Reflux in Babies - Key Information

Possible causes of reflux in babies:

Vomiting and positing (spitting up) is when milk or food from your baby’s stomach comes back up into their food pipe or mouth. It is often referred to interchangeably as either reflux or regurgitation. It may occur for a variety of reasons listed below:

1. Your baby may have ingested too much milk and reflux is simply clearing the excess.
2. 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. 
3. Feeding your baby when they are over tired or over-stimulated
4. Consuming a large feed quickly 
5. Already full with undigested milk in the stomach
6. Putting upward pressure on the tummy when sitting or nappy changing, after a feed
7. A tummy bug
8. Allergy or intolerance to what was ingested. Always discuss these reactions with your healthcare professional.

When your baby is vomiting or positing it is important 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. Avoid offering a replacement feed immediately after reflux as the tummy needs a chance to settle. Seek professional help immediately if your baby becomes increasingly lethargic, limp or refuses to drink.

It can be 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 with reflux/regurgitation:

1. Ask your healthcare professional about thickening milk feeds. 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.  Alternatively, it can be mixed with an expressed breastmilk feed.
   • For formula fed infants, pre-thickened infant formulas are available. Seek professional advice before changing your current formula. Some formulas thicken with mixing; others thicken in the stomach. Alternatively, you can also add thickener to the infant formula you are already using. 
2. Sit your baby upright while feeding and keep them upright for up to 30 minutes after the feed
3. Change their nappy before or mid-feed to avoid changing at the end when their tummy is full.
4. Have your baby resting in an upright sling as much as possible.
5. Ask your healthcare professional about a probiotic suitable for infants to help balance the microflora in the gut.
6. Keep a diary of your baby’s regurgitation episodes and height gain to help your healthcare professional assess your situation better.
7. Burping Baby
   • 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.
8. Seek professional help from your doctor for specific advice or for appropriate medication when no practical measures listed above have given your baby any relief.

General ‘regurgitation’ or ‘positing’ is not to be confused with a more complicated condition of Gastro Oesophageal Reflux Disease (GORD)

Reflux or regurgitation in your baby is often normal and very common but severe reflux symptoms and complications is called GORD. There are usually two possible causes for your baby’s reflux pain.

1. An excessive amount of acid may rise from the stomach into the oesophagus creating a severe burning pain.
2. The oesophageal lining thickens and becomes inflamed from an allergic response to foods such as egg, cow’s milk, soy, corn, and wheat.

If you feel your baby is experiencing more than normal regurgitation or positing, consult your healthcare professional for advice.

Symptoms to look out for may include:

• If your 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 hiccoughs and constantly swallows even when they are not feeding. Also look out for gagging, choking or wheezing during or after a feed.
• You may notice poor weight gain.
• They are usually reluctant to smile and often have a worried look on their face. They are clearly miserable and often you are too.