Reflux

Reflux occurs when the baby’s stomach contents rise into the oesophagus (gullet). All babies have weak oesophageal sphincter muscles at the top of the stomach which allows this to happen and, if it does, many babies spit up milk. However, this is only a medical problem when the spitting up of milk is excessive and/or the baby is very distressed.

Breastfeeding is just as important for babies diagnosed with reflux as it is for all other babies. Breastmilk provides all the nutrients that a baby needs to reach her full potential. Babies who are not breastfed, have increased risk of infection (eg ear, gastrointestinal and respiratory)1 and tend to have lower scores on tests of intelligence.2,3

Baby

Reflux is equally common in artificially-fed and breastfed babies, but artificially-fed infants have episodes of reflux more often than breastfed babies and they last longer.4,5 Artificially-fed babies have less quiet (deep) sleep (when reflux rarely occurs). Artificial milk may also be more likely to cause problems if inhaled. Breastmilk is more nutritious and easily digested. If the baby brings up a feed, it is much quicker, easier and cheaper to give an extra breastfeed than to prepare extra bottles of artificial milk, especially when many babies with reflux are slow to develop regular feeding patterns. Artificial milk smells much worse than breastmilk when a baby brings it up.

Positioning

It often helps to feed a baby with reflux in a more upright position than is usual. You may need to experiment with different positions. Some mothers sit their baby facing the breast, astride mum's leg or cuddle them against the side of the sofa, facing the breast. Others have found that instead of cradling their baby around their body, they can cradle the baby down the body. To do this, some mothers feed twin-style, while others feed standing up; or you can recline so that your baby lies on top of your body. After a feed, keep baby upright and still. Many mums find putting baby on their shoulder keeps him happier.

How frequently to feed

Some babies do better with smaller, more frequent feeds. This causes less pressure on the sphincter muscle. They may not want both breasts at each feed, or may do better if offered only one side, but more often.

However, as reflux episodes are worse in the first hour or so after feeds, some babies may prefer a larger feed less often. These babies may feed from both breasts at each feed, and go longer between feeds. You may like to experiment to see what helps your baby.

Support and information

ABA's booklet Gastro-oesophageal Reflux and the Breastfed Baby combines the experiences of many families with the latest research into reflux. It includes practical suggestions for helping these babies with changes of posture, techniques for improving sleep, gentle ideas for playtime, and how to change your baby’s nappy without causing reflux. The booklet also covers medication and medical investigations and includes parents' own stories. It has a section on strategies that have helped parents cope with reflux. Booklets can be purchased from Mothers Direct.

Reflux booklet

Reflux Reality – A Guide for families by Glenda Blanch, in association with the Reflux Infants Support Association Inc, 2010 Michelle Anderson Publishing Pty Ltd, Melbourne

Reflux Infants Support Association (RISA) Inc. PO Box 1598, Fortitude Valley Qld 4006. Phone: 07 3229 1090.Website: www.reflux.org.au

Pediatric/Adolescent Gastroesophageal Reflux Association (PAGER). Website: www.reflux.org

* Please note, we cannot endorse the information you may find on the Internet. You may need to check the source and reliability of this information.

References

  1. Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D et al 2007, Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries, Rockville, MD: Agency for Healthcare Research and Quality.
  2. Horta BL, Bahl R, Martines JC, Victora CG 2007, Evidence on the long term effects of breastfeeding: systematic reviews and meta-analyses, Geneva: World Health Organization.
  3. Kramer MS, Matush L, Vanilovich I, Platt RW, Bogdanovich N, Sevkovskaya Z et al 2008, Breastfeeding and child cognitive development. New evidence from a large randomised trial. Archives General Psychiatry 65(5): 578–584.
  4. Heacock HJ, Jeffery HE, Baker JL, Page M 1992, Influence of breast versus formula milk on physiological gastroesophageal reflux in healthy, newborn infants. J Pediatr Gastroenterol Nutr 14:41-46.

  5. Campanozzi A, Boccia G, Pensabene L, Panetta F, Marseglia A, Strisciuglio P, Barbera C, Maguzzu G, Pettoello-Mantovani M, Staiano A 2009, Prevalence and Natural History of Gastroesophageal Reflux: Pediatric Prospective Survey. Pediatrics 123(3):779 -783

© Australian Breastfeeding Association May 2013