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You’ve seen those cute baby bibs that say “Spit happens.” You may have chuckled the first time you saw one.
It’s all fun and games until spit is happening all the time. If it’s a screaming baby who is doing all that spitting then the fun and games are definitely over.
Because of misinformation some nursing mamas are told to switch to formula to relieve reflux symtoms. This is unnecessary and could make things worse.
Managing breastfeeding and reflux is definitely doable.
BREASTFEEDING AND REFLUX
A baby who is spitting up all the time has some degree of reflux.
Breastfeeding a baby with reflux can present many challenges. Sometimes those challenges simply mean more loads of laundry. In the more severe cases reflux will involve medications. The most severe cases may require surgery.
What is a mom who is breastfeeding a baby with reflux to do?
My first baby almost never spit up. I could count the number of times on one hand and have fingers left over. My third baby spit up all the time. I was that mom with a trail of spit up down her back. But ya know, when it’s your third kid you just don’t care. I was just happy to start off the day with a clean shirt.
My attitude was that babies spit up. It’s what they do. No big deal.
And here comes the gratuitous spitting baby picture. I promise it’s the only one.
My, the times they have changed. As I’ve mentioned, I’ve been a lactation consultant for 25 years. That is long enough to see trends come and go.
Excessive spitting now has a name, and that name is reflux.
When my kiddos were babies you just did more laundry. About 10-15 years ago it seemed like every other baby was being medicated for reflux. The problem with that was there is not much research that has been done on the effects of these medications on infants (Source).
There has been increasing concern about the use of the medications used for reflux. We do know that these medications used for babies do have side effects in adults (Source).
Mamas just want to keep their baby happy, healthy and safe. Doing less laundry doesn’t hurt either.
Today the trend seems to be starting with treatments that don’t involve a trip to the pharmacy.
If your baby spits up a lot you’ll want to know what the options are. The first thing to know is not all reflux is created equal.
TYPES OF REFLUX CONDITIONS
Reflux aka Gastroesophageal Reflux (GER)
This is the term used when the contents of the stomach flows the wrong way. It goes back into the esophagus. The esophagus connects the mouth to the stomach.
This backflow can result in spitting up. It can also be Silent Reflux. That is when there is no spit up, but there is still regurgitation. There are not always symptoms with silent reflux.
Gastroesophageal Reflux Disease (GERD) is when the acid from the stomach causes pain. In some cases damage to the esophagus can occur.
GERD can interfere with a baby eating enough to gain an adequate amount of weight.
This is not a medical term. At least I couldn’t find it in my medical dictionary.
It is the phrase used to describe a baby who spits up a lot but is happy and growing normally. We say a happy spitter is a laundry problem and not a medical problem.
GERD SYMPTOMS IN BABIES
Any women who has been enormously pregnant and had heartburn can attest to how uncomfortable it can be. It’s no wonder a baby who is suffering from reflux is not always the happiest of campers.
But pregnant women get heartburn because of the pressure of their growing uterus on their stomach. Why do babies get reflux?
CAUSE OF REFLUX IN BABIES
Simply put, reflux in babies is caused by a weak sphincter at the opening of the stomach.
A weak sphincter is common in tiny humans. In their first four months two thirds of babies will be calling in the spit-up clean-up crew on a regular basis (Source).
Because of that weak sphincter, if you have an overabundant milk supply your baby is going to be more prone to having episodes of reflux.
You might be having one of two thoughts right now.
“Why worry – don’t all babies spit up some?”
“My baby spits up a lot. A whole lot. Like a lot a lot.”
Let’s go back to those definitions. Happy spitter? Buy some more bibs.
However, if feedings are a struggle, and after feedings are worse, read on for what you can do to make your baby with reflux happier.
If your baby is not gaining weight adequately then you should take her in for a visit with her health care provider. Additionally, working with a lactation consultant can also help you come up with the best plan.
You should also take your baby in to see her health care provider if you are just plain worried.
CAN TONGUE TIE CAUSE REFLUX?
There does seem to be an increase in the incidence of reflux in babies who are tongue tied (Source). This is something you would want to ask your healthcare provider about.
If you want to know more about tongue tie read Answering All Your Questions About Tongue-tie and Lip-ties – How They Can Affect Breastfeeding.
TIPS FOR BREASTFEEDING BABY WITH REFLUX
Let’s be real, even if you’ve just got a happy spitter, it can be unsettling if your baby keeps spitting up after breastfeeding.
Try these tips for a happier baby and less laundry.
- More frequent feedings will be smaller and more comfortable. Aim for every 1 1/2- 2 1/2 hours.
- Let her suck on a pacifier after feedings. That may help keep the food down in her stomach, where it belongs.
- Frequent burping will help. When air takes up room in the stomach it will get full faster and increases the chances of a reflux episode.
- Keep your baby upright for 20-30 minutes after feedings.
- Upright feeding positions will usually be more comfortable for him.
Using a front carrier makes it easier to keep your baby upright after feedings.
- Keep breastfeeding! Exclusively breastfed babies have a lower incidence of reflux (Source).
FOODS TO AVOID WHEN BREASTFEEDING A BABY WITH REFLUX
There are foods that you can take out of your diet that will help reflux symptoms. When I work with a mom and baby who are dealing with reflux this is one of the first things I recommend.
Doctors used to say this wouldn’t make any difference. Then they started seeing the difference it made. Now they recommend it as a first line defense. I love it when your health-care team works in harmony!
Dairy is the most common food group that can aggravate reflux. That means all dairy. No ice cream? I know, that just isn’t fair! Lucky for us dairy free ice cream is another thing that has come a long way. I will neither confirm nor deny that I always have a couple of cartons in my freezer.
A lot of people turn to soy when dairy has become a no-no. Unfortunately I have seen a lot of babies also be intolerant to soy. I recommend to the moms who I work with to consider eliminating both of them at the same time.
Eliminating soy is hard! It’s in almost everything. The easiest way to do this is to eat clean as much as you can.
There are two types of medications that are used to treat GERD.
PROTON PUMP INHIBITORS (PPIs)
Both of these class of medications reduce the amount of acid that the stomach produces. PPIs are considered stronger. They should not be taken together.
You will want to make sure you talk to your child’s health care provider before trying any of these medications.
I mention these things because I know some mom’s first stop is Facebook or Dr. Google. It’s distressing to see your little one in distress. If you hear that something worked for your best friend’s baby it might be tempting to give it a try.
You should only try these things if your pediatrician has recommended it.
- Treatments that are not recommended:
- Thickening feedings by adding rice cereal to expressed breast milk
- Any positioning for infant sleep other than flat on their back
- Medications – never use OTC meds, or another baby’s prescription. Never ever.
WHEN DO BABIES GROW OUT OF REFLUX?
Most babies will grow out of reflux by the time they reach their first birthday. The majority will have peaked at four months old.
FINAL THOUGHTS ON BREASTFEEDING AND REFLUX
Whether your baby is a happy spitter or truly miserable during that time reflux is no fun. However, there are things you can do to make things better. And as with all baby related things, there will come a time when you can look back and say, “I’m glad that’s over!”
Andrea Tran RN, MA, IBCLC
Andrea has been working with new families as an RN for over 35 years and a Lactation Consultant for over 25 years.
She has her MA in Health and Wellness with a focus in Lactation.