Breastfeeding A Baby With Reflux

What is reflux?

Reflux is a medical term used to describe the return of stomach contents from a baby's stomach through the esophagus, sometimes reaching the oral cavity. The full name of the condition is gastroesophageal reflux or gastroesophageal reflux disease. The acronym for gastro-oesophageal reflux disease is GORD or GERD, depending on where you are in the world and how it spells esophagus. According to sources, it is estimated that only 1 in 300 newborns actually have GERD and need treatment. However, the number of babies receiving acid-lowering drugs is much higher.

The condition is equally common in infants who are fed solid foods and breastfed babies. However, it is more noticeable in infants because their food is liquid, the esophagus is shorter and they spend more time lying down.

About 40% of babies are usually affected by this condition, and 5% of them vomit six or more times a day. Reflux is a temporary problem that usually goes away as the baby's digestive system matures. A small percentage of children have severe or persistent reflux.

Returning milk does not always mean reflux. In some cases, this is quite normal in young babies due to a full stomach.

Why do children vomit milk?

Dr. Jack Newman, a Canadian pediatrician and breastfeeding expert, explains how regular vomiting of milk can have a protective function if the baby is otherwise happy and overweight.

Breast milk is full of immune factors (not only antibodies, but also dozens of others that interact with each other) that protect the baby from invasion by microorganisms (fungi, viruses, bacteria). By forming a protective layer on the mucous membranes (sheath) of the intestine. This protective layer prevents microorganisms from entering the body through the intestinal mucosa. A baby who vomits receives additional protection, first when the milk has reached the stomach once and once more when it comes back (when vomiting).

Vomiting due to illness or other medical reasons is not the same as reflux. In such cases, the baby will look faint due to more severe vomiting and you will need to contact a medical professional.

Causes of reflux in babies

The lower esophageal sphincter is a ring of muscles that, when opened, allows milk to pass from the esophagus to the stomach, then closes and the return of food to the esophagus is impossible. However, in infants, the lower esophageal sphincter may be weak and allow milk to return, as their digestive system is still immature and completely underdeveloped. This means that when the baby's stomach is full, milk and stomach acid can come back causing discomfort.

In cases when the baby does not return the milk through the mouth or it does not reach the oral cavity, it is called silent reflux.

Keep in mind that the baby's stomach is still small and sometimes he can't help but vomit. When a newborn, the stomach is the size of a hazelnut. By the third day it increases to the size of a walnut. And around the 10th day it will be the size of a large hen's egg.

Over time, the muscular ring at the entrance to the stomach will mature and the reflux will pass without medical intervention. The child will just grow up!

Studies show a link between reflux and allergy or intolerance to cow's milk protein. In this case, if the mother tries to eliminate dairy products from her diet, the child's symptoms will subside.

If the baby responds well after the mother's feeding restrictions, there is no point in switching to formula.

Babies can vomit if they get too much milk (often called oversupply) or if the milk flow is too strong. In such a situation, you can express some milk until the flow slows down, and then offer the breast again.

How well the baby can handle the flow of milk depends on the fixation (length of the frenulum) and good function of the tongue. It is a good idea for a breastfeeding consultant to assure you of the correct breastfeeding and good positioning of the baby's tongue during breastfeeding. When the movements of the tongue are in the right direction, it is believed that this helps the process of swallowing. However, if there are limitations in its mobility (eg short bridle ), this can lead to slow digestion, inflammation, gas, bowel problems and cause symptoms of reflux, colic or secondary lactose intolerance.

 Impaired tongue mobility can also lead to excessive air intake, according to some practitioners (for example, American surgeon Scott Siegel believes that this aerophagia induces reflux and calls for more research).

Does reflux in newborns have the same acidity as in adults?

No, most often reflux (including silent reflux) in babies is not acidic. According to Linda Palmer: Milk (breast, formula or cow's milk) is completely alkaline, and baby stomachs themselves are low in acid compared to children or adults. This means that most infants do not experience acidic and this probably does not lead to discomfort and tissue damage in the esophageal area. Half of infants vomit visibly at least once a day. Even more babies have silent reflux (which means that the stomach contents return to the esophagus and go down to the stomach again without coming out of the baby's mouth).

This is also related to Dr. Jack Newman's reasoning that vomiting is probably favorable (and normal) due to all the protective factors of breast milk, as a result of which its repeated passage through the esophagus does not cause damage. Rarely, babies suffer from more severe forms of reflux.

Severe forms of reflux:

• a rare form of reflux called gastro-oesophageal reflux disease (GERD) can cause pain and other problems;
• some babies with allergies may suffer from an inflamed esophagus (eosinophilic esophagitis), causing reflux and difficulty swallowing;
• in a small number of cases, reflux is a sign of something more serious, such as narrowing or obstruction (eg pyloric stenosis).

There are no symptoms characteristic of the disease. The often described clinical pictures can be connected with other reasons. They include:

• drinking large amounts of milk, which leads to frequent belching or hiccups - symptoms that may also be due to allergies or normal behavior of the baby;
• insufficient weight gain or other feeding difficulties, such as pulling from the breast and irritation, refusal to eat or vice versa, continuous feeding for comfort - small volumes of milk are considered antacids;
• the baby is restless and irritable between meals and has difficulty sleeping, may wake up crying (unexplained crying may be for other reasons and may not be due to abdominal pain), arching his back in the form of an arch when eating;
• breathing problems, chest infections, pneumonia, asthma, wheezing or apnea - similar symptoms are sometimes seen with allergies;
• sore throat, inflammation of the esophagus, suffocation, coughing or difficulty swallowing, hoarse-sounding cries, bad breath - some of these symptoms may also be related to allergies or overeating.

How do I know if my baby has reflux?

If the baby takes small amounts of milk and then vomits, he has a cough or hiccups; does not gain weight well; twists his body during meals; it is restless; waking up crying or crying for no apparent reason you can assume there is reflux. But as long as the child's general condition is good, you don't have to worry, as this may be normal.

Medical tests for reflux in a baby under one year of age are rarely performed unless the baby shows signs of poor growth, severe suffocation or lung disease. Tests may include barium porridge X-ray, biopsy endoscopy, pH metry, and other invasive techniques. These tests should be used with caution. They can prevent breastfeeding and do not always give convincing results.

Breastfed babies seem to cope better with gastroesophageal reflux than formula-fed babies. During breastfeeding, the movement of the baby's tongue causes peristaltic waves in the gastrointestinal tract. These muscle contractions help move food down the stomach and to the small intestine. Human milk is digested more completely and almost twice as fast as the formula.

The less time the milk spends in the stomach, the less likely it is to return to the esophagus. In addition, breastfed babies are usually fed in a more upright position than formula-fed babies, and gravity can help keep milk and stomach acid in the stomach where they belong.

How can I prevent reflux?

If your baby's reflux is mild and he is still eating well, try breastfeeding less but more often. This will put less pressure on the lower esophageal sphincter (the muscular ring located between the esophagus and the stomach). Some babies with reflux may want to breastfeed often because milk acts as a natural antacid and breastfeeding itself can be soothing. However, if the baby overloads his stomach, the symptoms may get worse. In such cases, it is more useful to limit breastfeeding from one breast for a period of two to three hours before offering the other.

Other babies quickly learn that the pain follows the feeding, so they refuse to breastfeed. Different positions can be used with them; breastfeeding while the baby is sleeping; walking during breastfeeding.

Try the following tips:

• consult a breastfeeding consultant about breastfeeding positions (breastfeed the baby lying on his back or in an upright position), the correct absorption of the breast by the baby, the movement of the tongue;
• keep the baby upright for 20 minutes to 30 minutes after each feeding;
• if the meals are from a bottle, it is necessary to stop briefly every two to three minutes; you need to make sure that the hole in the pacifier is not too big (if this is the case it can lead to too rapid leakage of milk);
• the calmer the baby, the less frequent will be bouts of reflux;
• eliminate all exposures to tobacco smoke in the environment, as this is an important contributing factor to the condition;
• reduce or eliminate caffeine intake. Excessive amounts of caffeine taken by the mother can contribute to signs of reflux;
• avoid pressure on the child's abdomen (including when changing diapers);
• do not leave the baby on its back. Positions that have been found to reduce the signs of reflux include lying on the left side and placing the baby on his stomach. As the placement on the abdomen should be done only when the child is awake and under constant supervision. Posture is not appropriate during sleep as it increases the risk of sudden death syndrome in infants.

You can also try to lift the baby's head by placing something under the mattress on which he sleeps. It can help if his head is a little higher than his legs.

When should we see a doctor?

Vomiting after eating small amounts of milk is not a cause for concern. But talk to your doctor if you notice that your baby:

• often vomits;
• is irritable during or after a meal, cries and twists his back;
• regularly vomits large amounts up to two hours after eating;
• vomits green or yellow contents that contain blood and resembles coffee grounds;
• begins to get angry or refuse to feed, but if you offer a pacifier will suck;
• there seems to be pain in the abdomen or throat;
• does not gain weight.

If such signs appear, make a diary in which to note:

• how often the baby is fed;
• after how long there are bouts of crying;
• how long it lasts.

This information may be helpful to the doctor to differentiate the disease from other problems. It is also a good idea to monitor your child's weight regularly to make sure he or she is growing.

Are there any treatments for reflux?

If your baby's recovery is difficult or disturbing, your doctor may advise you to:

The symptoms of allergy or intolerance to cow's milk can be very similar to the symptoms of reflux. In up to 30% of cases, babies with severe reflux are allergic to cow's milk.

If you are breast-feeding your baby, you may need to avoid milk and other dairy products such as cheese and yoghurt so that they cannot get into breast milk. If your baby is breastfed, choose a hypoallergenic formula for a few weeks to see if it will affect his condition.

This will help neutralize the acid in the stomach, so the condition should not be painful for the baby. If you are breast-feeding, you can add the medicine to expressed milk. Otherwise it can be in chilled, boiled water or to an adapted formula. Be sure to check the dose with your child's doctor!

And the thickening of the milk?

Another general recommendation is for parents to thicken the milk that the baby receives by adding cereals to it. The theory is that because of its density, it will be more difficult to return food to the esophagus, but research has not shown that it is effective. You should be aware that giving a bottle of condensed milk can interfere with breastfeeding. If you and the doctor decide that it is worth trying, you can do so only to see if there is an improvement in the child's condition.

To avoid using a bottle, try offering the expressed milk with the added thickener with a spoon or glass.

Should you limit your diet when your baby has reflux?

It is important to eat a balanced diet and not limit yourself when breastfeeding. In order for your body to produce enough milk, you need to take in 500 extra calories a day. A varied diet is recommended, without excluding products from the menu, unless the baby has given reason to limit something from your diet (due to the development of acid reflux, for example). Alcohol, caffeine and all other stimulants should be limited or avoided during breastfeeding. As water is a major ingredient in breast milk, you should take enough.

If you make small changes to your diet, you can eliminate or reduce the symptoms of reflux in your baby, but not always. Some foods can change the taste of breast milk, making it more or less appetizing. You don't have to worry too much about consuming certain spices, dairy products, or other strong flavors unless your baby shows signs of reflux or another digestive disorder.

When a breastfed baby has acid reflux, you will want to know all the potential food sources that cause this discomfort in the baby. However, when the condition occurs after each meal - regardless of what you have eaten - then the cause is not in the food you have consumed.

If keeping a food diary is not effective in identifying the food source, you may need to follow an elimination diet. This consists in avoiding all milk sources for a period of not less than seven days. If the baby's condition improves over time, then he or she is likely to have problems digesting milk that contains milk protein or lactose. This is not always an indication of lactose intolerance or sensitivity to dairy products. Additional medical tests are needed to confirm the allergy or intolerance.

There are also more extreme forms of the elimination diet, such as limiting lamb, turkey, boiled white or sweet potatoes with salt, rice, pumpkin and pears - for a period of two weeks. After two weeks, one of the foods can be reintroduced into the diet every four days, monitoring the baby's reactions for signs of stomach upset or reflux.

It may be tempting to consider formula feeding when your baby has reflux in order to alleviate his condition. Mothers often worry that the problem is in the breast milk. Remember that human milk is the best possible food for babies. Experts familiar with gastroesophageal reflux disease and breastfeeding believe that replacing breast milk with formula can make the problem worse instead of improving it. In most cases, the child's time and maturation will take care of this problem and its disappearance. Meanwhile, mothers of babies with reflux can be sure that through breastfeeding they give their baby the best start in life.