REFLUX MINI-MASTERCLASS
In the early weeks, babies may ‘spit up’ occasionally after feeds, due to their immature gut.
This ‘laundry problem’ should resolve itself in 50% of babies, without any outside intervention. (GOR*)
In a small percentage of babies, the valve between the stomach and oesophagus does not close properly. (GORD*)
This disease can result in more regular and higher volumes of spit ups, and is likely to go alongside other symptoms, such as:
– excessive crying
– baby refusing feeds
– baby arching back in pain
– projectile vomiting
– skin rashes / cradle cap
– ‘explosive’, unusual colour or smelling poos
– poor weight gain
What might help?
1. Get a proper diagnosis (it can be hard to distinguish between lactose intolerance, CMPA – cows’ milk protein allergy, other allregies and GORD) by consulting a health professional or an IBCLC lactation consultant
2. Keep baby upright during feeds by elevating her/his head above bottom.
Some examples of good breastfeeding positions:
koala and laid back positions.
Smaller, more regular feeds are better than widely spaced big feeds.
3. If bottle feeding, keep baby at a 45 degree angle or higher and PACE bottles. Lots of good videos on YouTube re ‘paced bottle feeding’.
Essentially you are following baby’s cues, with regular pauses and stopping when baby is full (not when the bottle is full).
4. Baby wearing:
Between feeds, carry baby in an upright position.
It can really help with digestion and with reducing crying. You can satisfy baby’s need for closeness, perhaps without the need for excessive number of feeds.
(Watch baby with slow weight gain, so they don’t sleep through their hunger cues though.)
Breastfeeding related causes for reflux
Fast flowing milk or oversupply.
If you produce high volumes of milk, you may see your baby coughing, spluttering or even choking on the flow of milk while breastfeeding.
What can be done?
Find a professional lactation supporter who can help you manage your breastmilk supply. This could mean checking if you are dealing with true oversupply or not.
Offering baby the breast when it’s less full:
hand expressing a little before feeds
offering 1 breast per feed or even the same breast a few times before switching (block feeding under skilled guidance).
Biological/genetic causes for reflux
1. Cows’ milk protein allergy (and other allergies)
Cow’s milk allergy is relatively rare, but your baby has a higher chance of having it if it ‘runs in the family’.
What can be done?
Write a food-diary:
note down what you eat and how your baby reacts – do their symptoms get worse or better following a certain diet?
Start an elimination diet.
There is no way to diagnose CMPA, apart from excluding the ‘culprits’ from mother’s diet for a couple of weeks, then reintroducing them one by one.
(Please do this under skilled guidance of a GP or dietitian.)
True allergies are rare. Food intolerances are more common, and you may notice an improvement in symptoms as soon as hours or a day or two after you cutting out the allergen from your diet.
Dairy allergy is closely followed by soya, egg, shellfish and nut allergies.
Try not to panic.
Some of these allergies or intolerances don’t last for life, and with regular low level exposure, your little ones may get de-sensitised and, with time, ‘grow out’ of their symptoms.
https://laleche.org.uk/allergies/
2. Tongue tie
Babies with tongue ties or other oral restrictions are less capable of taking in milk efficiently, due to a lack of ‘seal’ around the bottle or breast.
This may result in the classic ‘clicking’ sound, which means air is being swallowed during feeds. This can cause reflux type symptoms, tummy discomfort and spit ups.
It may also mean baby is less able to suck efficiently when it comes to draining the breast from the fattier, thicker milk towards the end of a feed.
This can result in a ‘lactose overload’: babies taking more of the fast flowing milk, higher in lactose = milk sugar.
What can be done?
Get a qualified diagnosis for tongue tie! This means someone who is licenced to perform a full oral assessment on baby with a gloved finger inside baby’s mouth. If in doubt, get a second (and a third) opinion.
Treat the tongue tie if it needs treating.
Alongside this, there will be many strategies your can do at home (before or after the treatment), which come under the umbrella of body-work, a lot of which are detailed in my e-book: Reflux resolved.
If treatment isn’t justified or while you’re waiting, there are some strategies to make breastfeeding and bottle feeding more effective:
Upright positions for breastfeeding can work well as gravity is on your (and baby’s) side:
KOALA and LAID BACK positions can work well.
BREAST compressions towards the end of a feed can encourage baby to take more of the fattier (and lower lactose) milk, and hopefully cause less reflux.
Bottle feeding:
pace bottles
baby more upright with bottle horizontal
elevated side lying
round teats with a slow flow (0 or 1)
THERE IS A LOT MORE THAT CAN BE SAID…
Want to learn more about potential causes, diagnoses and treatment of reflux?
Check out my new e-book, packed full of content over 80 pages, with colour illustrations, links to baby massage videos and clickable links, as well as tracking tools and journaling templates for you, to ease the load. Ready to implement strategies and a bonus of 12 ‘calming holds’ visuals to help ease the symptoms for your baby.
