Do you have a baby who spits up all the time? Your baby may have gastroesophageal reflux (GER), typically called “reflux,” which is very common in most newborns. A smaller number of babies have gastroesophageal reflux disease (GERD), where reflux causes uncomfortable symptoms, such as pain and difficulty feeding.
Gastroesophageal Reflux (GER)
GER, or “reflux,” is when the contents of your baby’s stomach move up into their esophagus (the tube between their throat and stomach), whether they vomit or spit up.
The muscle that separates the lower end of the esophagus from the stomach (the lower esophageal sphincter) takes several months to mature, until then it can easily open, allowing milk or formula to “reflux” up from the stomach into the esophagus.
Because little babies spend so much time lying down, and because babies consume primarily human milk or formula during their first six months, it’s easy for gravity to let that liquid diet flow from the stomach into the esophagus.
For most families, this is more of a laundry issue. These healthy infants typically outgrow symptoms between six months and their first birthday.
Gastroesophageal Reflux Disease (GERD)
Gastroesophageal Reflux Disease (GERD) differs in that the stomach acid damages the esophagus and larynx, increasing baby’s risk of aspiration (inhaling fluid), breathing problems, and insufficient growth.
Babies with GERD may often be irritable, cry excessively, arch their back and refuse to eat. The following comfort measures are most recommended to help your baby cope with GERD:
Stress Reduction: Simple soothing is an excellent way to reduce stress and reflux symptoms. Skin-to-skin contact is one of the best ways to do this. Babies need to be held several hours each day to feel calm. Wearing your baby in an infant carrier or sling is an easy way to meet this need. Gentle massage and comfort sucking (on your empty breast, your pinky finger, their own thumb or a pacifier) also reduces stress.
Comforting Positions: Give baby plenty of tummy time or hold baby in an upright position to soothe symptoms. Babies should always lay flat on their backs for sleep; so only use these comfort positions when baby is awake and supervised.
Slow the Flow: For nursing babies, try slowing the feeding by using side-lying or laid-back breastfeeding positions. If you’re bottle-feeding human milk or formula, use a slower flow nipple.
Frequent Feeding: Feed your baby more often to reduce acid levels in baby’s tummy. Feed every two hours. If you’re bottle feeding, ask your baby’s healthcare provider how many ounces baby needs in a 24-hour period, and then offer smaller more frequent feedings
Burp: Frequent burping is essential for baby’s comfort; burp baby partway through the feeding as well as at the end.
Eliminate Tobacco Exposure: Babies exposed to smoke have significantly worse reflux and respiratory symptoms. Reducing or eliminating exposure to tobacco can help reduce the frequency of reflux episodes and improve baby’s overall health.
Build Better Bacteria: Your milk contains both good bacteria and a special type of carbohydrate called human milk oligosaccharide, which feeds beneficial bacteria and protects against bad bacteria. Nursing boosts increases this transfer of healthy probiotics. Talk with your baby’s healthcare provider about giving additional probiotics containing Lactobacillus reuteri. If you’re formula feeding, consider a probiotic-supplemented infant formula.
Wait Six Months for Solids: Both the World Health Organization and the American Academy of Pediatrics recommend exclusive breastmilk feeding for baby’s first six months. Wait to start solids at six months; this allows baby’s intestines time to mature and establish a healthy microbiome with the beneficial bacteria they need to digest other foods.
Eliminate Allergies: Cow’s milk protein allergy (CMPA) is the most common allergy in young infants, and 10% to 15% of babies with CMPA also struggle with soy. Most infant formulas are either cow’s milk or soy-based, so if your provider suspects CMPA, they may recommend switching to an extensively hydrolyzed formula to help improve their reflux symptoms. These special formulas are still made from cow’s milk, but they’re extensively processed, and the protein is broken down enough that most infants with CMPA can tolerate it.
The best way to reduce your baby’s risk of food and environmental allergies is to feed them with your human milk. According to the Academy of Breastfeeding Medicine, only 0.5-1% of babies will react to an allergen in their mother’s milk; but when it does happen, the removal of cow’s milk and soy from your diet may help improve baby’s symptoms.
Medications
Skip medications that reduce acid in baby’s stomach; long term use of these medicines can have negative health consequences for babies, including disrupting healthy bacteria in your infant’s gut and increasing infection risk.
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