Infant Reflux (the medical term is Gastro−oesophageal reflux or ‘GOR’)

Infant Reflux is the word used to describe what happens when the stomach contents and painful acid comes back up into the oesophagus or even into the mouth, this is due to an immature muscle connecting the stomach and the oesophagus which is known as the sphincter.

A reflux baby (GOR) is not to be confused with a GORD baby (gastroesophageal reflux disease). GORD is when complications arise which may require medication or surgery to correct.  Infant Reflux (GOR) is a common condition amongst children of all ages which often results in vomiting this can be in small or large amounts.  Infant Reflux can start as young as one month old, however it normally stops by the time they are about 12 months old.  Nearly 7 babies in every 10 have reflux.  For many babies this form of infant reflux can often be successfully controlled by simple remedies such as using a thickener with feeds, elevate the baby’s bed or keeping the baby upright during and after a feed.

Symptoms of infant reflux

Some common symptoms of uncomplicated infant reflux (GOR) can include:

• constant or sudden crying or colic like symptoms
• irritability and pain
• poor sleep habits typically with frequent waking
• arching their necks and back during or after eating
• spitting-up or vomiting
• wet burp or frequent hiccups
• frequent ear infections or sinus congestion

Your child does not need to exhibit all of these symptoms, in fact, only having one of the above could mean they have infant reflux. It does not; however, mean they need treatment.  If your child is showing one or more of the above symptoms but is otherwise happy and healthy then some simple lifestyle modifications will likely make life better until they outgrow it.

Symptoms indicative of Reflux Disease or GERD:

• refusing food or accepting only a few bites despite being hungry or the exact opposite requiring constant small meals or liquid
• food/oral aversions
• anaemia
• excessive drooling
• running nose, sinus infections
• swallowing problems, gagging, choking
• chronic hoarse voice
• frequent red, sore throat without infection present
• apnoea
• chronic ear infections
• respiratory problems—pneumonia, bronchitis, wheezing, asthma, night-time cough, aspiration
• gagging themselves with their fingers or fist (sign of oesophagi tis)
• poor weight gain, weight loss, failure to thrive
• erosion of dental enamel
• neck arching (Sandifer’s Syndrome)
• bad breath

As with infant reflux, children with GORD will not necessarily exhibit all these symptoms, for example children with silent reflux will not throw up. If you believe your child shows any of these signs, educate yourself on the treatment methods and then contact your doctor to discuss the best way to treat your child.

Silent reflux in infants is exactly the same as infant reflux minus the spitting up. When an infant refluxes silently the stomach contents travel up the throat but the infant is able to swallow it back down again before it actually comes out. This means the stomach acid burns on the trip up the throat and on the trip back down. Silent reflux in infants is not as obvious because there is no actual spitting up, which makes it much harder to detect.

Silent reflux can sometimes be more damaging because it can sit in the oesophagus longer.

Some babies with silent reflux will feed as a means of soothing their pain, so they may not have issues with their weight like other reflux babies do. This can further delay diagnosis and treatment as the problem is sometimes overlooked.

Medical intervention is often necessary and the same complications can arise as in other forms of reflux. The doctor may prescribe Zantac or Losec.

Your baby may suddenly start crying while feeding, or after the feed, without any other obvious cause for the crying, or they may grimace, or make a screwed up face like they are tasting something bad. They may be.

You may notice any of the other signs of reflux apart from the obvious one; vomiting. Sometimes you may hear the baby reflux, or see them swallow repeatedly, and see no evidence of it.

Symptoms of silent reflux in infants

Your baby may exhibit only some of these symptoms:

• poor weight gain, weight loss, failure to thrive
• gulping with a painful look on the face
• sour breath, wet sounding burps
• persistent or chronic cough
• frequent hiccups
• sudden burst of painful crying
• painful wakeups from sleep or poor sleeping habits
• poor feeding habits, possible feeding aversions
• neck or back arching during or after feeding
• excessive fussiness, crying or colic
• demands to be carried constantly
• refusing food or accepting only a few bites despite being hungry or the exact opposite requiring constant small meals or liquid
• food/oral aversions
• anaemia
• excessive drooling
• running nose, sinus infections
• gagging themselves with their fingers or fist (sign of oesophagi tis)
• chronic hoarse voice
• frequent red, sore throat without infection present
• apnoea
• chronic ear infections
• respiratory problems—pneumonia, bronchitis, wheezing, asthma, night-time cough, aspiration
• erosion of dental enamel

Below are some tricks I have used and what other parents have recommended.

• Keep your baby upright for at least 30 minutes after a feed.
• Keep baby’s body straight with their head higher than their stomach try using an elevated feeding pillow
• Burp baby frequently during and after the feeds as long as this doesn’t upset the baby.
• If the baby is bottle-fed, try AR (anti-reflux) formula, or a HA (hypoallergenic) one. You may need to use a larger size teat with the thickened formula. Formula’s for newborns are: Nan 1 HA Gold Premium Starter Infant Formula with Karicare Food Thickener, Novalac AR Infant Formula, Karicare AR Thickened Formula or S26 AR Thickened Infant Formula are just a few
• Try elevating the head of the cot/bassinet with a blanket, or elevated wedge
• Avoid overfeeding.
• Try feeding smaller amounts slightly more frequently (unless this upsets baby). Frequent large feeds can trigger reflux.
• The best time to lay your baby on the floor is when baby’s tummy is empty, i.e. before a feed
• Change nappy before a feed. Take care to elevate the baby’s head and shoulders. Avoid lifting the legs too high, and turn to the side if possible.
• If breastfeeding, avoid foods that can aggravate reflux such as citrus, tomato, fatty foods, spicy foods, chocolate and carbonated drinks
• Some reflux children may suffer from food sensitivities, and may need dietary restrictions (or the mother may consider an elimination diet). If you suspect foods may be responsible for your child’s condition, it is essential to discuss this with your health care provider. Do not change your or your child’s diet before seeking medical advice.
• Use a baby sling, which allows you to keep your child upright and keep both hands free so if you want to do some house work you can, or simple just go for a walk, babies like to hear their parents heart beat and this allows that
• Consider using a dummy; the swallowing action may help
• Avoid vigorous movements or bouncing the baby.
• Avoid any tight clothing around the waist, such as tight nappies, elastic waistbands.
• Put baby in the pram and rock it backwards and forwards over a bump in a rug, etc. Better still; go for a walk outside if you can – the screaming never seems quite so loud in the great outdoors.
• Play a ‘white noise’ CD on for background noise so that the baby is not easily startled by loud noises.
• Use products to help keep baby upright or help calm them, such as an automatic baby swing, bouncer and/or baby hammock as suitable. Never let them fall asleep unsupervised in these devices as they are not designed as sleeping products.
• Avoid exposure to tobacco smoke.
• Try infant massage, it’s been shown to improve digestion and will help relax baby

Symptoms of Colic

Colic tends to appears in the first two to four weeks of age and peaks at around six to eight weeks of age.  The crying from colic can occur at any time of the day but usually appears worse around late afternoon early evening. The symptom includes:

•  Loud and continuous crying that can last for three hours or more
• Pass gas
• Loud tummy rumbling
• Frowning and grimacing
• Babies face becomes red
• The baby can’t be consoled
• Legs are pulled up to the stomach and then may be fully stretched  
• Feet may be cold
• Hands may be clenched  
• Some babies refuse to eat or become fussy soon after eating  
• Difficulty falling and staying asleep

Despite the research into this condition the cause is still unknown and there is no one quick fix that works for every baby.  The most important first step is to check with your baby’s paediatrician to make sure there is no medical cause for your baby’s crying.  Once your baby is given a clean bill of health then all you can do is try your best to keep your baby calm and comfortable through an episode of crying, it usually fixes itself at around three to four months of age.

There are many theories as to why babies get reflux which are:

• Immature digestive system that is having spasms
• Immature nervous system, which causes a baby to tense up in response to normal external stimulation
• Mother’s diet may cause symptoms of food allergy or intolerances in her breast milk, certain foods that give the baby wind such as, cabbage, broccoli, cauliflower, chocolate, onions or cow’s milk
• Mother’s that breastfeed and drink caffeine and or inhale nicotine can also linked to infant irritability because the babies body is unable to efficiently get rid of these substances 

Each of these theories along with others is still being researched today.  Since there is no factual evidence on what the exact cause of colic is, there is no one easy solution to help parents ease or comfort their baby through an episode of crying.

• Keep a diary of when your baby cries, along with activities like napping, feeding and playing.  Look for patterns, which may offer a small clue to the solutions  
• Burp baby frequently during the feeds.
• Don’t overfeed your baby
• If the baby is bottle-fed, try a HA (hypoallergenic) formula e.g. Nan 1 HA Gold Premium Starter Infant Formula, Karicare HA Gold Plus Infant Formula are just two to try
• Consider using a dummy; the swallowing action may help calm the baby
• Use a baby sling, which allows you to keep your child upright and keep both hands free so if you want to do some house work you can, or simple just go for a walk, babies like to hear their parents heart beat and this allows that
• If you’re breast-feeding, try to eliminate dairy from your diet along with other foods such as onions, cabbage, cauliflower, spicy foods, caffeine, beans or other gas producing foods.  Before eliminating diary from your diet be sure to check with your doctor first.  Your doctor may or may not want you to eliminate dairy from your diet or he/she may want you to take calcium supplements
• If you’re bottle-feeding, do your best to reduce the amount of air that your baby swallows.  There are many bottle’s available on the market help reduce the amount of airflow try the Dr Brown range of bottles that are available on my website.  
• Take your baby to a part of your home that will provide less stimulation.  Bright lights, noise, or a large number of people may further aggravate the colic  
• Wrapping or swaddling your baby while walking around in a smooth steady motion, try the miracle blanket
• Go for a walk in a stroller or for a drive in a car seat  
• Give your baby a warm bath or place a warm water bottle on your baby’s stomach.  Be sure the bottle is not hot!
• Try rocking in a rocking chair; or swinging in a baby swing, or in a baby hammock.  
• Try a gentle tummy massage  
• Play a ‘white noise’ CD on for background noise as some babies like hearing the rhythmic sounds.

Talk with other parents and friends and get their suggestions on what methods they used to calm their baby.  There are a lot of different things that people have tried that are not listed above.  Keep in mind that not every baby will react to these methods the same.  Sometimes it may help, while other times it may seem to make the baby more uncomfortable.  Try one at a time and hopefully you will find one that comforts your baby while also giving your ears a rest from the crying.

 What is the difference between colic and reflux?

‘Colic’ is an unsettled baby with lots of wind.  Reflux babies also have a lot of abdominal wind.  If you look at the symptoms of colic they are similar if not the same as those of a baby with reflux.  So what is the difference between reflux and ‘colic’?   I, and many health professionals will agree with me, believe that colic as it was commonly known is today known as ’silent reflux’. 

It can sometimes be difficult for a parent to understand whether the baby has colic or reflux (and even GERD) since some of the symptoms (e.g. poor sleep, constant crying) can be similar. It’s also extremely important to rule out reflux as a cause of this crying, as it’s becoming widely acknowledged that many cases of colic are actually undiagnosed and untreated cases of reflux. In these cases, simply treating the reflux may eliminate the colicky behaviour.

The easiest way to determine whether a baby has colic or reflux is to look at the definitions and symptoms of each. Then compare them to your child’s symptoms.

Unfortunately I had two boys with “Silent Reflux”, all my friends said to me “You already had one child with silent reflux surely it couldn’t happen again”, “it would be easier this time as I knew what to do, ‘well weren’t we all mistaken’.

I was only able to breastfeed both boys for approximately 2 weeks as I had problems so both where formula feed from a young age, which I felt really bad about but I had a few friends that said that they breast feed their babies and they too had reflux.

From about week three things started to go pear shape, Jake was showing the following signs:

• He would scream all day
• Frequently hiccupped
• Arched this back and pulled he knees to his chest in pain
• Had allot of wind, which they call colic
• Seemed hungry but when I gave him the bottle he only drank small amounts then would pull off the bottle screaming
• Had poor weight gain
• He would only want to be held upright
• Would gag like he was regurgitating his food
• He was very easily startled and would wake at the smallest sound
• He would only cat nap during the day I would be lucky to get sleep for 10-15 at a time or even all day, I knew he was just so tired but he would fight going to sleep

At this time I was pulling my hair out, the constant screaming was driving me mad and I was so exhausted because he was just not sleeping so I went and I spoke with my paedicitrican he said that reflux can run in the family and it looked like Jake had silent reflux.

So we first elevated his bed with a sleeping wedge, then tried an Hypoallergenic AR formula, which helped a little, a week or so later the paediatrician recommended Jake be put on medication to help with the reflux.

A week or so after that Jake’s reflux started to ease but unfortunately I was left with a baby with bad sleeping habits, Jake was on this vicious cycle

First there was reflux, then came pain, then came crying which made the reflux even worse, which caused him to be over tired and very unsettled, he then had trouble sleeping which then lead back to more reflux, it went on and on, he was on this merry go round, which I had to stop.

Once we had the reflux under control I knew we had to break this bad sleeping routine.

Firstly I had to make sure that I was picking up on Jake’s tired signs and I didn’t let him become overtired otherwise it was game over, then because he was a easily startled baby I used to wrap him with the miracle wrap, I also introduced some “white noise music” at first quite loud to get him used to the noise, then it all came down to implementing a good routine which can be found in the books available on my website.

If I needed to do some house work or get some groceries I would put Jake in a sling, this kept him upright and close to me which kept him cam. When I was at home I also put him in a baby swing & a hammock which he enjoyed as it also kept him upright but he also enjoyed the swinging motion.

For me the key to my success after the silent reflux was under control was teaching Jake to self settle and as a mum this was the hardest thing to do because no parent likes to hear their baby cry. I also had a partner that drove a truck so I never wanted to wake him.  But after Jake learnt to self settle he finally started to sleep through the night and I finally started to feel human.

Also another big help for me was talking to other parents that where having the same problems as I was, and talking to close friends to reassure me that I was doing the right thing.  I was very lucky to get into a two different sleeping schools which help me realise I was doing the right thing and that I was not going mental and I got to meet some great ladies and their gorgeous babies, who were also going through the same problems and realised that I wasn’t the only person in the world suffering because my child wouldn’t sleep.

The books I have available on my website where like my bible I would also be referring back to them most days.

You have to remember that not everything is going to work for your baby you just have to try everything and settle on what works for you.  Make sure you surround yourself with family and friends that are there to support you, as you need it.

It’s very important to take care of yourself as your baby needs you to be strong for them, so if someone offers you help take it, don’t be too proud to take them up on their offer, take some time out for you whether it’s to have a nap, going shopping for a new outfit or even just get a haircut and feel like human being again.

Having a baby with sleeping difficulty is very difficult time you’re in life and puts many strain on your body & your relationship, you are not only physically exhausted but also mentally exhausted, and most people like myself not only have to be a full time mum to one or more children but also work full time, it not an easy thing to do.

Just remember you can get through it, there is light at the end of the tunnel have faith in yourself, having a child is a life changing event but in the end it’s all worth it, you wouldn’t change it for the world.