All babies spit up and regurgitate their feeds from time to time. This is extremely normal and can be expected when you have a new baby. When these episodes become persistent and are accompanied by pain or weight loss, it may be time to visit your HCP (Health Care Professionals).
Although reflux is regularly measured and associated with a baby regurgitating and vomiting, there is also another part of reflux that isn’t visible. This is called silent reflux and is harder to recognise and diagnose. Outwardly, the baby seems extremely healthy and would be considered as “thriving”. When a baby with silent reflux is presented to a HCP, they are often diagnosed with colic or considered to be a "fussy" baby.
Signs of silent reflux
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Baby crying excessively, and not just in the afternoon (as is with colic)
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Baby seems to want to feed ferociously, but never seems full (a baby may do this to ease the acid burn)
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Back arching when being held or seeming distressed when laid down on a flat surface
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Poor sleeping habits, during the day and night
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Baby hates the car seat (some babies dislike the hunched over position of the newborn seats)
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Baby seems to be constantly trying to get away from being held, will push and scrape at parents' face or arms (more noticeable in older babies)
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Baby cries most of the day or whines and wants to be picked up, or will display attention-seeking behaviour (this is to distract themselves from the pain). You can't spoil a small baby!
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Pulling or scratching at face or back of the neck
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Head banging or head extended right back when sleeping (this can be a sleeping technique that some babies adapt to stop the acid travelling up the oesophagus and into the throat)
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Sneezing, itching, rash or excessive runny explosive nappies (some signs of allergy/intolerance to cow’s milk protein or soy (CMSPI). It’s good to remember these factors can also be present in a baby who repeatedly vomits or spits up large volumes of feed. These signs and symptoms can be found in bottle-fed and breastfed babies!
Reflux generally subsides when a baby is roughly four months old. If reflux persists past this age, it may be an indication that your baby has reflux disease. This condition is medically known as GORD (Gastroesophageal Reflux Disease). Medications and further medical examinations may be needed.
Parenting a reflux baby is really tough and can be a very challenging and daunting experience.The regular baby rules that apply to new infants may need to be adapted and changed around slightly.
Here are a few tips for parenting a reflux baby
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Sling wearing has had a lot of positive feedback. Keeping the baby in the upright position will help with episodes of reflux, and some babies like the feeling of being close to their parent/caregiver. (My own little reflux baby didn’t like the sling at all, but many parents have had great results using them).
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Feeding smaller amounts on a more frequent basis can help. Changing the baby before a feed is also beneficial, as it limits the need to place the baby on their back after being fed.
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You may have to tilt your cot or mosses basket at an angle (safely).
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A wedge for sleeping will keep your baby tilted as much as possible, too. They can be expensive, so check online for second-hand ones.
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Different kinds of baby bottles can help, so try a few brands until you find one that suits your baby.
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Baby monitors that have move sensors and video control are also helpful if your baby has any aspiration or suffers from blue spells or coughing. (A wider, more comprehensive explanation can be found in my book, The Reflux Bible).
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Experiencing a baby that cries a lot can cause a parent to be flustered and embarrassed in social settings. Many parents state that they isolate themselves and feel they cannot do normal baby activities with their child. Baby massage classes for reflux babies are really beneficial to both child and caregiver. A good therapist will assist you on massaging the baby in an incline position. These classes are specifically for babies with reflux, so there is no need to be embarrassed if your baby cries more than average, as everyone there is in the same situation and understands.
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Try to seek out a support network close to you. This is a vital key to getting through those first few months, sometimes years. Remember, you are not alone. Unfortunately, there is a serious epidemic of reflux and reflux disease globally. My support group, Surviving Reflux Ireland, has over 7,000 members and is growing by the day. We welcome all reflux and allergy parents and caregivers for advice and support.
Myths Debunked
Weaning early cures reflux
This is not necessarily true, and in most cases can exasperate and aggravate reflux. Many reflux babies also have intolerance and an allergy to proteins in formula and breast milk. This can suggest that they may have a more delicate digestive system than most babies. Due to this, many babies seem to experience more episodes of reflux when being introduced to new foods.
For this reason, I always recommend taking weaning really slowly and choose reflux friendly foods that have been noted to be safe for others when weaning.
Generally spoon feeds should be started about six months (26 weeks) for breastfed babies, and not before 17 weeks for bottle-fed babies. However, the exact time for introduction will depend on your baby’s signs of readiness.
Introducing spoon feeds before 17 weeks is not recommended, as your baby’s digestive system is not ready yet. Early introduction of spoon feeds (before 17 weeks) can increase the chance of the risk of food intolerance in later life.
A breastfed baby won't have an intolerance to dairy
This is not true! If you are breastfeeding your baby and you are consuming dairy or soy, you can pass this on to the baby through breastmilk. A baby that is breastfed and has any allergy to the proteins will experience the same issues as a bottle-fed baby with CMSPI (cow’s milk soy intolerance). Eliminating all traces of the proteins from your diet can help this situation, but remember that dairy and soy can be in the most unsuspected foods. Even vitamins have traces of soy or dairy and can affect the infant, so check all labels on products.
You need to stop breastfeeding a baby with reflux and CMSPI
This is not true! You can successfully manage reflux and CMSPI while breastfeeding. Please source a certified breastfeeding specialist, who will guide you through the whole process. Breast milk is actually much better for your baby and is easier to digest, which, in turn, will help reflux greatly.
The baby is putting on weight and thriving so everything is fine
This is not true! Although it is a good sign that a baby is thriving and gaining weight, it can also mean that the acid reflux is silently causing damage to the oesophagus and ear nose and throat. When a baby with reflux is gaining excessive weight, it may mean they are over feeding to try to alleviate the burning sensation from the acid and isn’t necessarily hungry.
She/he looks fine, only babies who vomit have reflux
This is incorrect! A baby does not have to vomit, spit up, or regurgitate to have reflux. The absence of this is classed as silent reflux, and causes the baby enormous pain and suffering. This can also cause secondary acid damage to the infant.
A baby will grow out of reflux when they can sit up or walk
This is not entirely true. While this may be the case for babies with GOR (Gastroesophageal Reflux), it is not necessarily a case for babies with GORD (Gastroesophageal Reflux Disease). Babies with GORD can have issues well into the toddler stage of development.
Reflux causes no harm and is merely a laundry issue
Not true. Reflux disease can cause multiple secondary health issues. These can include ear nose and throat damage, respiratory issues that are prolonged into later childhood, sensory processing difficulties, acid damage and aversion to foods.
Conclusion
Having a baby with severe reflux disease can impact greatly on a family. The lack of support and understanding can exasperate the illness and has resulted in many parents seeking psychological advice and therapy. The impact this can have on a family can last for years. The condition is not recognised or understood properly with health care professionals. More support and research need to be provided and NICE guidelines need to be followed when a baby presents with symptoms of reflux and allergy.
Accident and emergency staff need to be updated and educated more when they are presented with a baby with this condition. Dismissing a baby as having “just colic” is not acceptable or excepted anymore.
If you need to learn more information on reflux and how you can help your baby, you can download my app to any device: Infant Acid Reflux is jammed packed with information, advice and tips. The app also contains a chat room, medication and weaning tracker, and has two videos by me; on how to prepare and give adult medication to your baby.
My book, The Reflux Bible, is also available to buy while stocks last. Please contact therefluxbible@gmail.com to purchase your copy.
I also provide 1:1 phone support consultations. These can be booked via email, also.
