The question a lot of new parents ask when they have a baby that’s unsettled and spitting up is – how do I know if my baby has reflux? Reflux is a topic very close to my heart! My son Jacob had severe Gastro-Oesphageal Reflux Disease (GORD) resulting in his failure to thrive. My daughter Emily’s reflux was more covert as it was silent.
At Mother’s Group and Mum Support Groups you might hear new mums discussing how much is normal for a baby to spit up? Could it be reflux? Are you wondering if your baby has a more serious reflux condition?
When Jacob was finally diagnosed with GORD as a baby it was a very challenging time for my husband and me. Not only were we incredibly sleep deprived and learning how to be parents, but to watch helplessly when your baby is in constant pain and ultimately refusing to feed was very traumatic. It took a long time to diagnose my son’s health issues and so my objective in writing this blog is to help other parents access the information they need and find support that is so crucial. You can read more about my personal experience of having a baby with GORD.
What is reflux?
It is normal for babies to vomit (also known as posseting or spitting up) milk now and again. In fact some babies bring up milk quite a lot – this is called reflux. It can happen any time, anywhere!
If your baby appears to be developing normally, growing and putting on weight, then bringing up a bit of milk should not be too concerning. In fact it’s quite normal. Kirsten Thompson neonatologist at the University of Western Australia has found that “half of babies under 3 months could have reflux to some extent”. But it is reassuring to know that it is common for babies to outgrow reflux symptoms by 1 year of age. My kids’ reflux improved remarkably once they were upright.
Unfortunately, some babies experience a more severe form of reflux in the form of gastro-oesophageal reflux disease (GORD) as was the case with my son Jacob. Some symptoms of GORD include, but may not be limited to:
– baby bringing up a lot of milk
– slow or minimal growth however, some babies with reflux comfort feed and as such have normal weight gain
– baby might be in pain – crying, bringing up their legs, squirming or arching their back as though they’re in pain. It could be sudden or go on for a long period of time. It could present at any time of the day or night but is more likely to happen after or during a feed or when the baby is placed on their back
– baby may be irritable including crying, whining or general fussiness for a lot of the day and/or night
– feeding difficulty or refusal to feed
– signs of abdominal pain such as waking up and screaming or arching their back
– Baby may be easily distracted when out and about and seem happy but then cry when the distraction is removed
– Baby might be tricky to settle or show signs of wind or colic
All children are different and every baby will exhibit different symptoms, some more than others. It is therefore important to go with your gut feeling if you think that your baby is not well and follow up with a health professional.
What causes reflux?
Many babies experience reflux because of a weakness in a valve at the top of the stomach. The oesophageal sphincter (the valve connecting the oesophagus to the stomach) opens to let milk in when baby feeds. It is controlled by a muscle that may be weak at birth or not working properly. Generally over time the muscle will get stronger. Babies are also born with a very small stomach and it takes time for their stomach capacity to grow. Add to fact that babies spend a lot of time lying down, they drink milk which does not have a lot of weight to it and the fact that their oesophagus is quite short and you can see why babies can bring up milk so easily.
Cow’s Milk Intolerance
An intolerance to a protein in cow’s milk can also cause a baby to reflux. With the benefit of hindsight I think that dairy may have exacerbated my son’s reflux. Under your health professional’s guidance elimination of dairy could be trialled to see whether this helps ease symptoms in the first instance. This would mean excluding dairy from your diet if you’re breastfeeding or if your baby is formula fed switching to a dairy free formula.
Tongue and Lip Ties
Tongue and/or lip ties can cause a baby to reflux, also colic symptoms and fail to thrive. The Australian Breastfeeding association defines a tongue tie as:
“Tongue-tie occurs when the thin piece of skin under the baby’s tongue (the lingual frenulum) is very short and restricts the movement of the tongue. The tongue is not free or mobile enough for the baby to attach properly to the breast.”
An upper lip-tie is where a piece of skin under the baby’s upper lip (the labial frenulum) is very short or thick and is pinned too tightly to the upper gum. This can restrict movement of the upper lip preventing it from being able to flange or ‘pull out’.
The surgical procedure called a frectomy is performed to cut the lingual or labial (tissue in the centre of the upper and lower lip) frenum. If you believe that your child has a tongue or lip tie then consult with your doctor, midwife or lactation consultant.
More Serious Causes
– Pyloric stenosis – a valve between the stomach and the small intestine is narrowed, preventing stomach contents from emptying into the small intestine.
– Eosinophilic Oesophagitis – a type of white blood cell called eosinophil builds up and damages the lining of the oesophagus.
How to ease your baby’s symptoms
– Try adjusting size of feeds and the timing of your feeds. Several smaller feeds throughout the day and night are better than fewer larger feeds. Babies have small stomachs so bringing up milk might be their body’s way of emptying the stomach if they have eaten too much
– Hold baby upright after feeding. Try for at least 30 minutes so that he has time to try to digest with the help of gravity! If you don’t have time to carry baby, try a baby carrier or a swing
– Raise baby’s head slightly in the cot or pram. You could try to do this with a towel under the mattress. It should be a very slight incline so that there is no risk of baby falling out or sideways. Baby should still be sleeping on a flat surface so make sure the rise is even across the entire surface
– If your baby is formula fed you could try a different type of formula to see if this suits your baby’s digestive system better. Preferably a dairy free formula alternative.
– Monitor your baby’s weight to confirm if they are digesting enough milk and gaining weight. After seeking medical advice from your doctor, your doctor may suggest starting baby on solids at 4 months.
– Medication – this is a last resort when all other treatment has not improved the symptoms.
Facts about Reflux
Reflux is not only about milk. www.reflux.org.au has identified some common characteristics of reflux that might help you to identify causes of concern:
– feeding issues are common in babies with reflux usually due to discomfort
– it can occur in both breast and bottle fed babies
– there is a high incidence of sleep disturbance in babies with reflux
– weight gain/failing to thrive
– it can be cyclical
– signs and symptoms may change as baby gets older
Contrary to popular thought, silent reflux does not mean that a baby with reflux does not cry. Silent reflux is diagnosed when a baby is believed to have reflux but the physical evidence of milk coming up cannot be seen. A parent may notice movement in their baby’s digestive system but the milk never physically comes up. The baby could be in just as much pain as a baby who vomits often. They might still be irritable but it could be more difficult to make a diagnosis due to lack of “symptoms”. Silent reflux requires the same treatment as other forms of reflux once it has been diagnosed.
When to seek help
Reflux can be a challenging and exhausting experience for parents and their babies. Try to get help and seek medical advice as soon as you become concerned about your baby’s health.
If you notice any of the following then it is wise to seek further advice:
– baby is not putting on weight
– baby is in pain or irritable during or after a feed or is refusing to feed
– brings up milk often
– if your baby is projectile vomiting often then this could be a serious illness and you should seek help immediately.
– if there is any blood in your baby’s vomit. It may look like dark specks.
– it may help to make a diary of your baby’s feeds including timing and note any signs of reflux such as bringing up milk.
Coping with reflux
You may find it a little frustrating cleaning up spilt milk all the time. Hey you might even start to smell like milk yourself. Try using our Bamboo Muslin Wraps as a cover when burping your baby. They are generously sized to catch the worst milky moments. Also make sure you wear clothes that can easily mask the mess (white is the new black) or pack a change of top in your car when heading out. Many parents will understand what you’re going through.
For extra assistance try the Reflux Infants Support Association or speak to your GP or paediatrician.
It’s hard to cope when you have a crying baby who finds feeding time difficult. You want to enjoy this beautiful moment nourishing your baby. I want you to know that I understand completely what you’re going through. The good news is that most babies will outgrow reflux over time as their body matures and develops. In fact most babies will have little or few symptoms by 12 months of age. I have proof that my reflux baby is now a thriving, healthy teenager who won’t touch soft drink because it makes him reflux. So hang in there – it will get better!