Baby have reflux? Here's what you need to know.
You're worried your baby has reflux. Her pain is the saddest, most trying, and sleep-deprived thing you've ever gone through. At this point, you'll do pretty much anything to make it better.
We're so honored to have Dr. Whitney Casares, Portland pediatrician, author and founder of Modern Mommy Doc, here to give you the information you need to survive a baby with reflux. (You will survive.)
You were made for this!
understanding reflux in baby
Of all the heart-wrenching experiences a new mom faces, watching her baby cry in discomfort is one of the worst. You’ve already been through the pain of birth and recovery, only to face this? It can seem unfair—and exhausting and confusing.
In my pediatric practice, I get questions regularly about one common cause of fussiness: reflux.
What is Reflux?
All babies have a floppy connection between the feeding tube—or esophagus—and the stomach. For some babies, the connection valve (a.k.a. pylorus) is too loose for the first few months of life, causing them to spit up most times they feed. This is normal as long as the spit-up looks like digested milk, not bright yellow/green or bloody. Although it creates a huge laundry problem, it’s not a problem for the baby. We call this reflux (gastroesophageal reflux or GER).
Sometimes, though, if there’s enough back flow of milk over and over again along the esophagus, it can cause irritation to the lining. That irritation makes a baby feel uncomfortable after feeds. She may arch her back and scream, refuse to take a lot of milk at each feeding or be generally fussy. The cycle of pain can lead to difficulties sleeping, poor weight gain, and a whole lotta parental despair. We call this gastroesophageal reflux disease (GERD).
When parents bring their infants to me with GERD concerns, there are a number of factors I consider:
Unfortunately, though breastfeeding is natural, it very rarely comes naturally for moms or their babies in the first few days to weeks postpartum. While some moms have latching issues, others have overactive letdown, where the milk comes out super fast when she’s breastfeeding. The baby may have a hard time handling the amount of milk that comes into his mouth or, when her breasts let down, milk may spray everywhere. In some cases, a mom might have to catch milk in a towel or nursing pad during feeds because there is so much excess on initial letdown.
Overactive letdown creates a firehose when baby is trying to feed, which is, I’m sure you can imagine, a pretty uncomfortable way to eat. A lactation specialist can help you with tips for positioning and decreasing the flow, if necessary.
No matter what your flow is like, positioning your infant upright after feeds can help to make sure food goes down versus up.
Think about yourself when you eat a huge meal or down a beer. You feel nasty, right? You feel like burping. You might even feel a little bit of spit-up coming up. If you were to lie down, you would feel even worse. The same goes for a baby. Experts recommend keeping your baby in an upright position after feeds as much as possible. Burp your baby often during feeds as well. This further allows the air bubbles to come up and the food to go down.
Consider a slower-flow nipple. Not all level one nipples are the same. Some flow really fast, creating that same waterfall or firehose situation for your infant when they suckle. For some nipple brands, trying out a preemie nipple can make a huge difference in your baby’s feeding experience.
1. Position baby upright after feeds and burp often.
2. Find a slow-flow nipple for bottle-feeds.
#2. Food Allergies or Intolerances
Foods like dairy, soy, and nuts are common culprits for intolerances and allergies in adults and babies, but allergenic compounds do not all pass through breastmilk. Allergy symptoms can include blood in the stool or rashes. If your child experiences one of these, call your pediatrician right away! For some babies with either intolerances or allergies, their gut’s adversarial relationship with certain foods causes irritation to build in the esophageal lining, leading, again, to more spit-up or discomfort.
Before cutting out these foods, check with a health professional so you don’t miss out on important nutrients in your diet.
Other foods less commonly implicated in GERD, but associated with general baby fussiness and gas include beans, broccoli, cauliflower, and Brussel's sprouts. Some women, when trying to sort through their baby’s needs, limit these foods, too.
The problem is, if you eliminate every potential irritant from your diet while breastfeeding, you’ll end up with a boring, bland meal plan that's poor in nutrients.
Plus, a mother’s diet while breastfeeding can have lifelong impacts. Food choices strongly influence the flavor profile of breastmilk and can help determine a baby’s flavor preferences, ultimately playing a role in healthy weight later in childhood.
Before overly-restricting your own diet, seek guidance from a trusted registered dietitian, like Anna or Megan of Alavita Nutrition.
Colic means you have a baby who cries and fusses more than three hours per day for at least three days a week for at least three weeks. This was my first baby—she hated the pacifier, the swing, the carrier—everything!! Some babies, it turns out, are just fussy. Colic can be confusing for parents, though, because it sometimes intersects and overlaps with GERD.
Colicky babies tend to need excessive soothing. When moms soothe (appropriately most of time) by offering a lot of milk or nursing frequently, some babies overeat, making them feel uncomfortable and eventually causing excessive spittiness which can, in turn, contribute to esophageal irritation. In other cases, there’s no actual GERD, the infant’s colic symptoms just closely mimic gut issues.
What to Do If You Think Your Child Has Reflux
When you’re a new mom, especially a new mom with a fussy baby, it can be confusing to problem-solve and cope. If you think your baby has GERD, call your pediatrician’s office for a thorough evaluation so she can consider the individual factors that may be affecting you and your infant. She may recommend additional help from a lactation consultant, a dietitian or, in some cases, medications to address irritation in the gut.
Above all, get the help you need to deal with the amazing, but often stressful, thing we call new motherhood.
Whitney Casares, M.D., M.P.H., is a Stanford-trained Portland, OR pediatrician and author of
The Newborn Baby Blueprint: Preparing to Care for Your Infant and Yourself. She blogs at
www.modernmommydoc.com, where she aims to help new moms win at parenting without