Spit Happens

Does your baby have reflux? Most babies do. Reflux means that your baby spits up. When people say their baby has reflux, they may mean that he has GERD, Gastroesophageal Reflux Disease, which means that a baby not only spits up, but is in pain, or suffering from a complication of his food refluxing into his esophagus.Breastfeeding and reflux, or GERD can be challenging.

Sometimes when I’m facilitating our breastfeeding group, and I listen to the different conversations moms are having, it sounds like every baby has reflux. For a while, it seemed like most babies were being medicated for reflux. Listen to a group of moms talking about breastfeeding and reflux and they will all have suggestions about how to deal with it. It can be confusing and concerning. Every mom wants a happy baby. Babies who have GERD are not happy.

Reflux, Happy Spitters and GERD

I could count on one hand, and have fingers left over, the number of times my first baby spit up. My third baby spit up all the time. He was a happy baby. He was a chubby baby. He fit the definition of having reflux. However, he didn’t have GERD. He was what I call a happy spitter. I had a laundry problem and nothing more.

Cute, chubby baby picture is of my Patrick. He is not chubby anymore. He’s still cute though.

Spitting up

It used to be that when a baby spit up a lot, it was just what babies did. Now it seems that parents don’t want their baby to spit up. Ever. It is what goes with the spitting up that makes the difference between reflux and GERD.

Some babies spit up and are not happy. They are not happy at all. In fact, they are very unhappy.

 

 

Symptoms

You have a problem if your baby has these symptoms:

  • Fussiness at the breast
    • Squirming
    • Arching
    • Crying
  • Poor weight gain
  • Crying after feedings
  • Difficulty sleeping due to discomfort from the reflux

 

 

How Often Does Reflux Occur

Up to two-thirds of babies exhibit some degree of what is considered reflux. True GERD is less frequent, occurring only in about 1/3 of babies. The difference between garden-variety reflux and GERD is the severity of symptoms. If your baby is so uncomfortable that he has difficulty feeding or is not feeding well enough to gain weight, that would probably be called GERD.

Babies who are formula fed or mixed fed have reflux symptoms more often than breastfed infants do. There does not seem to be a difference in reflux incidence or symptoms when comparing directly breastfed babies and babies who are bottle fed breastmilk exclusively.

Treatments

Medications

One of the most common treatments for babies suffering from GERD is to give them one of two types of drugs, either H2 blockers or PPI’s (Proton Pump Inhibitors).

H2 blockers are drugs like Zantac and may be prescribed twice a day. PPI’s are drugs like Prevacid or Prilosec. They are taken once a day. H2 blockers usually have a quicker response, within hours. PPI’s can take 2-3 days before relief from symptoms is noticed. These should only be given as a pediatric preparation and need to be prescribed by your baby’s health care provider.

These are both potent drugs that have side effects in adults. Research is starting to show serious side effects in young children as well.  Probably they should be used only when symptoms are severe, and other management efforts are unsuccessful.

Management

There are some simple things that parents can do to decrease reflux symptoms.

  • Positioning
    • Feeding in an upright position often can make a significant difference. You can use the football hold, but with your baby in a more vertical position instead of wrapped around you. The straddle position is not used very much but can help a lot.
    • Keeping your baby upright for 15-20 minutes after a feeding
      • Using a baby wrap or baby carrier can help keep a baby upright, yet allow you to do other things with your hands.
  • Offering a pacifier after feedings because this helps him keep the food down in his stomach, where it belongs!
  • Dietary interventions can have a big impact on a baby’s symptoms. I have to chuckle because LC’s always used to recommend this and doctors often dismissed it as not being very effective. I am happy to say that now most doctors are suggesting this before they are suggesting medications.
  • Usually, the first things to be eliminated are dairy and soy. Wheat can also be a culprit. Dietary elimination can be challenging. Amy wrote about it in her Mommy Story:

Mommy Stories – Being a Dairy Free Breastfeeding Mom

  • If you are eliminating a lot of things from your diet, I recommend working with a nutritionist if this is in your budget. This can help ensure you are getting what you need. Clean eating can make dietary elimination a lot easier because dairy, soy, and wheat are in so many packaged ingredients. You definitely need to learn to read labels.

Sleep position

Babies should sleep on their backs, and a diagnosis of reflux does not change this. Not their tummies and not their sides. I have heard and read about recommendations to use wedges and put the mattress or to put the crib on blocks to elevate the head. I know that the AAP’s recommendation is not to use wedges. Some parents considered them ineffective. I could not find any information about using blocks, so that is not something I can recommend. Discuss any variations with sleep with your baby’s doctor, including position variations and wedges or blocks.

https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/american-academy-of-pediatrics-announces-new-safe-sleep-recommendations-to-protect-against-sids.aspx

One last thought

Breastfeeding and reflux is a common problem, but not usually serious. GERD is less common but more serious. Every mom wants to keep her baby safe and happy. If your baby has reflux or GERD you can do both by following these suggestions outlined in this article.

Have you had to deal with reflux or GERD? What kinds of things helped you? Let us know in the comments.

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Weaning – Questions and Plans

 

Chen, P. L., Soto-Ramírez, N., Zhang, H., & Karmaus, W. (2017). Association Between Infant Feeding Modes and Gastroesophageal Reflux: A Repeated Measurement Analysis of the Infant Feeding Practices Study II. Journal of Human Lactation33(2), 267-277.

Yourkavitch, J., Zadrozny, S., & Flax, V. L. (2016). Reflux Incidence among Exclusively Breast Milk Fed Infants: Differences of Feeding at Breast versus Pumped Milk. Children3(4), 18.