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Ask Dr. Sears: Baby's Painful Night Noises

Q. My 5-week-old baby makes crying and grunting noises while asleep. He has reflux and is on Prilosec. Could that be the cause? Also, it seems like he isn't sleeping very deeply. Could this be a problem?

A. It's likely that your baby's reflux is the cause of both his sleep noises and his problem sleeping deeply. Most likely, your baby is restless at night because he has "baby heartburn"—that's what reflux feels like.

Reflux, also known as gastroesophageal reflux or GER, is the backwash of milk and irritating stomach acids against the sensitive lining of the esophagus. Normally a muscular valve that joins the esophagus to the stomach closes to prevent this regurgitation. But approximately thirty percent of babies experience some type of reflux because this valve is immature. As babies grow, the valve strengthens. Most infants eventually outgrow the reflux by their first birthday.

Mild reflux causes non-painful "spit-up." If it's severe, it can lead to painful night waking (often misdiagnosed as "colic"), and stomach acids can be regurgitated as high as the throat, causing grunting noises and even wheezing like baby asthma. I suspect this is what's behind your baby's grunting.

The treatment of reflux is based upon the following three principles, depending on its severity:
1. Lessening the secretion of stomach acids (which is why your baby is on an anti-reflux medicine)
2. Letting gravity help to keep the milk down better
3. And getting the milk to empty from the stomach faster

Here's the reflux regimen we use in our pediatric practice:

Feed baby half as much, twice as often.

That is the main reflux rule. Smaller, more frequent feedings are easier to digest, allowing milk to be emptied from the stomach faster.

Keep baby upright after a feeding.

Keep him upright and quiet (no jostling, please!) for at least a half-hour after feeding. This lets gravity help empty the milk from the stomach quicker. Wear your baby many hours a day in a soft carrier. Try to keep your baby as calm as you can during digestion, because crying increases intra-abdominal pressure and aggravates reflux.

Breastfeed as often and as long as possible.

Breastmilk is appropriately dubbed the easy-in/easy-out food because it empties from the stomach much quicker than formula and softens baby's stools to prevent constipation, which also might aggravate reflux.

If formula feeding, ask your doctor about a "hypoallergenic" formula.

These pre-digested formulas (Alimentum and Nutramigen) empty from the stomach quicker than standard formulas. Also, babies with reflux have a higher incidence of intolerance to cows-milk-based formulas.

Encourage frequent sucking.

Saliva acts both as a natural lubricant and helps repair the irritated lining of the esophagus. Let your baby suck on your finger, or even a pacifier, between feedings.

Elevate baby at night.

To let gravity help your baby at night, elevate the head of his crib approximately thirty degrees by placing blocks under the two front feet of baby's crib. You could also try a reflux wedge, available from infant product stores. This wedge allows baby to sleep at about a 30 to 45 degree angle, thus lessening regurgitation and painful night waking.

Keep a diary.

Note your baby's symptoms and jot down everyday whether they're getting better, worse or staying about the same. Your observation will help your doctor prescribe the appropriate acid-controlling medicines.

Get support.

Consult the Pediatric and Adolescent Gastroesophageal Reflux Association (PAGER) at reflux.org. This organization is composed of parents and professionals who have had children with reflux. They are very knowledgeable about the treatment.

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