When I start an evaluation call with a parent one of the first questions I ask is has your baby ever been diagnosed with reflux. Reflux can be an uncomfortable and yet fairly common condition for babies to have. How do you know if your baby has reflux? Can your baby sleep even if they have reflux? These are great questions that we will answer in the next few minutes. Things to keep in mind. If you are concerned your baby may have reflux please consult with your doctor. They may or may not prescribe medication but at least you’ll know what you’re dealing with. So let’s talk about sleep and reflux and how we can manage both so everyone can get some rest.
What is Reflux and is it Normal?
My son was diagnosed with reflux when he was 3 months old. He also had chronic ear infections for the next year and a half. It was quite a time, let me tell you. As a sleep consultant I know that the best thing for a baby in pain is sleep but sometimes they just can’t get there. Reflux is most often caused by an immature or weakened lower esophageal sphincter. It is the muscle at the top of the stomach that may not fully close to prevent the return of stomach acid into the esophagus. The regurgitation may be projectile (if you’ve seen it you know exactly what I’m talking about) or silent. This can be very upsetting for parents to watch. You feed your baby only to watch it all come shooting back out or your baby is squirming and crying obviously in pain.
Spit up is normal 50% of babies 0-3 months experience various amounts of spit up.
67% of babies 4-5 months old spit up but by 7 months most babies have grown out of any reflux.
Doesn’t happen after every feed and is not accompanied by distress
Right after or within 1-2 hours of a feed (an infant stomach is slow to empty)
Frequent projectile vomiting
Accompanied by distress
What Can I Do to Manage Baby’s Reflux?
Overfeeding is one potential cause of reflux and this is where I come in. When babies cry often one of the first responses from loving parents is feed the baby. If your baby has been fed in the last 1-1.5 hours they may not actually be hungry. Hunger cues and sleepy cues can look very similar. Try for a nap first if you know your baby has recently been fed. Overfeeding can cause discomfort in the belly and an over full tummy can cause the acid to flare up into the esophagus. Work on an eat, play, sleep schedule to avoid laying the baby down immediately after a feed. If mom has a very heavy let down you can try reclining when you nurse so baby isn’t getting as much milk as quickly. Also be sure your baby’s diaper isn’t too
tight, just like us in tight jeans baby’s experience discomfort if their tummy is being squeezed by a tight diaper or waist band.
Mom may also consider looking at her diet if she is breastfeeding. Some common causes of digestive upset in babies are:
- Spicy foods
I went off dairy and gluten with one of my baby’s and it helped so much. I was able to reintroduce those foods back into both of our diets after she matured a bit more and was able to tolerate them.
Talk to your doctor about medication if you feel your baby may need it.
Sleep and Reflux
Now that we’ve covered a few of the reasons why it may happen and how to manage it we can talk about sleep. If you are concerned your baby has reflux talk to your doctor (I know I’ve said it about 100 times, I mean it). Depending on how severe your baby has reflux it’s best to wait on independent sleep skills. The comfort and rest of you and your baby are priority number one. Most babies grow out of it on their own and so if your baby has severe reflux or GERD that is persistent ask for medical help.
During the height of reflux symptoms do your best to avoid overfeeding and laying baby flat immediately after feeding. Work on eat, play, sleep and try to feed slowly and steadily to avoid big gulps or swallowing air. As your baby grows out of these symptoms or is managed with proper medication you can help them develop some sleep skills that will allow their body to get some rest and grow and mature appropriately. It’s not a total loss, you can sleep even if your baby is experiencing reflux. Manage the symptoms first then we can talk about sleep.