Whilst many parents struggle to get their babies down to sleep each night, there are some babies for whom sleep is unattainable. There is a host of bizarre but fairly common ailments out there that rob sweet babies of their delicious slumber. This week we feature Gastro Oesophegeal Reflux Disorder known as GORD or more simply, reflux.
Image courtesy of Mayo Clinic.
Human babies are often born with under-developed sphincters, so some regurgitation is normal. But some babies are not simply regurgitating or posseting, they are experiencing GORD.
What makes their experience of reflux worse is their inability to tell us where it hurts and their inability to sit up or stand up independently and keep their stomach contents in their bellies via gravity. Most adults who experience GORD or heart burn will automatically stand up when the pain occurs, but babies are stuck in whatever position they find themselves at the time.
Often, it is once they are asleep and placed into their crib on their backs that the milk-acid mix runs out into their oesophegus causing two scenarios:
- a very visible large projectile vomit with an experience of pain or no pain (known as a happy refluxer)
- a leak into the oesopehegus with an experience of a sharp, burning pain (you cannot see this with the naked eye, but can with a barium swallow).
The baby may experience the following symptoms-
- they battle to stay latched as they experience a love-hate relationship with feeds
- their breath will have an acidic 'sour milk' smell
- they will often cough after a feed or when placed on their back
- they will sleep better upright than when placed on their back
- they will arch their back and yell when placed on their back
- they hate sitting hunched over like in a car seat
- they could lose weight or struggle to gain weight
- they could develop lung infections (known as aspiration) and ear infections as the vomit leaks into their ear canal and/or lungs.
Things that help-
- time- babies often outgrow reflux around the one year mark.
- feeds- smaller, more frequent feeds are tolerated better by baby. For great advice for breastfeeding a reflux baby visit the La Leche League.
- reflux chronic medications- these reduce the amount of acid the stomach produces reducing the chance of a burnt and painful oesophegus now as well as developing oesophegeal cancer later in life.
- positioning- opt for devices that promote at least a 45 degree recline. Slings are often better tolerated than car seats and prams.
- dummies- sucking and swallowing spit is a way to move the acid done the oesophegus and help neutralise it.
- infant antacids are available in Europe and are given after each feed.
- surgery- in severe cases, surgery is required to help close the sphincter or to insert a PEG that bypasses the oesophegus to feed the baby directly into their stomach.
Things that do NOT help (the bad advice that is often given by good people)-
- crying it out... all you will get here is a burnt oesophegus.
- expressing milk and adding thickener OR switching to formula with an added thickener in it (a waste of a lot of time and money with no clear results and a barrier to successful breastfeeding)
- changing a mum's diet (the only food that can 'cause' reflux is cow's milk protein and this is an incredibly rare food allergy... eliminate dairy for a week to see if it helps drastically)
- starting solids early (this only colours the vomit and makes laundry more difficult)
- knocking your baby out with colic medicine... once baby wakes you will have a burnt oesophegus to deal with.
Make enough 'switches' and you may eventually think one has helped... what is more likely is that enough time has passed that your baby is outgrowing the reflux as their sphincter closes and tummy muscles become stronger and more able to hold them upright.
Important to note-
- Many babies posset (a small 'spit up' that looks like curdled milk) and regurgitate from time to time. This is normal. Reflux is not posseting. Hint: A posset is covered by a burp cloth. A refluxer will require a large towel as well as changing both your clothes and your babies.
- Yes, babies cry. It is how they communicate. A little crying during the day is normal as your baby communicates their needs and you meet them. But prolonged crying is a sign that something is wrong. Get your baby checked out by a nursing sister/doctor.