Gastric Reflux

Whatever method you use to feed your baby and whatever food (breast or formula), you may experience your child regurgitating a lot of its feed.  Most babies do spill some of their feed so don’t immediately assume it is reflux without a professional diagnosis.

Reflux is due to a weak sphincter muscle at the lower end of the oesophagus near the stomach, which does not close properly, allowing gastric juices to flow back up the oesophagus.  Milk and acid spills out the baby’s mouth and in the case of children with cleft the nose as well.  Babies can also suffer from silent reflux ,which is difficult to diagnose because baby does not experience milk spilling, but has all the other symptoms associated with reflux.
Symptoms for both types of reflux may include:

• Difficulty feeding.
• Continuous crying.
• Unable to settle.
• Dramatic change from happy when being carried upright to very grumpy when being laid down due to the pain of gastric acid flowing the wrong way.
• Baby only takes short naps compared to other babies of the same age due to pain and hunger.

See a health professional
Get onto it really early - discuss your concerns with your Plunket Nurse or Doctor and ask about using Gaviscon or a food thickener to help lessen the amount brought back up.  There are also various drugs available on prescription which may help - talk to your Doctor.  A cranial osteopath trained in the treatment of babies may also be able to help.  Refer to the forum on the website for suggestions other parents may offer. www.cleft.org.nz/forum.php
Handy tips from parents

• Prop baby up after eating for at least 20 minutes.
• Use a reflux formula or thickener if expressing.
• Try feeding baby small amounts often.
• Do not be afraid to get medical help for the problem.
• Do not be afraid to try different things, as every baby is different.  But do give things a little time to work.
• Do not lie them straight down or sit them on your knee to burp them.  Place a towel over your shoulder and gently rest baby so their body is straight with their head on your shoulder and pat them or rub them gently on the back.
• At bedtime raise the head end of the cot and “short sheet” the cot or use a “Safe-T-Sleep” (available from baby equipment shops) so that baby doesn’t slide down the bed.  Always sleep baby on his/her side so that any reflux can drain away and remember to alternate sides at every sleep.  A clean cloth nappy under baby’s head saves on sheet washing and provides a clean place to lay their head each time.
• A foam wedge can be useful for a child in a bed.  It allows the upper body to be slightly elevated but the bed to remain flat thereby reducing baby sliding down the bed.
• A small sip of cooled boiled water after a reflux attack also helps baby clear their mouth and gets rid of a nasty taste.  If they have a dental plate fitted, don’t forget to clean it regularly, especially after each feed and after an attack.
• Plastic-backed bibs are essential!  Make your own with PVC raincoat material and toweling - make them big and they will be useful for solids too!  Also take extra clothes for baby when you go out, reflux babies don’t stay clean long and it pays to take at least a clean top for yourself too!
• Persevere with tummy time between feeds – protect flooring with a towel or cloth nappy.  Gaviscon or Reflux formula helps reduce the burning pain of reflux and makes tummy time more bearable.
• Wet wipes or a wet cloth in a plastic bag are handy to always have with you when you have young children.  Wash out bibs and clothes as soon as possible to avoid staining.
• Have a sense of humour, and develop a loving relationship with your washing machine!
• For further advice and support you could look at the New Zealand Gastric Reflux Support Group’s website http://www.cryingoverspiltmilk.co.nz/