Spit-up is normal for most infants, and doesn’t interfere with the day much. What about when your baby spits up a lot, or they seem to be uncomfortable and upset after and in between nursing sessions? Reflux is a common infant issue that can cause discomfort and be disruptive in the breastfeeding relationship. Reflux is a symptom and investigating the root causes can help you better understand what is the underlying cause and how to help your baby feel better.
Reflux symptoms usually present within the first 2 - 4 weeks of the infant's life. One study showed that more than 47% of infants have reflux symptoms at one month old and by seven months old, they report just 6.4% of babies are considered to have reflux. (1) Many practitioners say that reflux becomes better as the baby grows and matures and is rarely an issue past age one year old.
Children and adults can also suffer from reflux. Approximately 20% of adults have reflux. It is important to know that if your baby has reflux, they are at a higher risk for having reflux later in life. Up to 80% of adults with reflux also had it when they were a baby. (1) This does make one wonder if reflux ever really goes away or does it change over time?
GER - gastroesophageal reflux is when stomach contents come back into the esophagus.
GERD - gastroesophageal reflux disease is diagnosed when reflux symptoms are more more frequent and serious
LPR - laryngopharyngeal reflux also called silent reflux
Symptoms of reflux in babies:
spitting up after eating *
Projectile vomiting after or in between eating *
Arching their back while feeding
Choking or gagging while they are nursing or taking a bottle
May refuse to eat
Seems to want to eat all the time - the act of swallowing soothes the esophagus, but it is a vicious cycle since eating more can cause more refluxing
Coughing or wheezing
Slow or low weight gain
Cries and is irritable more than normal and hard to console
Seems to be worse when lying down.
*Silent Reflux is when babies are experiencing reflux, but they are not spitting up. The milk or formula stays in the esophagus and nasal passages for infants with silent reflux.
What’s happening during reflux?
The most common explanation for reflux is that the lower esophageal sphincter (LES) is less developed in an infant and it doesn’t always remain closed so milk and food travel back up into the esophagus after eating. Although this seems to be true, it is not the end of the story. There is a relationship between gut health and the integrity of the LES being able to function well.
Some bacteria in the gut can cause more gas in your baby. This gas can put pressure on the LES and it is not able to stay closed when needed as easily. Improving gut health and supporting the gut, can help reduce gassiness and reduce symptoms of reflux.
For some people, sensitivity to dairy contributes to reflux symptoms, affecting 42 - 58% of infants. (2) Cutting out dairy improves symptoms within 2- 4 weeks of elimination of cow’s milk dairy from the baby’s diet. This further suggests that looking deeper into healing the gut is important to address the root cause of reflux for your baby.
What you can do
Hold your baby in a more upright position after they have eaten. Babies with reflux may cry and be uncomfortable when they are lying flat. This can make nap times and nighttime more challenging when they are not able to lay down and be comfortable to sleep.
Wait a little while after feeding your baby before putting them in a car seat or stroller. Sometimes the position your baby is in while traveling in the car or stroller puts extra pressure on their belly.
consider a sling carrier with the ability to hold your baby in a more upright position to go for walks together instead of a stroller.
Cut out foods that your baby is sensitive to. If you are not sure, talk with an IBCLC (International Board Certified Lactation Consultant) who has education specific to gut health, a naturopath or functional medicine doctor to determine which foods may be a problem.
Improve your gut health by eating foods high in vitamins, minerals and prebiotic and probiotic foods to increase your stomach's ability to properly digest food and keep your good gut bacteria happy and thriving. Antibiotics can kill the bad and good bacteria. This can impact your baby’s digestion since we pass out gut flora to our baby’s during birth and breastfeeding.
Have your baby assessed for oral restrictions. Tongue ties, lip ties and buccal ties all impact your baby’s ability to feed. Reflux is a symptom in many babies with ties and there is often significant improvement in reflux symptoms when the restrictions are released. (3) Before releasing ties, it is important to address other structural tension and misalignments through bodywork and work with a skilled IBCLC to improve oral function, address strain patterns and increase mobility prior to the release being done.
Slippery Elm Powder is a safe and typically very well tolerated supplement for your baby. Slippery Elm powder coats the esophagus to reduce burning and pain from reflux. It promotes digestive health. Always talk to your health care provider before introducing supplements to your baby.
Offer shorter feedings more often rather than large feedings.
Medications for reflux
The most common treatment offered to babies with reflux is medication. Antacids, H-2 blockers, and Proton pump inhibitor(PPI) medications work slightly differently but they all suppress the production of stomach acid. In the short term they may seem effective, but it is important to evaluate their risks. Stomach acid is required to digest food and break it down. Reducing the ability to produce this stomach acid can cause the problem to become worse with time, not better.
Antacid, H-2 Blockers, and PPI medications can deplete the body of key vitamins and minerals causing malabsorption of nutrients and lead to deficiencies. They have been shown to deplete vitamin B12, folate, vitamin D and vitamin C, and the minerals calcium, copper, phosphorus, potassium, zinc and iron and affect magnesium metabolism. All of these vitamins and minerals are important for your baby’s brain development. Deficiency may also lead to skin problems, later behavioral disorders and other negative health outcomes. There is evidence that PPI medication is no more effective than placebos for babies under one year old. (4)
The older baby & child
Adressing the root cause of reflux improves your child’s overall health now and in the future. It may seem reflux symptoms go away as your baby gets older. However, it doesn’t magically go away. We just don’t see it the same as we did before. It may resurface looking different.
If we didn’t address the root cause of a symptom being expressed, it may seem to resolve. More likely, it just changes and expresses differently. We compensate. Our body wants to be in balance and will adapt to work as well as it can. Down the road, we may have other symptoms that appear from the same root problem as before.
Symptoms in older kids:
Spit up in the mouth sometimes - they probably won’t even say anything to you unless you ask them specifically since for them, it is normal. It may taste like food or stomach acid in the back of their throat.
Burping- especially wet sounding burps or excessive or loud burping
It feels uncomfortable to swallow
Experience pain or a burning sensation in their chest - heartburn
The feeling of food being stuck in their throat
Sour or bitter taste in their mouth - this can also result in the smell of bad breath
Hoarseness in their voice or wheezing
Prone to getting sinus infections and pneumonia
Reflux can make days and nights rough for you and your baby. While it seems reflux is common fo infants, it is not a diagnosis but a symptoms from a deeper cause. There are ways to help soothe your baby and reduce discomfort right away while you address the cause of reflux and work on long term solutions. The symptoms may change over time and can look different for each baby. If you need help along the way, get in touch with your IBCLC for support and an individualized care plan for you and your baby for a more enjoyable breastfeeding journey.