Signs and symptoms of reflux, how to tell if it’s gastro-oesophageal reflux disease, and how to manage baby reflux symptoms.

Welcoming a new baby into the family is a joyous occasion, but it can also come with its share of challenges. One common issue that parents may encounter is baby reflux, a condition that can cause discomfort for both the infant and the caregivers.

What is reflux?

Baby reflux, also known as gastro-oesophageal reflux disease (GERD), occurs when the contents of the baby’s stomach flow back into the oesophagus. In most cases, this happens because the lower oesophageal sphincter, a muscle that separates the stomach from the oesophagus, is not fully developed in infants. As a result, stomach contents, including stomach acid, may leak into the oesophagus, causing burning, irritation and discomfort.

If your normally happy baby starts crying and being fussy, there’s a possibility they may be suffering from reflux. You’ll also notice they may spit up regularly, or even experience regurgitation of the milk they’ve consumed.

Symptoms and signs of reflux

Recognising the symptoms of baby reflux is crucial for early intervention and effective management. While it’s normal for infants to spit up occasionally, persistent symptoms may indicate reflux. Common signs of baby reflux include:

Frequent spitting up

One of the hallmark symptoms of baby reflux is the frequent regurgitation of breast milk or formula after feeding. If you baby is frequently having wet burps, it can be a sign of reflux.

Irritability and discomfort

Babies with reflux may become fussy, irritable or seem uncomfortable, especially after feeding.

Arching back or neck

Some infants with reflux may arch their back or neck during or after feeding, possibly to alleviate discomfort.

Difficulty sleeping

Reflux can interfere with a baby’s sleep and can cause them to have breathing problems. This is due to the liquid in the food pipe causing distress, leading to frequent waking or difficulty falling asleep.

Poor weight gain

In severe cases, persistent reflux can lead to weight loss or failure to thrive (poor weight gain and development).

Other symptoms of reflux include:

  • Vomiting or projectile vomiting
  • Erratic feeding (refusing feeds or constantly feeding)
  • Fussing after eating
  • Excessive drooling
  • Wet hiccups or wet burps
  • Throaty noises
  • Sour breath
  • Constant swallowing 

These symptoms usually emerge when your baby is two to four weeks old, peak at four months of age and start to subside from seven months onwards (though it can continue into childhood and even adulthood).

Young children may suffer from reflux, however it is usually not due alone to lower oesophageal sphincter issues, but more diet and lifestyle related.

If you notice that there are specific times when your baby has reflux episodes, you might want to start keeping a diary about what food and drinks both you (if you are breastfeeding) and your baby consume, and the reflux symptoms, to ascertain if there could be links to diet.

Stress can also be a cause. If you and your baby are in a stressful environment, the chances of developing infant reflux is as much as five times higher.

If your baby is on solid food and is still having reflux, it’s important to speak with your child health nurse to ensure your baby is developing properly and meeting milestones. Consult a clinical nutritionist to make sure your baby is getting the appropriate nutrition, rule out allergies and get advice for breastfeeding nutrition for yourself.

Reflux can get misdiagnosed as colic, cow’s milk protein allergy or lactose intolerance.

How to manage baby reflux

While baby reflux can be distressing for both parents and infants, there are several strategies to manage and alleviate the symptoms. It’s important to note that every baby is unique and what works for one may not work for another.

Here are some general guidelines to help parents navigate the challenges of baby reflux:

1. Be calm when feeding

If you are stressed, your baby can sense it and will also become stressed. It’s important to practice good self-care as a parent. Be in a quiet, safe and peaceful environment to ensure you and your baby are flourishing.

2. Adjust feeding techniques

  • Smaller, more frequent feedings: Instead of large, infrequent meals, try feeding your baby smaller amounts more frequently. This can help reduce the likelihood of overfilling the stomach, and reducing acid reflux.
  • Burp your baby: Burping your baby during and after feedings can help release trapped air, minimising the chances of reflux.

3. Hold your baby upright

After each feeding, hold your baby in an upright position for at least 30 minutes. This can aid digestion and reduce the likelihood of stomach contents flowing back into the oesophagus.

4. Choose the right formula

Some specialised formulas are designed to be thicker, which can help reduce the likelihood of reflux. Consult with your paediatrician before making any changes to your baby’s diet.

5. Check teat size of bottles

If bottle feeding, check the teat size, making sure it’s not too big or small. As a general rule, it should leak several drops of milk per second

6. Elevate the head of the cot

Elevate the head of your baby’s cot by placing a wedge or rolled-up towel under the mattress. This slight incline can help keep stomach contents down during sleep.

7. Monitor your diet, if breastfeeding

Identify trigger foods. Some babies may be sensitive to certain foods in their mother’s diet, such as spicy foods or dairy products. Experiment with eliminating potential trigger foods and observe if there are any improvements.

8. Tummy time after feeding

Give them an hour or so of tummy time after a feed. Make sure not to let them fall asleep on their tummy as this sleeping position has links to sudden infant death syndrome (SIDS). Always place your baby on their back to sleep.

9. Consult with a paediatrician

If your baby’s reflux symptoms persist or worsen, it’s essential to consult with a paediatrician. They can evaluate your baby’s overall health, rule out any underlying issues and provide personalised recommendations. It’s important to get medical advice to ensure the best outcomes for you baby’s symptoms.

Usually, medical treatment is not needed, as reflux will often go away on its own as baby develops or as you make the changes listed in this article.

However, in a small number of cases, the reflux can be extremely severe and cause baby to lose excessive amounts of weight or fall far below expected milestones. When this happens, your health care provider may suggest a course of medication. Often, this can be due to gastro-oesophageal reflux disease, which is typically diagnosed from bloody vomits (due to an ulcerated oesophagus). It can be nasty and awfully unpleasant for the infant—who will be letting you know that, in no uncertain terms!

10. Allergies and gut health

In some cases, allergies may contribute to reflux symptoms. If you suspect your baby has allergies, work with a healthcare professional to identify potential allergens and make appropriate adjustments to their diet. It is usually uncommon for older children to have persistent reflux, and diet and lifestyle factors will usually be the main cause of concern here.

If your child’s diet contains a lot of refined, processed foods, with very little fruit and vegetables, the bacteria in the small intestine can become imbalanced, leading to an overgrowth of bad bacteria which then can lead to indigestion—reflux. Consulting a clinical nutritionist who specialises in gut health will be a great place to start.

Reflux: A reason for unsettled babies

If your baby is consistently unsettled and has one or more of the symptoms mentioned above, it may be due to gastro-oesophageal reflux. There are lots of small changes you can make which usually leads to excellent results.

Remember too that reflux doesn’t mean you’ve done anything wrong. It may simply be the age of your baby and it could go away in a few weeks. If you are concerned or if your baby is losing weight, it’s important to visit your doctor to rule out any other health problems interfering with your baby’s wellbeing.

Any advice given is general in nature and is not intended as a substitute for medical advice and must not be relied upon as such. For any healthcare advice, always consult a healthcare practitioner.

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