Reflux

Reflux happens when some stomach contents (eg breastmilk) pass from the stomach back up into a baby’s oesophagus (muscular tube that leads from the mouth to the stomach), and sometimes spills out her mouth. This spilling, which can be called spitting up, posseting or bringing milk up, is common in babies, especially after a feed. Reflux occurs in adults too, but we’re mostly not aware of it. Babies spend a lot of time lying down, have a liquid diet and a short oesophagus. These factors make reflux more noticeable.

Baby

Reflux is equally common in formula-fed and breastfed babies, but formula-fed infants have episodes of reflux more often than breastfed babies and they last longer.1,2

Simple reflux

If a baby with reflux is otherwise happy and putting on weight well, this is called ‘simple reflux’. It doesn’t hurt the baby and it usually stops by itself as the baby grows.  

Reflux disease

There is also ‘reflux disease’ which is a medical problem and requires medical advice.  

The following symptoms may indicate reflux disease, which needs medical advice:

  • Your baby is bringing up a large amount of milk after most feeds.
  • She seems to be in pain after breastfeeds.

  • She is fussy and unhappy between feeds.

  • She arches her back after most feeds.

  • She has problems gaining weight.

  • Ongoing breathing (respiratory) problems.3

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 between the oesophagus and the stomach. 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 feeds4, 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 Breastfeeding: and reflux 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 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 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. Hegar B, Dewanti NR, Kadim M, Alatas S, Firmansyah A, Vandenplas Y 2009, Natural evolution of regurgitation in healthy infants. Acta Paediatrica 98(7):1189-1193
  2. Parilla Rodriguez AM, Davila Torres RR, Gonzalez Mendez ME, Gorrin Peralta JJ 2002, Knowledge about breastfeeding in mothers of infants with gastroesophageal reflux. Puerto Rico Health Sciences Journal 21(1):25-29
  3. Arguin AL, Swartz MK 2004, Gastroesophageal Reflux in Infants: A Primary Care Perspective. Pediatic Nursing 30(1): 45-51, 71
  4. Vandenplas Y, Rudolph C, Di Lorenzo C, et al 2009, Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). Pediatr Gastroenterol Nutr 49(4):498–547

 

© Australian Breastfeeding Association August 2014