Reflux is common in babies. Reflux is the same as spitting up and is not necessarily GERD. Most babies spit up some, and some babies spit up lots. Starting by about 2 weeks and continuing for months, many babies will continue to spit up through their entire first year. Sometimes a baby is gaining weight well, and does not seem to be experiencing pain or discomfort with spitting up. The label “happy spitter” can be used to describe this normal behavior. It’s an inconvenience and a laundry issue, but no medical treatment is necessary.
Symptoms of reflux can include irritability after feedings, arching during and/or after feedings, and spitting up and crying more than usual. These vague symptoms can also result from many other causes.
Symptoms of GastroEsophageal Reflux Disease can be severe. As stomach acid splashes up through the immature sphincter at the top of the stomach, it burns the esophagus. Vomiting, gagging, difficulty swallowing, coughing and wheezing, prolonged crying, refusing to feed, and weight loss or slow weight gain can be seen with GERD. Your baby’s doctor should be notified promptly if you observe any of these severe symptoms. Other disorders can also cause these symptoms so a diagnosis needs to be confirmed. Unfortunately, there is really no simple and accurate diagnostic test for GERD.
Changes in feeding are usually the first recommendations for symptom management. Adding cereal to thicken breastmilk is often suggested. Not helpful if your baby is just breastfeeding. You can pump breastmilk and add cereal, but know that the digestive enzymes in breastmilk will quickly liquefy the cereal, defeating the thickening effect. Adding cereal also goes against the current recommendation of waiting to six months of age to add solids. Cereal is high in calories and less nutritious than milk. The sense of fullness it creates may cause your baby to consume less milk.
Some breastfed babies will self-limit their time at the breast to avoid overfeeding. Others will overfeed because sucking provides comfort. Frequent small feedings, frequent burping, and keeping your baby upright for 30 minutes after feedings may help, but probably won’t resolve all of the issues of reflux.
Two conditions mothers need to be aware of that can mimic GERD include oversupply and cow’s milk protein sensitivity.
In oversupply, low fat feedings can produce some symptoms of GERD. If you are mostly pumping, consider combining pumpings for the day. Then divide the milk into feedings for storage to help to equally distribute the fat. Review recommendations for managing oversupply to help ensure balanced feedings.
Cow’s milk protein sensitivity can necessitate removing dairy from mom’s diet, which can be challenging since there are so many hidden forms. Once dairy has been removed, it can take at least 2 weeks to see an improvement in your baby’s symptoms.
Treating simple reflux or GERD can be frustrating because much of the treatment is trial and error. Medications to reduce stomach acid are typically prescribed for babies in only the most severe cases, since we really don’ t know what the long-term effects may be. It may help to know most babies will outgrow reflux by one year.
For help, see your baby’s doctor to rule out any serious medical conditions. A lactation consultant can advise you about oversupply, food sensitivities, and comfort measures for your baby with reflux.