Ask yourself these questions:
- Does your baby groan like a Wimbledon tennis player on heat when laid flat at night time?
- Do you have have to change your baby's clothes (or your own) not because of poo-narmis but because of vom-narmis?
- Do you either load the washing machine daily with acidic vomit laden clothes or have a wash basket full of crusty milk dribble bibs? (Each of the previous questions depends on how much you can be bothered to launder).
If you answer yes to one of these, your baby may have reflux. Gastro-oesophageal reflux to be precise. Yes, I know, a crude way to diagnose, but here comes the (semi) science bit.
So, what you talkin' about Doctomum?
My second son, Bobcat, was rather different from the first. Manifesting in the answer 'yes' to the questions above. Whilst he was healthy, gaining weight and on the whole, happy; he was however, a soggy soul. He had reflux.
The aim is to give you a bit of a medical mum perspective on it - having experienced it personally with my son and managing other peoples kids. This is not for you to feel you have to diagnose the condition in your baby but to act as pointers which you can always approach your GP with or if you already have the diagnosis, a background and tips on management for it.
Just to say...
Reflux is so so so common in babies and they do grow out of it. They DO! Trust me, I'm a Doctomum. It doesn't seem like they ever will *currently picking crusty milk-vom curdles from between bosoms* but they will grow out of it. They WILL! Ride it out and they will.
By 4 months Bobcat had got a lot better, probably actually by 3 months he was better but I was still utterly cream crackered at that point so didn't notice. He still has a tendency to vom now at 4 months plus, but not in the previous capacity.
Almost every baby will have a degree of it and for most it does not cause a problem (apart from being the soggy clothes fiasco and the subsequent water bill).
So why do babies get reflux & what is it? (the semi science bit)
Picture your food pipe (oesophagus), it goes from you mouth to your stomach, and just where is hits your stomach there is a tightening (a valve) to stop the food coming back up your throat. Look, here's a badly drawn picture:
In baby's this valve is loose, so milk tends to just flow straight back up, showering you and your baby in curdled delight. Every baby's valve will have a different 'tightness' to that valve, some will just vomit a bit, some will make it look like a scene from the exorcist. Some will 'silently reflux' - basically the symptoms of reflux without the obvious copious vomit.
As the milk in the stomach is mixed with normal stomach acids, it can burn (the equivalent of baby heartburn) as it comes back up the throat and cause all of the discomfort like signs in the baby.
To a degree, an element of reflux is normal in a baby. Almost every baby possets (normally a little spitup/palmful of milk after a feed and this can be due to the troublesome loose valve they have.
As they get older, the valve tightens and in the vast majority it gets better.
Think if it like this, look at your little baby now, all sack of new baby spud-like (floppy, lumpy in places). Now that's what his loose valve is like, and as he gets bigger he will be less saggy sack of 'tatoes-like and more strong like bull-like. So it will get better. I will stop writing 'like' now.
There is normally nothing structurally wrong. There are exceptions to the rule that sometimes there is an underlying condition, but the majority have simple reflux for the reasons above.
What are the symptoms of being a sog-mog (refluxy baby)?
- Vomiting. The vomit can just dribble out of their mouth or in bad cases be projectile. There is another condition called pyloric stenosis (where the outflow of the stomach is too tight) which presents similary but gets worse, not better over a short period of time. Your doctor will try to make sure which one it is.
- The vomit should just be milk or curdled milk.
- Discomfort after feeds: back arching, crying, squirming.
- Rattly/gurgleness (more than the normal cute gurgleness).
- Symtoms worse when laying flat - more vomiting/arching/squirming/difficult to settle.
- Seems windy.
- Seems in pain after feeds.
- Whingey/crying after feeds.
- Feed refusal (due to the association they develop with pain).
- They don't have to vomit - the can have silent relux - all the symptoms without the vomit. Some of these baby dudes seem to cough/gag a bit, chomp on something then swallow it back again (ummm, delicious) with not a dribble in sight. They can also be a bit more hiccupy than other babies.
- If bad enough, can fail to gain weight adequately
- Tired and soggy looking parents.
These are not hard and fast symptoms, each one could just be a normal part of being a new little being in the world or a few of them together could mean a reflux.
Other things that are a bit shitty at this time.
Colic and wind can look similar to reflux and are more common. Colic tends to happen around the same time every day (ususally the dreaded witching hour, around 5pm, and is periods of inconsolabilty not seemingly related to feeds. Wind is well, burping and farting, as you probably know, and some babies need more help winding than others.
These two terrors (colic and wind) can also coincide with reflux, making those first few weeks even more sleepless and stressful.
Also just a quick mention to the ol' Cows milk protein intolerance, as this also crosses over with reflux (it can cause reflux). It is worth bear in mind if reflux doesn't respond to conventional management and there are other symptoms of it present. Research has shown cow's milk protein allergy or intolerance is underdiagnosed.
It can be hard to tell these all apart and I wouldn't expect a parent to bear the burden of diagnosing. It's too difficult in your own child, I know that. That is why we have doctors to do this job for us.
How can I tell my baby is a soggy soul?
This is best diagnosed on a good chat with your doctor and an examination of your baby.
With reflux it is likely that your baby will be very normal on examination - this is good as it helps rule out nasties like pyloric stenosis or other causes of vomiting in babies.
This history of the problem is what the diagnosis is based on.
Most often no fancy tests need to be done, unless the problem is very severe and there is concern about the underlying diagnosis.
Finally, as with alot of medicine, often the best way to diagnose is to trial some management therapy - whether it be simple gravity-like methods to medications - if these work, then you may have the diagnosis in hand.
Please make it stop...(how to help your baby)
- Absolutely number one hero in the fight against reflux. Keep them upright whenever possible, it will make your life so much easier. Obviously this is very hard at night or naptime but you can wedge towels under the matress or buy a fancy wedge off t'internet. Always wedge your blankets/towels under the mattress as loose blankets can be harmful to babies and their breathing. Again this will get better and as they get older you will be able to lower the incline on their mattress. My Bobcat is almost flat now at 4 months - you will get there too! NB: There may be a lot of sleep deprived swearing in the meantime until it sorts itself. Reflux is a git to your sleep.
- Slings are amazing for this - not only are they settled near you (one of natures natural pain relievers) but they are upright (try to do the legs out pose as knees up new born position may increase pressure on the tummy, and don't place them in there straight away after a feed, leave it 10 mins plus - all to avoid a vomit attack down your cleav).
- Winding and posture
- Good winding - whatever posture is your baby's poison (over the shoulder, leaning forward seated, jiggling about etc) and for at least 10 minutes
- Keeping upright for 30 mins after feeds - I know this is hard in practice, this is why slings are good.
- A nice little pat. I find most babies reflux or not, just like a little pat on the back. nice little comfort for them.
- Feeding little and often - babys have tiny stomach so less in means less to overfill, less to vomit and easier for them to empty their stomachs into their guts. You may find if you breastfeed your baby they do this naturally and are more of a 'snacker'. Its a pain to have a frequent feeding snacker (I had one with my first, no luxury 4 hourly feeds more me!) but the benefit is they are trying to help themselves without the need for doctors to butt in.
- If bottle feeding check, you're not accidentally over feeding. Their stomachs can only hold so much. Often, I find that the back of the pack guide to how much they should be taking is a little generous, so don't worry too much if they are not taking as much on here as long as they are steadily gaining weight. For formula or mixed feeders consider trying one of the 'stay down' type formulas, designed to thicken when they reach the stomach, aiding gravity, so they food stays down. NB: you will need a bottle with a larger teat hole as the formula is thicker and they can cost a few pounds more than the regular formula, but it may be worth it to settle them (and it wont be forever, after a few months, consider switching back to regular formula). To my knowledge these types of formula are not available on prescription but can be found in most big supermarkets and Boots.
- Muslins and bibs galore.
- Anything to cut down the added angst of too many daily costume changes for all. I'll say it again, ride it out, it will get better, and by 3-4 months you will find you are using significantly less muslins!
- Early Weaning (4 months'ish)
- The theory is that the more solid the food the more it will stay down. Now this is debatable as naturally reflux tends to improve by this age and is really only something to do under the advice of your doctor or health visitor if the reflux is bad enough. But it can potentially help.
Most don't need medication, but if they do, the top one is baby Gaviscon.
- Infant Gaviscon: Much the same as the Gaviscon (simple anti-acid medicine and slight feed thickener with few side effects) you drank by the bucket load in pregnancy but in little sachets you mix with formula or breast milk. Main draw back is for breast feeders as you will most likely need a bottle to administer it which can be a faff. I used to give it to my son with an evening formula feed as that's when his reflux was worse and just hold off for the other feeds, but every one is different. You can give it with most feeds or tailor it to you baby under the advice of your doctor. It does cause some constipation though, not horrifically so, but it's worth weighing it up if you think the benefit is worth it.
- Anti-acid medicines e.g. Ranitidine, Omeprazole etc: Reduce the amount of acid on the stomach so it should be less painful to reflux. These can have diarrhoea or constipation side effects. They are mainly used under advice from paediatrician and what happens to be their choice of medication/what is flavour of the month research wise. Good idea for really troublesome reflux with weight loss especially in breast fed (no need to add to bottle) but can't always be used in all infants depending on their previous medical history.
- Pro-kinetic medicines e.g. Domperidone: These medicines empty the stomach out quicker so there's less chance for the feed to 'reflux' out. Again these are best advised under a paediatrician and can't be used in all infants. Sometimes a little cocktail of these medicines can work for stubborn reflux.
If you can get away without using medications for a condition that the majority grow out of then great, do this. It is tough going, I know it is. You can do it, it's awful to see you baby in pain but in will get better.
If they are gaining weight adequately and healthy then in my opinion I would try to hold fire with medications and use gravity/slings/feeding/wait and see approach first.
Reflux is even commoner in premature babies - here medications and advice from a paediatrician is more commonly used as weight gain is so vital to these little guys, so management can differ here.
Something's bothering me... (when to worry)
Things that may mean a trip to the docs:
- Weight loss or poor weight gain
- Feed refusal
- Signs of dehydration
- Green bile vomit - this means the stomach outflow is blocked. Occasionally in older children and adults with sickness bugs they can have greenish vomit but you should get this checked out ASAP. Brown or red vomit is not normal also, get that checked out too.
- Projectile vomiting that is getting worse or not getting any better.
- Not pooing for a while and being unwell with it (outside the realms of normal constipation)
- If the baby seems unwell to you/not right. Parents have an instinct - the way the baby cries, they seem not quite with it, or something just doesn't sit right with them. Act on it.
- I can't list every reason to worry, please go and see a health professional in person or ring NHS direct for advice if you have concerns.
If you feel your baby may have reflux, ask your GPs or health visitors advice.
This is just my take on reflux and how I deal with it with my own children and with children as patients. It is not a substitute for seeing a real-life doctor in person.
If you have concerns this will hopefully will aid as a pointer if you think your baby as reflux. If you have a child already diagnosed with reflux, I hope it may reassure you and give you some ways to help them (and you) cope with it.
The stuff written in this post is what I say to patients daily off the top of my head and may not be the most up to date research wise but it's what I find helpful with my own kids and has helped other parents.
Check out NHS take on Reflux here
If you have any tips that you have felt worked well with your baby or you have found this helpful, please post below and share.
As always, please see my disclaimer.