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Infant Reflux – Are We Asking The Right Questions?

Uncategorized Feb 12, 2018

Reflux affects approximately 278,000 babies in the UK each year (40% of babies’ experience reflux[1], based on birth rate 2015[2]). Infant reflux is a problem in our society, one that is not appropriately acknowledged for the consequences it has: a refluxy baby can result in post natal depression, reflux even tears families apart. I know of multiple cases where parents have ended up separating and even divorcing because the stress introduced to the relationship by a reflux baby.  This is serious.

 

We must change the conversation around this.

 

So what do you do if you have a baby who you think has reflux? 

  

The first thing, is to really understand reflux for babies (it is not the same thing as in adults), and what causes it. Then you can do something about it. And more than something, you have a higher chance of doing the right thing for your baby.

 

Reflux or Regurgitation?

Reflux is normal.  And this is a phrase that every parent of a reflux baby hates. Being a parent of 2 reflux babies, I totally understand why it is so irritating.

 

Over the last number of years, we have culturally shifted to using medical terms too often, and jumping to label ourselves and others with a named problem.  To give the problem an identity. But is reflux the right one?

 

If your baby spits up, a little, a lot or even what appears to be loads, but is otherwise healthy and happy, and is gaining weight, then this is completely normal. Read on if you want to try and reduce the vomiting.

 

Reflux becomes a problem when baby is suffering pain with it, either because there is stomach acid in the regurgitated milk that irritates the food pipe (oesophagus), and / or there is digestive troubles with bloating, trapped wind and abdominal pain; and / or baby is failing to gain weight and not thriving.

A reflux baby is never described by their parents as a happy baby, or a sleepy baby. Typically, they are so unhappy that their parents are at their wits end, not sleeping more than a few broken hours a night, and not understanding why nothing helps their baby except passing wind.

 

What can you do about it?

You can find out what is causing the reflux. Reflux is not a disease or a condition. It is a symptom of something else. And this is where the NHS is failing babies. We do not have the systems in place to help us figure out what is going on and therefore what the best course of action should be.

 

You should also be aware of the Red Flag symptoms – if you see any of these, you should contact your GP immediately.  These are designated Red Flags by NICE.

 

 

What Causes Reflux?

 

  1. Birth trauma.

    This could be from the most gentle and natural birth or from a long an arduous labour, from ventouse and other interventions or a section; birth trauma can happen to baby at any stage. It could be from the way baby was positioned in utero. How can this be a problem? Well, baby’s skull are designed to move, so that they can be birthed. And if the bones of the skull, and bones of the rest of the body do not fully go back in alignment, then the body does not function perfectly. A direct example of this leading to reflux could be that the skull bones are not in the right position, so their jaw is misaligned slightly and they cannot open their mouth wide enough to latch on to bottle or breast. This means they will be drinking air. Air that goes in must come out. Sometimes this air forces its way upwards and pushes stomach contents with it, sometimes it will go down and cause discomfort in an immature gut.
     

  2. Latch and tongue-tie

    However and whatever your baby is latching onto, is incredibly important, and it equally applies to bottle and breast fed babies. If baby cannot latch properly, they will be drinking too much air with the same result as outlined above.
     

  3. Food intolerance or allergy

    There may be something in your baby’s milk (breast or formula) that your baby’s naturally immature digestive system cannot digest properly so it ferments in their gut causing gas and the associated discomfort that brings.

    I'm going to be discussing the specific aspects of the components of milks (formula, other forumlas and breast) on a live webinar on Monday 26th February. I will be discussing how these impact your baby's reflux positively and negatively to help you make the best choice for your baby... You can find out more and register here.

     

So what can you do about it?

It really depends on what you want to resolve, where you think the root of the problem is and going from there.

Make sure your baby is rested. Properly. Take stock of what you are expecting of your new baby. The first few months of life are really nothing much more than sleeping, feeding and growing. They are called the Fourth Trimester for a very good reason. If your baby is awake more than 2 hours at a time in the early days, if they are not napping properly, then this could be the cause of “reflux”. The symptoms present as reflux, but the problem is a lack of sleep. How? Because when baby is tired, they cry, and when they cry they drink air… enough said.

 

To reduce the volume of vomit, simply put down the book that says feed baby large amounts every 4 hours, and give much smaller feeds more frequently. Respond to baby’s physical size. Research shows that baby’s stomach does not stretch like that of an older infant for the first few weeks. It is essentially like a juice carton with a straw. If the carton is full and you squeeze it or lie it down or shake it about, it will spill.  This the very same with a young infant.

 

To check baby’s structural alignment after birth, visit a cranio-osteopath or chiropractor (who specialises working with infants) from about 2 weeks. They will be able to tell you what position your baby’s mouth is in for drinking, and if there is other misalignment in the body (e.g. digestive system) that may not be supporting baby as best it could it.

 

Check baby’s latch, this is so important, regardless of how your baby is feeding (breast or bottle) have their latch checked. If you observe any of the following, then your baby is drinking air:

  • Spilling / leaking milk from their mouth

  • Gulping / choking or gagging when drinking

  • Bobbing on and off (breast or bottle) when feeding

  • You can hear milk sloshing in baby’s tummy

And we know by now what happens when baby drinks too much air…

 

When it comes to getting your baby assessed for a tongue tie, I only recommend you see either an International Board Certified Lactation Consultant or a Tongue Tie Practitioner. No offense here when I say that most GP’s, health visitors, paediatricians and breastfeeding counsellors do not have the requisite skills and level of expertise to spot a difficult to spot posterior tongue tie. The two I mentioned have trained specifically in this area.

 

Do not be put off by anyone that says “there is a tie but it’s not affecting feeding”. If there is a tie, there is a potential issue that has a far greater impact than feeding. It affects the bone development of the face, it affects the need for orthodontic treatment later in life, it affects speech and communication development, it affects digestive abilities as the tongue is needed to effectively mix food with saliva. I get really upset when I hear that baby’s have not had a tie released when they know its there because it is a very simple procedure that can be done quickly and much easier when baby is little. Why take the long term risks? See my video on this here.

 

Keep a Food and Symptom Diary. If you are still struggling after all the above, then start a food and symptom diary, it could be that baby is reacting to something in their milk and / or food. It is never too late to start. You can download a free template here.  See if you can figure out the patterns that are underlying the discomfort, there is mostly a pattern there. There is a growing awareness of intolerance of milk proteins in infants (cow’s milk protein allergy – CMPA).

 

If you are breastfeeding and suspect baby has reflux of some sort, I suggest you remove all dairy and soy from your diet for at least 3 weeks.  You should see some sort of improvements in this time if there is a dairy intolerance (either protein or lactose – and before you say it, lactose in human milk is not the same as lactose in cow’s milk). There is a high degree of cross allergies between cow’s milk and soy so it is easiest and best to remove them both at the same time.

 

In truth, any food, has the potential to be an irritant or allergen to anyone, including your baby.  If either parent has an allergy, then there is about 30% chance that baby has this allergy too; this is not guaranteed.

 

If none of this helps at all, then it may be time to see you doctor.

 

And rather being prepared for battle, be prepared for a conversation. Because the approach now is to either to “reassure” parents that reflux is “normal” and “baby will grow out if it”; and clearly, reflux is so devastating on relationships and families, it is also a trigger for PND in both parents. And added to this, the medications are not guaranteed to work. 

In fact, in a survey I have been running (here), with over 1,100 responses so far, in only 21.8% of babies did the medications have an effect rated 8/10 or more for effectiveness by that parents.

 

89.6% of babies with reflux are taking prescription medications (most of which are not declared as safe for under 12 months by the manufacturers), 64.9% of whom are on, or have tried, more than one prescription medication. So you see, medication is not the only answer, or indeed the best answer. And I have not gone into the side effects and long term consequences of these medications either.

 

You should be able to tell your doctor that nothing is working, that you have done everything you think is possible. Tell your GP how you feel. Tell them you are close to breaking point. Too often mothers feel they are not listened to and so do their own research online and come up with their own diagnosis and prescription, then demand their GP give it to them.

 

The Answer

The solution to reflux lies in understanding the root of the problem and diagnosing it correctly at first will give every baby a better chance of a happier infancy because reflux is not a one-size-fits-all solution.

 

Are You Ready to Make The Change To Support Your Baby?

 

Pre-order my book The Baby Reflux Lady's Survival Guide here.

 

Register for my Infant Milk Webinar here.

 

 

 

[1] http://bit.ly/NICE_Reflux_Red_Flags

 

[2] http://bit.ly/UKCensus_Births_2016

 
 
 
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