Managing Reflux and the Happy Spitter!

Ann Caird, postnatal Doula and infant sleep consultant

My previous post considered the symptoms of the Happy Spitter and those of Gastro-Oesophageal Reflux. Now I’ll suggest some practical measures and strategies which may be useful in reducing and managing spitting up and GORD alongside medical treatments.

How Long does Reflux Last?

Usually the Lower Esophageal Sphincter (LES) tightens naturally over time reducing reflux and spitting up naturally. Developmental milestones may also impact on reflux; once a baby learns to be more upright – sitting and standing – this can naturally reduce symptoms, the crawler, on the other hand may experience more symptoms.

So what can help?

Practical management strategies fall broadly into 3 categories; feeding, positioning and mother’s diet.

1. Breastfeeding and Human Milk

Breastfed babies tend to suffer fewer episodes of reflux than formula fed babies. Why? Not only is human milk a natural antacid, but is also easily digested so leaves the stomach faster than formula, consequently breastfeeding reduces the chance of reflux especially at night. Further, the action of sucking at the breast is beneficial – the sucking action stimulates muscular contractions in the gastrointestinal tract which helps to keep food down as well as stomach emptying. It’s generally suggested to aim for small frequent feeds, allowing the baby to finish one breast completely before switching sides so the baby takes a balance of both fore milk and hind milk to support digestion of lactose in the fore milk. If a large amount of fore milk is taken without the higher fat hind milk, the high lactose foremilk can ferment in the baby’s stomach and may resulting in wind, colic and/or reflux type symptoms.

Sometimes, oversupply or fast let down may exacerbate reflux, as can poor latch, so if this is suspected, seek good breastfeeding support which can help tremendously.

2. Positioning.

It’s a good idea to try to position your baby in a more up-right position, elevated on your arm if lying down or in a sitting position when feeding, and avoid unnecessary jiggling or handling after feeding, especially when burping. On the whole symptoms tend worsen when the baby lies flat, and parents find that their baby is more comfortable in an upright position, therefore some parents find slings or baby carriers useful. Also, reducing pressure on baby’s tummy by avoiding tight clothing can make babies more comfortable and reduce reflux.

While some parents find elevating the cot head helpful, research suggests this is not effective, and placing the baby in a semi-upright position in an infant seat at 60o incline and slumping can worsen reflux. Research does suggest though that left lateral lying can ease reflux symptoms because then the stomach opening faces upwards helping to prevent the stomach contents escaping. If using this position, ensure your baby isn’t able to roll onto his tummy while sleeping. The prone position is also helpful in reducing reflux; however, this is only recommended for when the baby is awake and can be monitored, and is not recommended as a sleeping position.

3. Mother’s Diet and Environmental Factors.

Consideration of the mother’s diet is useful. Some studies show a link between allergy / intolerance to cow’s milk in the mother’s diet, so eliminating this may be useful. Babies may also react to wheat, eggs or soya, so this is worth considering, but seek medical support if food could be an issue. Caffeine can be problematic too, as too much may have the effect of relaxing the LES, causing problems for the baby. Finally, eliminating the baby’s exposure to tobacco smoke will help if this is an environmental issue, as tobacco smoke is a significant contributing factor to reflux.

Some alternative therapies that may help babies with reflux include craniosacral therapy and cranial osteopathyl . The Australian Breastfeeding Association also suggest that the Bowen technique, homeopathy and reflexology can have good results as they relax and calm tense and distressed babies.

Sources and Further Reading:

Aaron, et al, 2002. A Systematic Review of Nonpharmacological and Nonsurgical Therapies for Gastroesophageal Reflux in Infants. Archives of Paediatrics and Adolescent Medicine, 2002; 156: 109-113.

Analytical Armadillo (2010). Foremilk/Hindmilk…  and a lot of Confusion!Australian Breastfeeding Association, 2008. Gastro-oesophageal Reflux and the Breastfed Child (booklet) Available from the ABM

Barmby, L. (1998) Breastfeeding the Baby with Gastroesophageal Reflux

Bonyata, K.  Spitting up and Reflux in the Breastfed Baby

Bonyata, K. Forceful Let down and oversupply 

Knorr, S. (2003) Gerd and the Breastfed Baby

My baby has reflux. Can I still breastfeed him?

Tobin, J., McCloud, P., and Cameron, D. (1997) Posture and Gastro-oesophageal Reflux: a Case for Left Lateral Positioning.Archives of Disease in Childhood, 1997, 76; 254-258.

For an excellent critical analysis of reflux, diagnoses and treatment, see Reflux – Broken Babies or Profitable Product?

ABM Breastfeeding Helpline: 08444 122949

Anns new web site can be found by clicking here.

Disclaimer: Doulas and Peer Supporters are not medically trained, so do not diagnose or medically advise. Information provided is to inform parents, and complement but not replace that of a medical professional.

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