How do I know if my baby has reflux?

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Baby in distress crying

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 reflux.

What is reflux?

My reflux baby at 8 weeks

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. It can happen any time, anywhere!

Possetting is where baby vomits fresh milk and is more like milk overflow, for example when baby burps immediately after a feed and spits up.  This needs to be differentiated from the small curdy vomits that occur after feeds.  Typically 20 minutes or so after a feed.  When the milk has mixed with stomach acids and enzymes therefore creating the curds.

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 and able to sit and stand.  It’s probably the reason why these development milestones were achieved very early for both my kids!

Severe reflux

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 signs and symptoms of GORD include, but may not be limited to:

  1. Spitting Up: Most babies spit up after feeding, and this is considered normal. However, if your baby is frequently spitting up large amounts of vomit with curds, seems to be in pain, or is not gaining weight properly, it might be a sign of reflux.
  2. Sleeping Problems: Baby may be very difficult to settle to sleep and wake frequently in distress.
  3. Feeding Issues: Dr Renee Shilkin former GP and author of Crying Babies & Beyond has identified 2 types of feeding issues.  First is distress on sucking and can result in some mother’s discontinuing breastfeeding.  Bottle feeding may be successful because baby can be held upright.  Babies may then refuse the breast if they know they can feed without discomfort with a bottle.
  4. Frequent Crying: Reflux can cause your baby discomfort, leading to excessive crying, especially after feeding.  Typically 20 or so minutes after feeding.
  5. Arching Back: Some babies with reflux might arch their back during or after feeding, as if trying to relieve the discomfort.  They may also bring up their legs and squirm.
  6. Irritability During or After Feeding: Reflux can lead to pain and discomfort, making your baby fussy during or after feeding.  Baby may be excessively irritable, whinge, cry or scream for prolonged periods without apparent reason.
  7. Difficulty Swallowing: If your baby is having trouble swallowing or seems to be choking or gagging frequently, it could be related to reflux.
  8. Poor Weight Gain: If your baby is not gaining weight as expected, it could be due to reflux interfering with their feeding habits.  Be aware that some babies with reflux comfort feed and as such have normal weight gain
  9. Respiratory Symptoms: Reflux can sometimes lead to respiratory issues like coughing, wheezing and or snuffly due to constant irritation from refluxed milk containing acid and enzymes.  My son constantly sounded hourse.
  10. Ear Issues: recurrent ear infections can further exaserbate baby’s distress.
  11. Breath holding or apneic spells: can happen and this can be frightening for a parent.

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?

Oesophageal Sphincter

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 reflux symptoms

–  Try different positioning during feeding – I found positioning my son in an upright position definitely helped.  We used the football hold or twin hold where the head is held high and the baby’s body is lower whilst feeding.

– If your baby is refusing the breast or you want to continue breastfeeding then you could try ‘finger feeding‘ for a time to try to preserve breastfeeding.  Finger feeding allows baby to remain upright and your finger resembles a nipple.

– 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. Also try the football hold

–  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.

– Swaddling your baby – can help sooth baby’s startle reflex

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

Silent Reflux

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.

Mum burping baby

Coping with reflux

It’s difficult to cope when you have a crying, screaming and distressed baby who finds feeding time difficult and won’t settle to sleep. You want to enjoy this beautiful time nourishing and nurturing your baby. I want you to know that I understand completely what you’re going through.  We couldn’t go out with baby Jacob for months due to his distress and projectile vomitting.  I was so worried and I felt no one would listen to me.  If you suspect that your baby has reflux then do everything you can to find a healthcare professional that will not only listen to your concerns but will take action.  Trust your motherly instinct to make sure your baby and you get the help and support you need.

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.  So hang in there  – it will get better!

For extra assistance try the Reflux Infants Support Association or speak to your GP or paediatrician.

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.  I would often travel with large bath towels when going to other people’s houses.

 

Nicole Cassey

written by

Nicole Cassey

Nicole Cassey, Mum to Jacob and Emily, founder and general dog’s body at Bubbaroo. Nicole was inspired to create Bubbaroo and Australia’s first swaddle after the personal experience she had with her first child, Jacob.

Nicole explains "It is such a steep learning curve becoming a parent. Getting to know the baby you created and finding your groove as a parent. You sometimes feel like you need to become a detective to try to interpret your baby's cues, personality, cries and behaviour. This is my passion to help parents on their journey, especially new parents as they transition to parenthood."

Nicole has a passion for sharing knowledge and community, regularly organising and presenting at various expectant parent and sleep workshops. Nicole ensures she is up to date with the latest evidence-based safe sleep and health research. Bubbaroo collaborates with experts in their field that share similar values and philosophies and have a passion for helping and supporting parents and expectant parents.

Nicole’s attention to detail with the creation of her premium quality baby, toddler and child sleepwear is exceptional. Nicole has been committed to ensure that Bubbaroo is not just a mass market brand producing products, Nicole’s focus is on helping your baby sleep safely in products that stand the test of time.

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