Reflux is when stomach contents flow back up into the oesophagus. This may or may not include vomiting and is harmless in many cases so there is often no particular need to worry but if you are concerned please consult your doctor.
Some possible causes of reflux:
- Your baby may have ingested too much milk and reflux is simply clearing the excess
- The digestive system is immature and the valve at the entrance to the stomach is not yet working properly
- Milk may have hit the stomach too quickly when it was empty
- Milk allergy or intolerance
- Tummy bug
- Bowel obstruction (rare)
Reflux Disease (GORD) is not to be confused with ‘Vomiting’ or ‘Positing’
Vomiting and positing is when fluid or food returns from the stomach and can commonly be referred to as reflux or regurgitation. It may occur for a variety of reasons listed below:
- An immature valve at the top of the stomach may not be closing and keeping food down in the stomach as it is designed to do. This is common in babies. If your baby vomits and is otherwise thriving and happy your main concern might just be the extra washing.
- Feeding your baby when he is over tired or over-stimulated
- Consuming a large feed quickly on an empty stomach
- Allergy or intolerance to what was ingested either through breast milk or with infant formula
- Putting upward pressure on the tummy when sitting or nappy changing
- Already full with undigested milk in the stomach
- A bowel obstruction. This would usually also present with no bowel movements
- Unbalanced intestinal micro-flora
When your baby is vomiting or positing it is important that they are not becoming dehydrated. Watch for at least six wet nappies in a 24 hour period and continue to offer your baby regular feeds during the day. Offer more water or breast feeds if they also have diarrhoea. Avoid offering a replacement feed immediately after a vomit as the tummy needs a chance to settle. Seek professional help immediately if your baby becomes increasingly listless and refuses to drink.
If your baby is continuing to grow well then there is probably nothing to worry about but talk to your doctor if you have any concerns.
Gastro Oesophageal Reflux Disease (GORD)
Reflux and regurgitation in your baby is often normal and very common but severe reflux symptoms and complications is called GORD. This can interfere with the enjoyment of life for everyone. There are usually two possible causes for your baby’s reflux pain.
- An excessive amount of acid may rise from the stomach into the oesophagus creating a severe burning pain
- The oesophageal lining thickens and becomes inflamed from an allergic response to foods such as egg, cow’s milk, soy, corn and wheat.
Symptoms to look out for may include:
- If you baby suffers oesophageal pain, they will be very unsettled and crying in pain not just discomfort.
- You may notice they cry whenever they lie on their back for a play, sleep or nappy change.
- You may also find they often only sleep for short periods which can then develop into a cat napping habit when older.
- You may also find your baby may hiccough and constantly swallow even when they are not feeding.
- They may or may not vomit.
- They are usually reluctant to smile and often have a worried look on their face. They are clearly miserable and often you are too.
It is a stressful time for everyone involved and good support from family and friends is vital. Here are some ideas that may help comfort your baby:
- Give thickened milk feeds. (Not suitable if GORD is due to a wheat allergy). This can be done in the following ways:
- If breastfeeding, add food thickener to a small amount of water or expressed breast milk to make a paste and give before or during a breast feed.
- If using infant formula, purchase pre-thickened infant formula (AR). Some formulas thicken with mixing; others thicken in the stomach
- You can add thickener to the infant formula you are already using
- Sit your baby upright while feeding and keep them upright for at least 30 minutes after the feed.
- Change their nappy before or during a feed to avoid changing at the end when the tummy is full.
- Have your baby resting in an upright sling as much as possible.
- Sleep them in a rocker or bouncer placed in the cot to keep them in a semi-upright position. You could try propping the head end of the cot 45°C and use a sheet harness or wedge to keep them in position. (They may slide down to the end of the cot, squashing the tummy making it just as uncomfortable to sleep).
- Positioning baby on the left side. This may slow the regurgitation of stomach contents. Secure them in position using a wedge or rolled towels either side of their body.
- Try administering a probiotic suitable for infants to help balance the microflora in the gut.
- Determine whether the infant formula you are using is a suitable choice. Seek professional advice before changing it.
- Seek professional help from your doctor for appropriate medication when no practical measures listed above have given your baby any relief.
If your baby is relaxed they will expel wind more easily than if they are tired, jiggled constantly or kept awake too long after they should be asleep. Physical tiredness and stress will tense the tummy rather than relax it, making it difficult to expel air.
When burping, keep your baby’s back vertical or horizontal rather than curved. If your baby has not burped but is ready for sleep, put them to bed anyway even if it means getting them up to burp when they cry in 30 minutes time. They will have relaxed during this time making it easier to burp.
This section is for your information only and is not intended to take the place of medical advice. See your doctor or another healthcare professional for advice specific to your baby.