Oh yes, my favourite topic, reflux….. I wish I knew nothing about this topic but it’s now a matter close to my heart.
What is baby reflux?
All babies suffer in some shape or form and it’s linked with the stomach maturity. Pretty much after a feed the contents travel back from the stomach and babies spit up a little bit, in some cases it’s mostly identified due to the amount of vomit after a feed. For most babies this is not a problem, it’s just means a bit more washing to do. For some babies though, there are other symptoms which make the matters worse because there’s a lot of acid coming up as well which burns the oesophagus and all the way to the throat.
Reflux and Silent Reflux
There are 2 types of reflux. The first type, which ends up being easier to diagnose is mostly identified by the amount of vomit. But there’s also Silent Reflux, where baby doesn’t vomit but seems to bring the contents up anyway and a lot of acid which causes a lot of pain.
Reflux is NOT colic
I get cross when people tell me reflux is normal. Yes, I understand it’s normal, but not when it causes so much pain to the baby. Most of the times parents don’t even know the baby has reflux (especially if it comes as silent reflux) because GP’s just say it’s colic and that it will get better. But this is not the case all the time. In some cases it requires medication and further support from a gastro paediatrician.
The best way I find to distinguish between colic and reflux is watching out the body. When it’s colic, babies tend to bring their legs up to their stomach. When they are suffering from reflux they get really stiff, you can’t bend their legs at all and they tend to arch their backs a lot and potentially starting to refuse feeds.
When is reflux a problem?
- Regurgitation -If vomiting becomes more forceful (projectile), looks green or yellow-ish in colour or looks to have blood in it.
- Exceeds one year of age – If you are still seeing reflux issues after one is over a year.
- Feeding issues – If your baby can’t feed.
- Losing weight, or poor weight gain – If he or she starts to lose weight or you see that the weight gain on your babies growth chart is poor.
- Unusual changes?? – If you see any changes that worry you or anything gets worse.
- Extreme crying – He or she won’t stop crying for long periods of time or is very distressed.
There are 2 ways babies start to handle reflux, either they start rejecting feeds because they link feeding with pain, or they do comfort feeding where they don’t stop feeding because the milk helps to neutralise the acid. But if they drink too much it makes matters worse.
What can you do to deal with reflux
Before you go down the medication route (which I have avoided for a long time) there are a couple of changes you can try to introduce:
- Try to feed in upright positions
- After a feed ensure you burp your baby (this is valid for colic too) and keep him upright for at least 30m. Yes, at night too!!! (I can tell you this is so hard because it breaks your sleep completely)
- Raise your cot so your baby is sleeping at an angle. There are some pillows too such as the wedgehog which are placed bellow the mattress. As my cot is round, it’s not easy to raise it up by the feet so I use a wedgehog. This helps the acid not to come all the way up while baby sleeps
- Avoid changing nappies after a feed (during the first 30m) and when doing so, try to keep baby at an angle. This is really hard if it’s a poo, because then you have to decide whether to change immediately and baby to vomit a lot or to try to hold on the 30m.
- Dress light clothing and be careful around the belly area
If you are breastfeeding be careful with your food too. Avoid any acidic foods such as tomato, oranges and so on.
What if the steps above are not working, what else can I do?
If none of the steps above are working, I would look into Cows Milk Intolerance or Allergy (CMPI / CMPA). This tends to be one of the culprits from reflux. If you are breastfeeding you’ll have to cut all dairy from your diet for 6 weeks and believe me, there’s milk everywhere!!!! Some babies will also react to Soya as the protein is very similar. If your baby is in pain and you’re not sleeping believe me it’s worth the try. If you are formula feeding, try to find a dairy free formula.
If cutting dairy doesn’t help, the next step is to try a thicker. A lot of the GPs will prescribe Gaviscon, but it’s quite common that it will cause constipation, hence baby will have pain anyway. But there are other thickeners such as Carobel or Thick and Easy. I would try a normal thickener before trying Gaviscon.
If nothing else works and you need to ask for medication, I would film your baby and show it to GP, as GPs tend to ignore reflux and dismiss it by saying it’s colic. You know your baby best, if you believe it’s not colic keep on fighting for it.
In UK at least, the following medication is available:
- Omeoprazole (PPI blocker) – stops the acid production at the stomach. It seems to work with a lot of babies whereas others react to it. My little one seem to suffer from stomach pain. Other side effects are sleep disturbance. This is weight dependent, so as your baby gains weight the dosage will have to increase. There is a liquid version of it, which makes it easier to give it to babies.
- Ranitidine (H2 blocker) – There are several compositions of ranitidine. Ranitidine acts as an anti-acid and helps to deal with the acid pain. Ranitidine is also weight dependent. The simplest version of ranitidine (the 5ML / 5mg) seems to have less side effects – mainly diarrhoea – but it’s also quite expensive. A bottle of 100ML costs around £100, so GPs are quite reluctant to prescribe it.
- Domperidone (Zantac) – This one accelerates digestion, which in turn helps to reduce the amount of food that comes up. Unlike the other 2, this can’t be prescribed by GPs as it can lead to heart problems. If you have heart issues in the family it’s not recommended.
Each baby is different so some babies might need a combination of the meds above. I would say that whereas you might need the meds to help your baby to cope with the pain and eat better, you should try to understand what’s triggering your babies reflux. In many cases it’s linked to food intolerance, allergies and you’ll require paediatrician support to get there.
I’m still fighting to get somewhere with my little one, as she refuses feeds and struggles to sleep – and I’m a zombie mum – but hopefully will get to the bottom of it all. All I can say is good luck if your little one has reflux and trust your gut. Keep on fighting until you have answers!
If you want to know more about reflux please check the Living with Reflux community. There is also a facebook group which is really supportive!