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    The Roots of Reflux

     

    Reflux is so common and can cause some parents to stress so hard. The language around reflux can range from dismissive (happy spitter) to disturbing (gastroesophageal reflux DISEASE). One thing is universal about reflux: parents hurt when they see their babies in pain. Much of the treatment for reflux is about symptom reduction rather than discovering and addressing the root cause. Let’s explore some common reflux remedies and their efficacy.

    Holding baby upright after feeds

    The concept here is that holding the baby upright after feeds will prevent the milk from coming up. It might or it might make it worse. Babies prefer to breastfeed in a semi-upright, extended position that provides length and support to the stomach, esophagus, and airway. Maintaining this tight tummy to tummy position after feeds is an excellent semi-upright position that facilitates digestion. However, many parents are instructed to move the baby away from the breast or chest and held up and away from the parent’s body, often on the lap or knee. When baby breaks tummy to tummy contact with the parent, the result is actually a shortened esophagus and airway. Baby depends on tummy to tummy support to prevent slumping forward. If upright holding after feeds is a technique you want to try, keep baby tummy to tummy, like the koala hold or laid back breastfeeding.

    Avoiding Tummy Time

    Tummy time is a critical activity for digestion. When humans of any age are in tummy time, the compression of gravity actually speeds up the digestive system. If the digestive system is moving faster, then less milk will be in the stomach to spit up.  Tummy time helps strengthen and stabilize core muscles that support the digestive system.

    Cutting Dairy

    This one is a big maybe. Usually dairy intolerance has more symptoms than only reflux. There is usually blood, mucous, or foam in the stool as well as diaper rash from the irritation. If you do cut dairy, make sure to cut it from everything, including your vitamins and supplements. Many products designed for nursing parents contain dairy ingredients. You can check your products’ ingredient list or the company FAQ page to ensure you are only taking dairy-free supplements. If you do cut dairy, the Academy of Breastfeeding Medicine recommends a short term change is all that is needed for trialing this theory. You’ll make milk free of cow proteins in about 24 hours. 

    Switching to hypoallergenic formula

    This is a common suggestion but not recommended by the Academy of Breastfeeding Medicine. Breastfeeding is the norm and we want to treat our reflux babies in the most biologically safe way. Human milk is the standard. 

    Elimination Diet

    This one is also a maybe. The parent’s diet gets blamed for a lot of baby behavior. Usually, there is no need to restrict parents from eating the foods they love. Foods like broccoli don’t cause the baby to have gas. However, there are some snack products marketed for breastfeeding that should be eliminated if there is reflux. Fenugreek is a common ingredient in lactation teas and cookies. It has been shown to contribute to reflux. That’s an excellent first thing to eliminate if you’re considering an elimination diet.

    Incline the bassinet or nap in a swing

    Just a few short years ago, the Rock-n-Play bassinet was recalled and pulled off the market permanently due to its unsafe design. Incline positioners and swings can hold babies in the same C shape that risks closing off the airway. If you want to incline your baby, your own body is the safest surface. Also, the snuggles are a nice way to spend an afternoon.

    Probiotics

    Another maybe. Our gut bacteria are different than they were a few generations ago. Working with your healthcare team to find the right probiotic may have health benefits to you and your baby. It may even stave off future allergiesHowever, not all probiotic products are created equal. Some have strains of bacteria that feed directly off the special oligosaccharides in human milk. When taking probiotics or giving them to your child, the probiotic is only going to work if it has appropriate food to eat itself. For adults, this means getting plenty of inulin, a special plant fiber. This can be found in seeds and leafy veggies as well as some lactation supportive products.

    Breastfeeding support

    Yes, breastfeeding support improves reflux. Especially support that includes an oral function assessment by a skilled IBCLC. Parent to parent support is excellent for helping with latch and positioning techniques that reduce air swallowing (a very common cause of reflux). Other parents can share strategies about tummy massages and burp methods that can support you in supporting your baby. Breastfeeding support from your healthcare team might include chiropractic adjustments or postpartum nutrition counseling with your midwife. Having an IBCLC on your care team will help you discover the root causes of reflux on both the baby side and the parent side of the equation. Reflux is often multifactorial. You may need to make adjustments to several things to completely solve your baby’s reflux.


    Danielle Downs Spradlin, MFA, IBCLC, CLC, BRMT, NOMAS

    Danielle is the lactation consultant behind Oasis Lactation Services. She focuses on whole family wellness solutions for meeting your personal breastfeeding goals. She provides telehealth lactation support globally. Reach her at OasisLactationServices.com


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