Conservative strategies are usually the first line of treatment for gastro-oesophageal reflux (reflux). They may help manage some symptoms of reflux in babies. Some conservative strategies are listed here:
- Feed baby in an upright position and keep baby upright for 30 minutes following the feed. Avoid the seated position or laying baby on their back during this time; and avoid the slumped position.
- Try smaller feeds more often (this should not be more often than every three hours) as frequent large feeds can trigger reflux. This does not suit all babies, and larger amounts with longer times between feeds may suit some better.
- Avoid overfeeding. If baby vomits immediately after a feed, do not feed again but wait until the next feed. Talk to the doctor or child health nurse to make sure baby is getting an appropriate amount of food.
- Thickened feeds are sometimes helpful for reflux babies, especially those who vomit. If the doctor recommends using a thickener, commercial thickeners can be mixed with a small amount of water and fed to baby before, during or after a feed. Parents should take note whether the thickener seems to help, and talk to their doctor if baby becomes more unsettled.
- A large percentage of babies with reflux seem to suffer from foods sensitivities (e.g. cow’s milk protein, soy). If food sensitivities (allergies or intolerances) are suspected, parents should talk to the doctor before they make any changes. Breastfeeding mothers may be able to eliminate suspect foods from her diet; however, it is important she gets professional guidance. A dietitian who specialises in food sensitivities can help.
- Burp baby frequently throughout the feed (do not interrupt if baby is feeding comfortably).
Many babies who suffer from gastro-oesophageal reflux (reflux) are difficult to feed at some stage or another. Their behaviours may include:
- screaming and refusal to feed despite obvious hunger
- fussing at the breast; they may fight/pull off or push the breast away after a short time
- stiffening up, arching their back, squirming and general distress during feeding (though some are happy between feeds)
- excitability, easily over-stimulated (even talking may interrupt these babies)
- demanding feeds frequently (some are unhappy unless feeding)
Breastfeeding mothers may blame themselves if their child has feeding issues. They may worry their milk is causing problems, and may consider giving up breastfeeding. It is important that if their baby does have feeding issues, they seek medical advice and address any issues early.
It may help them to know that reflux occurs in both breast and bottle fed babies, that there are no guarantees that switching from breast milk to formula will help their baby’s reflux or feeding issues in any way, and that breastfeeding is the recommended option for the majority of reflux babies.
Strategies to try
There are many strategies parents can try, and finding ones that help may take time. It can help if parents listen to their instincts, keep looking for answers and talk to their doctor if they have any concerns.
- Relax baby as much as possible before a feed, don’t try to feed while baby is screaming, hiccupping, seems to be in pain, or is obviously refluxing.
- Try soft music or droning noise in the background (feed baby in the laundry while the washing machine is on or while the vacuum cleaner is going).
- Distract baby by rhythmic motion, soothing sounds, physical contact or doing something different e.g. a walk outdoors. When settled, ease baby onto the breast.
- Concentrate on feeds where baby is more relaxed/less distressed. This may be when baby is just about to drift off to sleep or before he/she is fully awake. Anticipate waking time and be ready to offer breast immediately.
- At night, try to prevent baby crying for long before attempting to feed, by postponing nappy change, avoiding turning on lights or unduly disturbing baby; keep baby relaxed and drowsy.
- If baby feeds well at night, give extra feeds then. Try moving cot nearer to the bed so baby can be feed as soon as awake.
- Do not try to force feed baby if he/she is continually refusing; this could make the problem worse. Try again in 15-30 minutes. In the meantime, use distractions to settle baby.
- Try minimising distractions to feed baby. Feed in a quiet, darkened room, with minimal noise. Alternatively, some babies feed better with distractions, so for them, try using toys or the television.
- Talk about any issues or frustrations with partners, family or friends, or contact a support group.
Parents should trust their instincts and do what feels right, but if they have concerns they should seek advice from the doctor, child health nurse, dietitian or speech pathologist who specialises in children with feeding issues.
© Reflux Infants Support Association Inc