start trying right now:
Positioning. Keeping babies upright during and for at least 30 minutes after feedings can help to reduce reflux by allowing gravity to work at holding the food in their tummies.
Car Seats. Look for car seats that allow babies to be reclined enough that they aren't slouched yet inclined enough that they are fairly upright.
Sleeping. Keep baby propped during sleep. The American Academy of Pediatrics recommends all babies sleep on their backs because it reduces the risk of SIDS. This is fine for babies with reflux as long as the baby is safely propped up to at least 30 degrees.
Carrying. Try carrying baby around as much as possible in a baby carrier throughout the day. Carried babies tend to cry less, and crying will make reflux worse. Plus, it keeps baby upright.
Clothing. Make sure baby stays in loose-fitting, elastic waists whenever possible.
Thickening. Some babies with reflux will respond well to thickening their milk with cereal. As always, discuss this with your pediatrician before trying it.
Feeding. Breast milk is more hypoallergenic than formula. Try eliminating the foods that can make reflux worse, i.e., dairy products, caffeine, fatty foods, spicy foods, citrus. If bottle feeding, formula changes can help some babies. Try smaller, more frequent meals through out the day. Also, avoid feeding baby right before bedtime.
Burping. Stopping to burp baby frequently (at least after every ounce) during feedings can help.
Sucking. Sucking on a pacifier can increase saliva production, which can help neutralize some of the acid that may come up.
Massaging. Try infant massage, it’s been shown to improve digestion and will help relax baby.