All about Infant Reflux
Let’s talk about reflux. Reflux can bring up a slew of questions and concerns for parents, especially if they have a baby who is experiencing a bad bout of it. For many parents it’s often hard for them to know how bad it is, when to be concerned, when to expect it to subside, what to expect from it and how to help and comfort their little one through it.
So I have broken it down for you in this post, answered some of the most common questions I get asked and I hope you find it helpful.
But before we get into the nitty-gritties of it all, let’s get a better understanding of what reflux is.
So what is reflux anyway?
In short, reflux means that the stomach contents are being pushed into the esophagus. For most babies, this is not associated with much pain, as some measure of reflux is normal for most babies and and most people in general.
Our stomachs are full of the food we eat and digestive acids. A little muscle at the top of the stomach (the esophageal sphincter) holds everything in place. However, that muscle is still developing for babies. So, because that muscle is immature, the contents from the stomach can be pushed up into the esophagus. For most babies, there is no reason for concern and these babies are often referred to as “Happy Spitters.”
However, for some babies, the acid from the stomach can cause pain in the esophagus. This is called Gastroesophageal reflux disease (GERD). Babies with GERD need to be seen by a doctor for the appropriate diagnosis and support.
What are signs of painful or concerning reflux in babies?
spitting up and vomiting associated with pain
difficulty being soothed/constant crying
becoming fussy following feedings
arching away from the nipple during feedings
frequent coughing or congestion in the absence of illness
wheezing or trouble breathing
irritability during feedings
refusal to eat
poor weight gain
difficult and disrupted sleep
How much is my baby actually spitting up?
I know you’re concerned about your baby’s spitting up after every meal, especially when it looks like they’ve spit up their entire feeding. And It’s always alarming when your baby spits up because you immediately think that something must be wrong. But don’t worry, your baby is likely a ‘happy spitter’ and there’s not much cause for concern. And remember, that spitting up is normal for babies.
Let me tell you that it’s usually only a tiny portion of their feeding - 2 teaspoons at most, 1/3 of an ounce or a mouthful of milk if you can picture that And yes it can seem alarming.
Here’s a reminder of why babies spit up:
They may have swallowed too much air with their milk
They ate too much or are bloated,
Their (underdeveloped) esophageal sphincter causes the stomach contents to come right back up.
These are all normal causes for infant spit up. And if this is your baby, but they are generally happy during and after their feedings, then these are called happy spitters and they will outgrow their spitting up as they grow.
When should I be concerned about my baby’s reflux?
It’s estimated that more than half of all babies experience spit-up and signs of reflux.
Keep in mind that some reflux-like symptoms are completely normal. Babies are born with an immature esophageal sphincter—a muscle that, over time, will grow stronger and eventually stay closed except when the baby is swallowing, keeping everything in the stomach as it should.
Not all babies who show signs of reflux need medical treatment. Doctors usually become concerned if a baby is experiencing severe pain, having trouble gaining weight, showing blood in their stool, refusing to eat, or developing respiratory issues. It’s important for parents and healthcare providers to work together to assess whether reflux is truly causing distress for the baby. But if you feel your baby is in pain and your concerns aren’t being taken seriously, don’t hesitate to seek a second opinion. Consider consulting another doctor or a pediatric gastroenterologist to ensure your concerns are addressed.
Why do babies experience reflux to begin with?
Babies commonly experience reflux for several reasons:
Immature Digestive System: A baby's digestive system is still developing, and the muscle (lower esophageal sphincter) that keeps stomach contents from flowing back into the esophagus is not yet fully mature. This muscle may open easily, allowing food and stomach acid to travel back up, leading to reflux.
Liquid Diet: Babies primarily consume milk, which is a liquid. Liquids move more easily from the stomach to the esophagus compared to solid foods, increasing the chances of reflux.
Lying Down Often: Babies spend a lot of time lying on their backs, especially after feeding. This position makes it easier for stomach contents to flow back into the esophagus.
Small Stomach Capacity: Babies have small stomachs that fill up quickly. When a baby's stomach is full, it’s more likely that food and acid will flow back up into the esophagus, causing reflux.
Frequent Feeding: Babies eat frequently, which means their stomachs are often working to digest food. This constant digestion can increase the likelihood of reflux.
How can I help my baby with reflux to sleep better?
Doing these things can significantly improve your bayb’s reflux symptoms, which in turn, will also help them sleep much better.
I know it can seem so daunting to try and figure out how to help relieve your baby’s reflux. There are a million different opinions and suggestions on the internet and from well-meaning family and friends. And it can be overwhelming tot have so much information and know how to sift through it.
So I’ve give you some of the most effective tips that can really help improve your baby’s reflux and reflux symptoms.
So let’s jump right in…
𝗙𝗲𝗲𝗱 𝘆𝗼𝘂𝗿 𝗯𝗮𝗯𝘆 𝗶𝗻 𝗮𝗻 𝘂𝗽𝗿𝗶𝗴𝗵𝘁 𝗽𝗼𝘀𝗶𝘁𝗶𝗼𝗻 𝗮𝗻𝗱 𝗸𝗲𝗲𝗽 𝘁𝗵𝗲𝗶𝗿 𝗵𝗲𝗮𝗱 𝗿𝗮𝗶𝘀𝗲𝗱 𝗵𝗶𝗴𝗵𝗲𝗿 𝘁𝗵𝗮𝗻 𝘁𝗵𝗲𝗶𝗿 𝘀𝘁𝗼𝗺𝗮𝗰𝗵.
Gravity can assist milk down the esophagus.𝗞𝗲𝗲𝗽 𝘆𝗼𝘂𝗿 𝗯𝗮𝗯𝘆 𝘂𝗽𝗿𝗶𝗴𝗵𝘁 𝗳𝗼𝗿 𝟮𝟬-𝟯𝟬 𝗺𝗶𝗻𝘂𝘁𝗲𝘀 𝗮𝗳𝘁𝗲𝗿 𝗲𝗮𝗰𝗵 𝗳𝗲𝗲𝗱𝗶𝗻𝗴.
Gravity can help keep milk down in the stomach until it begins to digest.𝗕𝘂𝗿𝗽 𝗮𝗳𝘁𝗲𝗿 𝗲𝘃𝗲𝗿𝘆 𝟮-𝟯 𝗼𝘂𝗻𝗰𝗲𝘀 𝗼𝗿 𝘄𝗵𝗲𝗻 𝘆𝗼𝘂 𝘀𝘄𝗶𝘁𝗰𝗵 𝗯𝗿𝗲𝗮𝘀𝘁𝘀.
Burping decreases the chance for an air bubble to cause spitting up.𝗙𝗼𝗹𝗹𝗼𝘄 𝗮𝗻 ‘𝗲𝗮𝘁, 𝗽𝗹𝗮𝘆, 𝘀𝗹𝗲𝗲𝗽’ 𝗿𝗼𝘂𝘁𝗶𝗻𝗲.
Putting time between their feedings and when they sleep will allow them time to digest their food. It will also eliminate snack feeding and too many feelings in a short time span.𝗢𝗳𝗳𝗲𝗿 𝗮 𝗽𝗮𝗰𝗶𝗳𝗶𝗲𝗿 𝗮𝗳𝘁𝗲𝗿 𝗳𝗲𝗲𝗱𝗶𝗻𝗴𝘀
Sucking can ease the pain by increasing saliva and downward contractions of the esophagus.𝗧𝗮𝗹𝗸 𝘁𝗼 𝘆𝗼𝘂𝗿 𝗱𝗼𝗰𝘁𝗼𝗿 𝗮𝗯𝗼𝘂𝘁 𝗮 𝗽𝗿𝗼𝗯𝗶𝗼𝘁𝗶𝗰 𝗼𝗿 𝗺𝗲𝗱𝗶𝗰𝗮𝘁𝗶𝗼𝗻 𝗶𝗳 𝗻𝗲𝗰𝗲𝘀𝘀𝗮𝗿𝘆.
Research suggests that administering probiotics results in less crying & discomfort , less spitting up, and less constipation.
Should I start an elimination diet or change my baby’s formula?
This can help, but please discuss any dietary changes for you or your baby with your doctor/pediatrician first.
Cow’s milk can increase painful reflux symptoms for many babies dealing with GERD. (Check labels for casein, the milk protein.) Soy can also be a culprit. Again, each baby can have unique sensitivities, so always check with your Dr. before making any major changes to your baby’s diet.
How do I know if my baby needs medication?
Some babies with reflux need medication and some don'‘t. If your baby does need treatment, you will need to work closely with your pediatrician/pediatric GI specialist to find the correct medication and dosage for your baby. Finding the correct medication and dosage for your baby may take time and it’s especially important to remember that as your baby grows, the dosage may need to be adjusted.
What should I do if my baby spits up while sleeping?
I know this can be alarming for parents of babies with reflux. Try not to panic. You typically do not need to intervene if your baby spits up while sleeping. A baby’s anatomy is designed to protect against choking from reflux or spit up. If your baby wakes because they are wet or experiencing some other discomfort, it’s okay to provide the support they need. Clean them up if necessary and put them right back down to sleep.
Is it safe for my baby to sleep on their back if they spit up?
All babies should be placed to sleep on their back, even babies with reflux.* This position does NOT increase the risk of choking. It is, indeed, safe.
The AAP says this: “Sleep position does not increase the risk of choking and aspiration in infants, even those with gastroesophageal reflux because infants have airway anatomy and mechanisms that protect against aspiration.”
What if my baby with reflux rolls to their tummy while sleeping?
Once a baby can independently roll from back to belly, they have the muscle strength and neck control to lift their head and safely sleep on their tummy. (Make sure you’ve taken baby out of the swaddle at this point.)
Most pediatricians agree that it’s safe to allow your baby to sleep on their tummy if they roll there independently. Why? If your baby can independently roll from back to belly, they have the muscle strength and neck control to lift their head.
Be sure your baby is not swaddled if they’re rolling or showing signs of rolling.
If your concern is specifically about the safety of tummy sleep for a baby who spits up or has reflux, I understand. Allow this to set your mind at ease: By the time your baby can roll independently, their neck and trunk muscles are stronger, the esophagus is longer, and the esophageal sphincter is more mature.
Should my baby sleep with their head elevated? Do crib wedges help reflux?
Short answer. No, The American Academy of Pediatrics does not recommend elevating a baby’s head for sleep. The AAP reports that “Elevating the head of a baby's crib is not effective in reducing GER. It's also not safe as it increases the risk of the baby rolling to the foot of the bed or into a position that may cause serious of deadly breathing problems.”
The use of a crib wedge or any other product designed to position a baby in the crib simply isn’t safe or effective for helping reflux.
When I hold my baby upright after feedings, they fall asleep. How can my baby learn to fall asleep independently?
We know that a baby falling asleep independently is so helpful in learning to sleep through the night.
Here are some tips to keep a baby awake while being held upright after daytime feedings:
Try a distraction! look in the mirror, show them toys, open a window and look outside, etc…
Hold your baby upright and away from you so that they can see out. Try a baby carrier!
If your baby is old enough, you can use an exersaucer or a baby jumper.
Prop your baby up on your legs with your knees elevated and talk to them.
At bedtime, offer a feeding before bath time. Many bathtubs naturally hold a baby in an upright position, so it serves as a great activity to break up feeding and sleep while still maintaining the position necessary to decrease reflux concerns.
For night feedings, your baby will most likely fall asleep while being held upright. This is okay and to be expected. Don’t worry, they will not create a bad habit out of this.
*Please Note: Certain positions, such as in a swing or car seat, try to avoid car seats and swings for 20-30 minutes after a feeding, as they can cause pressure on the stomach and make reflux symptoms worse.
Will sleep training work for a baby with reflux?
This isn’t a simple yes or no answer. It largely depends on the severity of the reflux you’re dealing with. However, in general, babies in pain will continue to struggle with sleep and it’s crucial that you address any physical concerns and discomfort before making sleep a priority.
When do babies typically outgrow reflux?
Most babies outgrow reflux by the time they are around their first birthday.
Here's a general timeline:
0-3 Months:
Reflux is most common in the first few months of life when the digestive system is still developing. Many babies experience frequent spitting up during this period.
4-6 Months:
As babies begin to grow and their digestive system matures, the frequency of spitting up often starts to decrease. Around this time, many babies begin spending more time in an upright position and also start solid foods, both of which can help reduce reflux.
6-12 Months:
The majority of babies see a significant reduction in reflux symptoms. The lower esophageal sphincter (the muscle that prevents stomach contents from flowing back up into the esophagus) becomes stronger.
12-18 Months:
Most babies will have outgrown reflux by their first birthday or shortly thereafter.
As always, speak with any and all of your concerns regarding your child’s reflux to ensure proper guidance and diagnosis if necessary. Your Dr. is your child’s best advocate.
