Reflux

Reflux occurs when your baby’s stomach contents are released back up towards their mouth. It is unlikely to harm your baby or cause any long-term problems. 

Your baby may have signs of reflux after a feed that include: 

• bringing up milk during, or shortly after feeding 
• burping, belching or swallowing hard. 

Reflux is not the same as vomiting

Reflux and vomiting are different. Reflux is effortless, while vomiting is forceful. Some reflux and regurgitation is normal and will usually improve as your infant grows and their digestive system matures. Reflux often increases between six weeks to four months, and for some children it will continue until they are 12 months old. 

If you aren’t sure whether your baby is experiencing reflux or vomiting, call PlunketLine to speak to a registered nurse. 

What causes reflux?   

The oesophagus is the tube connecting the throat to the stomach. At the end of an oesophagus, before the stomach, is a ring of muscle called a sphincter. This keeps food after it is swallowed in the stomach. Reflux or silent reflux occurs when the sphincter doesn't work correctly and allows stomach contents which can include food and stomach acids back up into the oesophagus. For some children, this can cause discomfort and periods of being unsettled.

Both reflux and silent reflux are common in infants as they have a shorter oesophagus and their sphincters are not fully developed. Reflux usually resolves without treatment as the sphincter strengthens and baby grows.

You can help your child if they have reflux. 

During feeding: 

• take your time with feeds 
• try to stay calm and relaxed during feedings, if possible 
• burp your baby during feeding 
• don't force your baby to take more milk than they want – some babies like to eat smaller amounts more often 
• for bottle feeding, check that the hole in the teat is not too big, as feeding too quickly can make reflux worse 
• use large bibs and a towel or cloth after feeds to catch the milk and protect clothes. 

After feeding: 

• hold your baby upright for a short time after they feed 
• try not to handle your baby too much 
• where possible, it may be helpful to change baby before or during a feed, rather than afterwards when their stomach is full.

If your baby brings up a lot of milk, they may be hungry again and you might need to feed them again sooner than usual.  

For most babies, you don't have to do anything about reflux. It is a natural process which will get better by itself. Changing formulas won't help and neither will a change from breastfeeding to bottles. 

There are thickened formulas for babies who are formula fed with reflux, although there is not a lot of research to support how effective these are. There are also many over-the-counter products aimed at reducing wind, colic and reflux, but there is no scientific evidence that shows these preparations work. If you choose to use such a preparation, make sure you choose one that has no alcohol or sugar. 

Silent Reflux is also known as Laryngopharyngeal Reflux or LPR. Silent reflux is when the weak muscle at the top of the stomach means some food is squeezed upwards into the oesophagus, causing the baby’s stomach contents come up the oesophagus and flow into the back of the throat and nasal passages.

However, unlike reflux, the stomach contents are not released back as far as the baby’s mouth, and there may not be any outward symptoms of spilling at all. This is a common condition in babies and for most of them, it is nothing to worry about. An estimated 8% of newborns experience either excessive or ‘silent’ reflux, which can result in a very unhappy baby.

With silent reflux, painful ‘heartburn’ symptoms are experienced instead of vomiting. Because there is no vomiting, this can be confused with wind or colic. Babies suffering from silent reflux typically experience discomfort 60-90 minutes after feeding.

Silent reflux is different to vomiting because reflux or spilling is effortless, while vomiting is forceful. 

As the baby’s stomach contents fall back into the stomach instead of being burped or spit up, it can be difficult to identify that silent reflux is upsetting your baby.

As long as your baby is healthy and growing normally, reflux is not usually something to be concerned about.

Symptoms

This type of reflux doesn’t always cause obvious symptoms, hence why it is called ‘silent’. Signs to look out for in your baby or young child might include:

• hoarseness
• chronic cough (or "barking")
• noisy breathing, wheezing, or pauses in breathing
• chronic respiratory conditions (such as bronchitis) and ear infections
• Trouble feeding, spitting up or inhaling food
• Difficulty gaining weight
• gagging
• nasal congestion

How to feed your baby if they have silent reflux

While breastfed and bottle fed babies suffer from reflux equally, studies have shown that reflux in breastfed babies tends to be shorter and less frequent than those who are bottle fed. Breast milk is generally digested faster than formula, so it has less time to hang around and cause trouble.

Regardless of how you are feeding your baby, you should follow the advice below:

Feed your baby in an upright position

If you are breastfeeding, you may need to try different positions to find the best one that will allow your baby to remain fairly upright during feeding. Some mothers report success by having their baby face their breast while straddling their leg. Others prefer to stand up while feeding their baby in a modified twin-style hold.

Keep feeds small and frequent

Your baby may prefer to feed often, and this is actually better for them than a large sudden intake of food as this causes less pressure on the stomach muscle.

Keep your baby upright

For at least half an hour after feeding, keep your baby upright. You may want to hold them on your shoulder or perhaps use a front pack or baby seat.

Introduce a reflux-friendly routine

Try to keep to a routine where your baby feeds when he wakes up, so that they’ll have plenty of time to allow the milk to digest before lying down to sleep.

Don’t let your baby fall asleep while feeding

Catnapping on the breast or bottle always leads to pain once the feed has finished so try to avoid feeding when your baby is tired.

Try feeding solid food first

Once your baby is old enough to be eating solid food, try offering this to him before his milk feed as this seems to keep the milk down. For younger babies, try a small amount of thickened milk at the beginning of a feed. Many bottle fed babies find relief from reflux when thickened formula is used.

In a small number of babies, reflux can lead to problems including gastro-oesophageal reflux disease (GORD). Speak to your Plunket nurse or doctor if you're worried, or if you notice any of the following in your baby: 

• long or frequent periods of irritability and crying 
• reflux is forceful, or is green or dark yellow 
• blood in the reflux 
• their back arches after feeds 
• poor sleeping 
• poor weight gain 
• long-lasting cough or wheezy breathing 
• changes that you are unsure about
• the reflux continues after your baby turns one year old.