What is reflux?
Reflux is the word used to describe what happens when the stomach contents – food (milk) and acid - come back up into the gullet or into the mouth. Most babies have a degree of reflux because the muscular valve at the end of their food pipe, which acts to keep food in the stomach, hasn’t developed properly yet. This means that when your baby’s stomach is full, milk can come back up. If he brings up small amounts of milk it’s called posseting. Babies often 'posset' a bit when burping, hence the use of muslins over the shoulder.
This article highlights the general symptoms of reflux and then goes on to discuss the differences between gastro-oesophageal reflux (GOR), gastro-oesophageal reflux disease (GORD) and silent reflux and then suggests ways in which you can help ease your baby's reflux.
It’s only when strong acid from the baby’s stomach comes up into his oesophagus that it can be painful and this is not that common. During a baby’s first year, the muscular valve gradually gets stronger and better at keeping food down, so his chance of having reflux decreases.
Around 50% of all babies will experience some reflux during their first three months, but this will prove to be a problem for only a very few. By the age of 10 months the number of babies experiencing reflux will have dropped to around 5%.
If your baby shows discomfort when feeding, such as arching away, refusing to feed and crying, it can be a sign of reflux. She may also frequently vomit or spit up (more than normal posseting, which is only about a teaspoon) and cough a lot, including at night, with no other sign of a cold. Other symptoms include:
- Waking often at night
- Comfort feeding to help alleviate pain
- Weight loss or poor weight gain
- Excessive crying or irritability during or after feeding
If your baby displays any of the above symptoms check with your GP.
The term 'reflux' refers to a condition, gastro-oesophageal reflux (GOR) and a disease, gastro-oesophageal reflux disease (GORD).
If an infant refluxes frequently, then the GP or paediatrician may diagnose them with gastro-oesophageal reflux (GOR). This is a relatively common medical condition amongst children of all ages:
- It often presents with regurgitation or posseting.
- It tends to peak between one and four months of age and normally ends by 12-18 months.
Although it may cause anguish for parents prior to diagnosis, this form of the condition can often be successfully controlled by simple remedies such as keeping baby upright.
There can be, however, a more serious side to reflux in children when it can cause troublesome and severe, signs and symptoms, or complications. The most common complication is damage to the oesophagus (oesphagitis), or long-term problems and this is diagnosed as gastro-oesophageal reflux disease (GORD). It persists despite simple lifestyle measures and will often result in your child having to have medication. Symptoms may include:
- Feeding difficulties
- Failure to thrive
- Breathing problems
If you see any of the following symptoms in addition to the ones listed above for reflux, check with your GP:
- Vomiting bile (green material)
- Repeated projectile (forceful) vomiting
- Crying that does not stop
- Vomiting blood
- Abdominal distension
- Severe constipation
- Stools that are bloody or jet-black
- Persistent refusal of feeds
- Weight loss, or poor weight gain over a period of time
- Excessive crying or irritability during or after feeding or regurgitation
- Vomiting old food, i.e., several hours after feeding
- Choking or blue spells
- New onset of vomiting after six months of age
It is rare for infants to suffer from GORD. Bringing milk up is very common for most babies, who tend to grow out of posseting or vomiting by 12-18 months.
Babies can also suffer from silent reflux, a condition where no outward symptoms appear, i.e. being sick, which can make diagnosis difficult. Babies show signs of being in pain, especially when not upright, and may have a persistent cough.
You can help ease your baby’s reflux by adapting the way you carry and feed him:
- Frequent, small feeds may help prevent your baby’s stomach getting too full.
- Keeping him upright during and for at least half an hour after a feed can help to reduce reflux by using gravity to keep the milk down.
- Try to keep as still as possible and have quiet time after feed. Formula fed babies may require longer periods to settle because formula is digested at a slower rate than breastmilk.
- Avoid tight clothing, particularly clothing that is tight around your baby’s stomach, as it can make reflux worse by increasing pressure on the lower oesophageal sphincter.
- Think about how and when you travel. Most car seats and travel systems have a deep ‘well’ for one static seated position where baby can be slumped in an uncomfortable position. When baby slumps and slouches over like this added pressure is placed on their tummy and the baby will feel the pain of rising acid. This pressure can be very painful and can increase reflux episodes.
- Gentle movements, perhaps being worn in a sling or being pushed in a buggy, may work well too. Try carrying baby around as much as possible in a baby carrier throughout the day. Carried babies tend to cry less and crying will make reflux worse, plus, it keeps baby upright. Consider different baby slings or wraps and decide what works for you and baby.
- Some parents have found that baby massage and cranial osteopathy have helped them cope with colic and reflux. To find a qualified therapist in your area, search www.iaim.org.uk or www.osteopathy.org.uk.
Breastmilk is more rapidly digested than infant formula and babies with reflux may need more frequent, smaller breastfeeds. If your baby is formula-fed you should discuss the options with your health visitor or GP. See our section on feeding. Some parents claim that avoiding certain foods while breastfeeding can help -you can try to cut out dairy, caffeine, citrus and rich, spicy foods - to see if it makes any difference by slowly reintroducing each one at a time to your diet and monitoring any change in your baby's reflux.
Seeing your child in pain or discomfort is distressing for any parent. If you have any concerns, always seek advice from your health visitor or GP. There is plenty of information and support available to help you deal with the challenges of reflux.
NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700.
You might find attending one of NCT's Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.
Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.
Living with reflux is a UK non-profit for information and support for sufferers of GOR and GORD.