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Reflux in Babies

Stanley Chow

Your baby is crying uncontrollably, not sleeping and spitting up (lots!). The cause could be gastroesophageal reflux disease, a long name for a well-known condition: heartburn. Referred to in the medical world as GERD and reflux, the condition is super-common in babies, and, luckily, the solutions are usually super-easy.

One-third of babies spit up without it being a medical problem. But for scores of others, it can be painful and interfere with feeding, sleeping, growth and development. When babies don't spit up, it can make the condition hard to diagnose. Reflux occurs when contents of the stomach make their way up the esophagus and irritate its lining. How much pain this causes baby depends upon the severity of the reflux. If the stomach contents come up just a little, baby may feel pain but not spit up. But if the reflux is severe enough that the stomach contents come all the way up, baby may spit up a lot, especially when lying flat. On the following pages, find out how to spot the signs of GERD and give your baby some instant relief.

Soothe Your Infant Now

  1. Listen and react Babies with GERD cry because they hurt, and uncomfortable crying increases pressure inside the abdomen and aggravates reflux. Crying also increases air swallowing and trapped stomach bubbles, which also aggravates the condition. Respond to baby's cries as promptly and sensitively as you can.

  2. Provide frequent, small feedings The less food in the stomach at one time, the lower the degree of reflux and the faster the food empties from the stomach; so small, frequent meals are best. Also, the more often baby eats, the more saliva is produced, and that helps neutralize stomach acid. Saliva also contains a substance that heals the damaged lining of the esophagus. A good rule of thumb is to feed baby twice as often, but half as much.

  3. Keep nursing Breast milk is digested twice as fast as formula and contains enzymes that aid digestion. In fact, it's like a natural antacid.

  4. Switch formulas Babies with reflux may also suffer from food and milk allergies. Your pediatrician may advise a “hypoallergenic” formula in which the proteins and/or lactose are better tolerated by sensitive intestines and digested more easily.

  5. Create a jostle-free zone No tossing, bouncing or jostling baby for about half an hour after feeding. Too much movement can cause stomach contents to move around and up into the esophagus.

  6. Gravity is your friend Keep baby upright for about 30 minutes after a feeding. (If holding her in your arms wears you down, try wearing your baby in a carrier.)

  7. Burp baby well If you're nursing, burp him when you switch breasts. If bottle-feeding, burp baby after every 3 to 4 ounces.

  8. Let 'em be a sucker A pacifier might be helpful to a baby with severe reflux. Frequent sucking stimulates soothing saliva.

  9. Loosen up Tight diapers and waistbands can increase intra-abdominal pressure and aggravate reflux.

Know the Signs

A baby may have reflux if he:

  • Is colicky (experiences length crying episodes).
  • Frequently wakes in apparent pain.
  • Sleeps restlessly.
  • Arches his back and squirms as if he's hurting.
  • Seems in pain right after feeding.
  • Refuses to eat or doesn't feed long enough (baby may arch his back and withdraw from feeding or want to nurse frequently—nursing is comforting, and breast milk can act as an antacid).
  • Has frequent wet, sour burps.
  • Makes throaty nooises—gagging, choking and raspy breathing.
  • Has breathing difficulties—frequent respiratory infections, wheezing, stop-breathing episodes.
  • May be thought to have "baby asthma".

Keep a Diary

Before seeing your pediatrician, record your baby's experiences per episode, including:

  • Signs and symptoms you've noticed and how long they lasted
  • How severe you believe the episode was.
  • If symptoms are improving or worsening.
  • Home treatments you've tried and their results.
  • The time of day baby has the most severe symptoms, such as crying jags.

Be down with Elevation

Babies with reflux often suffer from painful night waking because, when lying flat, they don't have the benefit of gravity to help keep food down. If baby is a restless sleeper, elevate the head of his crib about 30 degrees using blocks and books. You can also help baby avoid reflux during diaper changes by using a reflux wedge to elevate him off a flat back.

What Your Doctor Can Do

When you have exhausted the above advice, your doctor may recommend medicines that lessen stomach acid production. In some babies, reflux is due to a suck-swallow problem, causing them to swallow too much air while feeding. A therapist who specializes in suck training may be able to provide support.