Dr Chiara Hunt and sister Marina Fogle of the Bump Class investigate reflux
All babies cry, some more than others and some seemingly all the time. When does excessive crying suggest that there might be a medical problem behind it? Reflux is when the muscle at the top of a baby’s stomach that keeps milk in after it’s been swallowed is not quite strong enough, allowing milk and stomach acid to travel back up the oesophagus. This occurs mildly in a lot of babies causing them to vomit or ‘posset’ soon after a feed. For most babies this does not cause them any discomfort and they keep enough milk down not to lose weight.
However, when it is severe it can cause pain and discomfort or worrying weight loss. Sometimes the milk travels all the way up causing them to vomit often, losing most of their feed and resulting in poor weight gain. Silent reflux is when the baby doesn’t vomit but the acidy milk keeps on going up and down the oesophagus. This is often very painful and can be more difficult to diagnose. These babies tend to scream the whole time but don’t vomit more than normal babies.
Silent reflux is often confused with colic as the symptoms are similar. Babies with both are clearly uncomfortable, but babies with reflux tend to scream all day long while colic tends to affect babies more in the evenings. Colic can often be eased with over-the-counter remedies such as Infacol, and babies tend to grow out of it between 10 and 12 weeks.
Many paediatricians feel the reason we see more reflux nowadays may be because we are more likely to put babies to sleep on their backs. ‘Refluxy’ babies are more comfortable on their fronts, yet putting babies to sleep on their backs significantly reduces the risk of cot death. So, as tempting as it might seem to relent and put your baby to sleep on his front, don’t – it’s not safe.
Most reflux can be diagnosed by a GP or a paediatrician simply by talking to the mother and examining the baby. In severe or complicated cases there are tests that can be done to confirm the diagnosis, but these are somewhat invasive so are not done routinely.
The treatment for both reflux and silent reflux are the same. Many are mild and require only simple measures to make the baby more comfortable, but others require medication prescribed by doctors.
As miserable as it can be for both the baby and the mother, rest assured that the vast majority will grow out of it, most within the first six months or when the baby is established on solids, even without treatment. And most ‘refluxy’ babies turn out to be robust, healthy and happy toddlers, full of beans and ready to explore the world!
✽ Keep your baby upright, particularly during and after feeds. Putting him in a bouncy chair for daytime naps might help. Put a couple of books under the legs at the head of the cot to raise his head at night.
✽ Feed little and often, particularly if your baby is vomiting a lot.
✽ Dummies can help as they encourage the baby to suck the acid back down.
✽ Cranial osteopathy can be helpful in calming babies.
✽ Gentle pressure or a warm pad held on the baby’s tummy can ease the discomfort in a bad spell.
✽ Feeding thickeners or special formula designed for babies with reflux can help by causing the milk to sit more heavily in the stomach.
✽ Reflux is sometimes linked to cow’s milk protein allergy, especially if your baby also has eczema, so your doctor might recommend a cow’s milk-free formula. If you’re breastfeeding, try excluding cow’s milk from your diet for a minimum of two weeks.
✽ Early weaning might be helpful; most paediatricians recommend weaning ‘refluxy’ babies between four and six months as this has been documented to improve their symptoms.
✽ Gaviscon or sodium alginate coats the stomach and oesophagus, protecting it from the burning stomach contents, and thereby reducing symptoms. It also acts as a feed thickener.
✽ There are various other prescribed medications (most commonly Ranitidine or Omepraole) that treat reflux by decreasing the amount of acid produced by the stomach.
Dr Chiara Hunt and Marina Fogle run the Bump Class in South Kensington. Find out more: thebumpclass.com