Breastfeeding, Babies with Reflux

It is not unusual for babies to spit up after nursing. Usually, babies can spit up and show no other signs of illness. The spitting up disappears as the baby's digestive system matures. A normal, healthy baby usually outgrows her spitting up within 4 to 6 months. You can count your baby's wet and dirty diapers to reassure yourself that your baby is getting enough nutrition. The baby should have 6 to 8 wet cloth diapers (5 to 6 disposable diapers) and at least 2 bowel movements in a 24 hour period (if under 6 weeks of age). If your baby is gaining weight (at least 4 ounces a week) you can be confident that your baby is getting enough milk.

CAUSES

Some babies have a condition called gastroesophageal reflux (GER), which happens when the muscle at the opening of the stomach opens at the wrong times. This allows milk and food to flow back up into the esophagus (tube in the throat) causing damage to the lining. A baby with GER may or may not spit up.

SYMPTOMS

Reflux can cause the infant to behave in ways that are confusing and upsetting to many parents. These may include:

  • Crying, as if in discomfort.

  • Waking up frequently at night.

  • Problems swallowing.

  • Frequent red or sore throat.

  • Signs of asthma, bronchitis, wheezing, or problems breathing.

  • Projectile vomiting.

  • Arching of the back, as if in severe pain.

  • Slow weight gain.

  • Gagging or choking.

  • Frequent hiccupping or burping.

  • Severe spitting up, or spitting up after every feeding, or hours after eating.

  • Refusal to eat.

DIAGNOSIS

Many healthy babies might have some of these symptoms, but do not have GER. There are babies who might only have a few of these symptoms and have a severe case of GER. Not all babies with GER spit up or vomit.

Sometimes the stomach contents flow back into the esophagus, but do not make it all the way up and out of the baby's mouth. This is called "silent reflux" and occurs without vomiting or spitting up. Some babies with GER do not have a serious medical problem. Caring for them can be hard, since they tend to be very fussy and wake up a lot at night. More severe cases of GER may need to be treated with medicine, if the baby, in addition to spitting up, refuses to nurse. He or she may need medicine if little weight is gained, weight is lost, or periods of gagging or choking occur.

TREATMENT

If your baby spits up after every feeding and has any of the other above symptoms, it is best to see his or her caregiver. Other than GER, your baby could have another condition that needs treatment. If there are no other signs of illness, he/she could just be sensitive to a certain food or a medicine.

HOME CARE INSTRUCTIONS

If your baby has GER, it is important to continue to breastfeed. Breast milk is more easily digested than formula. One cause of reflux is delayed emptying of the stomach, and human milk digests much more quickly than formula. It has not been found effective to "thicken feeds" with solids. This interferes with breastfeeding by replacing the mother's milk in the baby's diet. This in turn may decrease her milk supply. In addition, it may endanger the baby, as these solids may be thrown up (regurgitated) and possibly sucked into the baby's lungs (aspirated). Early introduction of solids may also trigger allergies.

Other simple measures may help:

  • Try to feed the baby smaller amounts more often, since larger meals increase the frequency and discomfort of reflux.

  • Limit nursing to one breast per feeding.

  • Try gentle handling and keeping the baby upright after feeding. Parents should always be thinking "head above bottom" when positioning their infant.

  • Feed the baby in an upright position, also. This is more easily done if the baby's bottom is on the mother's lap and his upper body is supported on a small pillow.

  • While being carried, a baby sling or baby carrier can help keep the baby upright.

  • A wedge under the head of the baby's sleeping surface can help when the baby is in bed.