It has taken me quite a while to write this blog. As a breastfeeding peer supporter I generally avoid sharing my own story, but my story is relevant to why this blog has been written so I’ll start with this.
So here’s my confession: my daughter was a “reflux baby” and was treated with pretty strong medication for two years. I didn’t investigate this, I took the information I was given at face value, and it is one of my biggest regrets as a parent.
I joke that when Amy was born she cried straight away and didn’t stop! Amy spent her first weeks wailing, coughing, writhing and red in the face, pretty much all day and most of the night. At 5 weeks old, she was diagnosed with reflux and we were prescribed infant Gaviscon by our GP. Like many Mums, I took the prescription gratefully, and the numerous prescriptions that followed.
An illustration of our first weeks of parenthood from grizzling, to full-on screaming!
As a new mum, I didn’t know that a breastfeeding assessment should have been the first thing offered to help me, or that there are many things known to cause ‘reflux’ in babies. It was a long, hard road, and one which could have been shortened with good timely support.
So now, as a peer supporter who has a lot more knowledge about reflux, I find it frustrating when I come across a fellow ‘reflux mum’ and after some gentle questions it is clear mum has been sent on her way with medication for her baby without further support or investigation too.
Problem reflux (GORD) has a variety of symptoms, which you can read more about here.
A baby who is spitting up a lot without distress or without other problematic symptoms it is unlikely to have reflux disease. If your baby is crying mostly during the evening hours yet content most of the day, they may be experiencing normal baby evening fussies. Many babies spit up and vomit without being bothered by it at all. So while these things can be alarming for parents (and messy!), it is important to be aware of the difference between what is normal and what is “reflux disease”. Lots of babies without reflux disease are sick, have periods of being unsettled, fart, look like they are trying and failing to poo, burp and bring up their legs in what seems to be discomfort. Mostly this behaviour is simply down to an immature gut, and it will pass with time.
Mums who worry their baby has reflux often say to me, “I think it’s reflux because he just won’t let me put him down in the cot! I think he hates being on his back.” Here’s a secret which might help you feel better: most newborn babies hate being put down and prefer to be held. That’s normal baby behaviour.
So it’s worth asking yourself, “Does my baby really have GORD?” before starting medications for reflux. If you aren’t sure, a breastfeeding professional, your GP or HV should be able to talk this through with you.
Many medications used in treatment of reflux disease are used “off label”, they weren’t originally developed with infants in mind, and there aren’t many studies into the long term effects of reflux treatments on babies.
So you’ve read all of the above and you still believe your baby may have GORD? I’m sorry if you are still with me at this point. Dealing with reflux is a really distressing and difficult thing to cope with, and I know at times it can feel relentless and never ending. Here is some more information for you to consider.
Three common causes of reflux in breastfed babies (this is not an exhaustive list)
1. A shallow latch
If your baby is not attached deeply to the breast they may take in more air as they feed. When air is expelled it can result in spitting up. Trapped air can also be very painful for baby. This can result in reflux symptoms such as back arching, crying and hiccoughs. Babies with shallow attachment may also struggle to transfer milk, leading to a fussy baby who wants to breastfeed 24/7.
This is why NICE recommends a breastfeeding assessment as part of its quality standards:
Sorting out a shallow latch can be as simple as doing a little work on positioning and attachment. Some babies with shallow attachment may have anatomical differences which hinder deeper attachment – things like tongue tie and high arch palate are increasingly being linked to reflux.
2. Breastfeeding management
Culturally, we have an expectation of having a few hours between feeds and we do see this impact on how we feed and treat our babies. Instead of smaller, frequent feeds sometimes we encourage our babies to “go longer” and take in more milk, less often. Some babies cope with this just fine but others may struggle, with large volumes of milk hitting the stomach and then coming straight back up. Some babies may protest- loudly!- about having their feeds delayed. Responsive feeding, and watching our babies instead of the clock may help with fussing. More about responsive feeding.
Western babies also spend a lot of time on their backs, which is no help for reflux. We commonly feed babies in the cradle hold, and then they are placed on their backs in Moses baskets and in prams. However our babies evolved to be held. You cannot cuddle a baby too much. Simply carrying our infants more and experimenting with other feeding positions can go a long way towards helping babies with a tendency to reflux feeds.
3. Food intolerances and allergies
If your child has been properly diagnosed with GORD and you have been prescribed medication it’s interesting to note research suggests a significant link between allergies, particularly CPMA and GORD – some studies show a link of up to around 40%.
Does that mean all mums with reflux babies should immediately be told to cut out dairy products? No, I don’t think so.
As you can see above, there are other things to explore before taking drastic steps, unless your child is exhibiting other clear symptoms of cows’ milk protein allergy. The breastfeeding network talks about symptoms of CPMA here
Addressing attachment, examining oral anatomy and considering breastfeeding management first is usually quicker and easier than making big changes to your diet. It is far more likely a more commonplace issue is the problem and it can take 4-6 weeks for both mum and baby to be totally free of dairy protein. Looking at the basics first is really important.
If you are concerned about CMPA it’s a good idea to speak with a GP or health visitor so they can arrange for you to see a dietician.
4. More great reading on management of reflux and other potential causes here.
You’ve had a reflux diagnosis for your breastfed baby. What now?
We’ve talked about the NICE guidelines above and so we know a breastfeeding assessment may be helpful. It’s worth making sure the person who does the assessment is skilled and experienced in doing this, so you probably want to see a breastfeeding counsellor, La Leche League leader or IBCLC.
It might be a good idea to make sure you see somebody who is familiar with tongue tie and posterior tongue tie, and who knows the symptoms of oral ties, just in case this is a factor.
The great thing about doing this is that these are people who can help you look at the full picture and consider all the angles, including the things we have discussed above.
In some cases medications can be appropriate and necessary.
Coping with a breastfed reflux baby
Reflux does generally pass and get easier with time. With some help and support it may pass more quickly. Asking the right questions is the first step to moving forward.
How did my own story end? Well, after getting some support from an IBCLC, my daughter was diagnosed with a cows’ milk protein allergy among other intolerances. We finally came off all our medications and beat the demon that is reflux. She still doesn’t sleep in her cot, but that’s okay – I like the cuddles ❤.
By Paula Rowley
This blog is not intended to replace the advice of a medical professional, simply to give information for further discussion. Please make sure all medications and healthcare issues are discussed with a medical professional or a health visitor first.