Q. Our 2-month-old has acid reflux. What are the best positions to hold him in while I am feeding him?
A. Acid reflux, also called gastroesophageal reflux (GER), is one of the most common infant feeding problems, with around 25 percent of all babies experience some degree of it. GER can cause a range of conditions, from the mild (frequent, painless spitting up) to the severe (colic, abdominal pain, and frequent night waking). In fact, GER is one of the most common causes of so-called colic.
To better appreciate GER feeding strategies, it helps to know the mechanics of the condition. Normally, a circular band of muscle, called the lower esophageal sphincter (LES), separates the stomach from the esophagus. After food enters the stomach, the LES contracts, acting like a one-way valve that closes and prevents the stomach contents and acids from regurgitating, or refluxing, back up into the esophagus. In some babies, the LES is temporarily immature, so it allows partially digested stomach contents and acids to be refluxed. This irritates the lining of the esophagus and causes the pain that adults term heartburn.
If your baby has a more severe degree of reflux, your doctor may prescribe medicines that lessen the production of stomach acids. Most babies begin to outgrow the reflux between 6 and 9 months, the age at which they also start spending more time in the upright position, which itself lessens regurgitation. The following feeding and positioning tips will help minimize acid reflux.
Keep your baby upright and quiet after feeding. For an infant with GER, an upright position is key, since gravity helps keep the stomach contents down. Sit with your baby on your lap with his head nestled against your chest. Keep him in this position for at least thirty minutes after a feeding.
Offer smaller feedings frequently. Here's my reflux rule of thumb: Feed your baby twice as often, half as much. It stands to reason that if a smaller volume of milk enters the stomach, it will be digested faster and there will be less to spit back up.
Feed tummy-friendly milk. If you are breastfeeding, continue exclusive breastfeeding for as long as possible. Breast milk has many advantages over formula, especially for a baby with GER. It's digested faster than formula, which minimizes reflux, and it contains enzymes that aid digestion. Also, while babies are not allergic to mother's milk, they can be to many types of formula, especially babies with GER. If formula-feeding, use a hypoallergenic formula as recommended by your baby's doctor. Besides being tolerated better by sensitive intestines, some of these formulas are digested more quickly so they remain in the stomach for a shorter time.
Position your baby for comfortable sleep. Babies with reflux often suffer from painful night waking, since lying flat doesn't provide the benefit of gravity to keep food down. If your baby is sleeping reasonably well, there is no need to make any changes to his routine. However, if he is a restless sleeper (some clues: waking up with colic, abdominal pain, wet burps, and sour breath), elevate the head of the crib about 30 degrees. This slight incline is often enough to lessen nighttime regurgitation. While it's certainly safest to put your baby to sleep on his back, if he simply won't sleep in that position, encourage him to sleep on his left side, the position in which the stomach inlet is higher than the outlet, which also helps keep food down.
Get support. For help from parents who have survived and thrived with babies with reflux, visit the Pediatric and Adolescent Gastroesophageal Reflux Association online.