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The Not So Perfect Napper and Reflux

Heidi Skudder Baby Sleep, Breastfeeding

There I said it! My baby does not sleep perfectly! It’s probably one of the most frustrating things to admit when your sole job is getting babies to sleep well – but it is true. See the thing is, in my workshops and with private clients, I will always tell parents that you can always get a baby to sleep well both in the day time and throughout the night, with a little bit of hard work and determination from you as a parent and a little bit of help and support from myself.

There are very few cases where a baby’s sleep will not improve, or you will not be able to get them through the night and that is usually down to one of a few things;
-reflux
-food allergy
-medical condition (floppy larynx, sleep apnoea etc)

Otherwise after setting up some good sleep habits, and allowing your baby to learn to settle themselves, most sleep problems are erased within days if not weeks depending on the sort of route you choose to follow (cry/no-cry approach). There are also obviously those who choose to set up sleep from the very beginning, coming along to my workshops whilst pregnant or getting in touch when a baby is only a very few weeks old to get some guidance on how best to shape their baby’s sleep to become a great sleeper from early on, and this was my approach with baby Rupert.

I set up a routine with Rupert very early on, and he was falling asleep on his own after a song and a cuddle from as soon as he was able to without being milk drunk. This meant that he was having fab long day time naps, especially his lunch time nap which would be 2-3 hours. He was also sleeping well at night time and waking for the two feeds I would have expected him to at his age (5-6 weeks).

CUE. REFLUX.

Silent Reflux is often missed by so many, as it does exactly what it says on the tin…it is silent. That does not mean the baby, the baby is often screaming in pain and massively uncomfortable, but often if you do not know the symptoms, it can go totally missed for a long period of time. Reflux occurs when the stomach acid travels back up the oesophagus, causing pain, burning and sometimes causing the milk/stomach acid to mix to go into the mouth. However, there is usually no sickness and you will mostly be unaware that it is happening unless you really know the signs to look for.

Rupert’s reflux started to become apparent around about week 4-5. Having sorted his tongue tie, he started to tug at the nipple often and get a little frustrated. I assumed initially I had a forceful let down and used to catch the beginning of the milk in a muslin to slow the flow down for him. This then stopped but then I started to notice other signs too, these included;

Smelly breath – he started to smell like sour milk most of the time.
Blowing bubbles – was this teething come early? Probably not. The reality is reflux babies make excess saliva to deal with the taste of the stomach acid in their mouth.
A night time cough and waking up very congested during the night time.
Day sleep went to pot! This was not a common “I feed or rock my baby to sleep” scenario where he was then waking up after a sleep cycle because he needed help again. This was a little baby boy who had been falling asleep beautifully on his own, and sleeping super well, who then started to cry when put down and needed several attempts to settle him. It also then became a little man who started to wake after 25-30 minutes of a nap and need several re-settles to get back to sleep. Each time he was picked up, you could hear him smacking his lips and slightly choking on the stomach acid that was obviously creeping up into his mouth. It didn’t take me long to realise that reflux was on the cards.

Silent reflux can affect sleep in not so obvious ways, unless you really know and have experience of how babies sleep. Day time sleep can often be awful, with the baby refusing to settle or having “cat naps” rather than nice long sleeps in the day. Of course, there are many babies who cannot do these long naps for other reasons (an ability to link their sleep cycles, self-settle, overtiredness), but I had helped Rupert learn all of these skills, and knew that he was never awake for longer than he should be for his age (1hr 30 minutes), so I just knew it had to be something else.

The reason reflux babies find it difficult to sleep is that when laid down, the stomach acid can creep up and cause pain in their oesophagus, throat and back of the mouth. The theory then being that pain in the body causes the release of adrenalin, which makes a baby much more alert and it then becomes hard for them to fall to sleep. When the baby then finally does go to sleep, it falls into deep sleep which causes muscles to relax – one of those being the diaphragm muscle which then means that the stomach acid is more likely to creep back up, again causing baby to wake in discomfort.

Night time sleep for many silent reflux babies is a often a very different story and this is where silent reflux is often dismissed. If they had reflux surely they would be uncomfortable laying so flat all night long? This is often not the case and many babies will continue to sleep well overnight, with emptier tummies and also often so exhausted from lack of day time sleep.

So this brings us to where we are at now… Rupert is now on Gaviscon, and also Ranitidine to help with his reflux. The first day we gave him ranitidine, he did a solid 1.5 hour morning sleep, a 3 hour lunch nap and seemed much more well rested, even though he has never really been a grumpy or crying baby. This continued for a week or so, and then the effect started to wear off and his day time sleep became very broken again. The dosage was upped again by the doctor and it seemed to help, but I can no longer “rely” on him doing a solid sleep and often have to go in and resettle him after 30 minutes when he will then go into another few sleep cycles before waking.

We had been introducing formula to see how it goes, and then stopped it again. The latest reintroduction went alongside his day time sleep going backwards again, so we are now looking at whether his silent reflux is caused by a dairy allergy or intolerance, which can often be the case. It is a long journey of lots of trial and error, and I plan to try him sleeping on his tummy very soon to see if that helps him. It is certainly not a bad case of reflux, and I have seen many more babies with silent reflux who are crying in serious pain, but it is bothering him enough not to be able to sleep so well during the day time. I do have to keep reminding myself that this is ok, and that I have done all I can to help him sleep well, part and parcel of “knowing too much” I suppose. The pressure on myself, by myself is huge!

A big virtual hug to all those mummies and daddies who might be dealing with a reflux baby, both diagnosed and undiagnosed. It is a long process, and sometimes with symptoms that are often not taken seriously by GP’s (we have all heard someone who has been told “if they are putting on weight then it isn’t a problem”). Stay strong, and keep pushing – your baby will get there! Reflux sucks!