The reflux journey is long and for some clients can be a really difficult and frustrating time. As parents we are given little knowledge of our baby’s digestive development and issues from the beginning and therefore trying to negotiate around the process of diagnosis and finding out what is causing babies reflux can be exhausting.
Many babies will have some level of reflux from the very beginning and this is totally normal – babies are born with an underdeveloped muscle at the bottom of the oesophagus where it meets the stomach and this means that milk can creep back up causing baby some discomfort. A little bit of positing after feeds is usual and is not something that usually bothers a baby too much. However it is when the milk comes up with force and causes either full on vomiting or burning of the throat amongst other symptoms, that can start to cause baby problems.
Reflux in smaller babies is often masked by the first few weeks of sleepiness, so baby often appears to be thriving well and not even necessarily being sick or showing any symptoms of reflux. As time goes by, reflux will start to show and in my experience this is usually around the 6 week mark. Many of my reflux clients often make remarks such as “it was all fine until he started to become very uncomfortable at 5 weeks”. I found the same with my little boy too and from week 4 slowly started to realise something was going on, with it being really clear to me by week 5 that he was not comfortable. Reflux can also appear later too, or even earlier in really bad case scenarios.
The reflux symptoms a baby shows will often help determine the cause of their reflux. Some babies will show symptoms which show signs of baby having some sort of difficulty feeding such as tongue tie (infact tongue tie and reflux symptoms are often confused so it is always worth having a baby checked for tongue tie if they seem to be experiencing discomfort from reflux like symptoms). Other babies will show reflux symptoms that often appear to worsen when they are exposed to cows milk for example, whether through mums diet or via formula. This link often helps tell us that this baby has a cows milk intolerance. There are other foods that can set babies off too – exposure to soy, wheat, eggs and nuts through mums diet to name but a few.
Once on solids, acidic fruits and tomato based recipes may cause reflux, as could starchy foods that baby is finding it hard to digest. Other babies just find it hard to keep milk down due to the underdeveloped muscle that means milk creeps up slowly and comes into the throat/mouth. Whatever the cause of the reflux, first of all reflux has to be spotted and diagnosed and this means knowing the signs and symptoms – the list of which is huge and many of these are often not known as reflux symptoms.
When spotting reflux, I always make sure that my clients first of all tick certain boxes when it comes to their babies being unsettled and not sleeping well. The first thing I check with them is that their baby is getting enough milk and is feeding well enough to feel content and settled. I have seen too many mummies convinced that their baby has reflux when actually baby has just been hungry and once given some more milk, said baby has shown far less refluxy type behaviour. If you are seeing things like baby refusing to sleep, pulling off of the boob (not bottle), arching backwards, crying often and appearing to be in discomfort, it is worth trying a top up if breastfeeding or a bottle feed. Giving a bottle feed rather than a breast as a one off test also helps us see if baby is more satisfied afterwards. If they are then we can think about whether it is that baby is not getting enough milk to feel contented which means looking into either top ups or trying to increase your milk supply, or whether baby has difficulty latching or taking in air when feeding and therefore might need to look into the latch of the baby which will include a tongue tie assessment for some.
Once the feeding box is ticked and you are confident baby is latching as well as possible, does not have tongue tie and has access to plenty of milk, then you can start keeping a record of other symptoms that could be causing reflux. Some small babies have very sensitive digestive symptoms and can have temporary intolerances to formula or exposure to dairy through mums milk so using a product such as Colief is a good starting point, to help see if this makes baby more comfortable. Coleif breaks down the lactose in milk so that baby is able to digest more easily – sometimes this makes a huge difference and baby shows many less symptoms, but if not, then looking more into reflux diagnosis is a good option.
Some common signs of reflux include;
Vomiting after feeds or even some time after feeds
Pulling away from the boob/bottle
Crying during/after feeds
Refusing to feed
Taking small feeds frequently
Slow weight gain OR rapid weight gain
Baby is said to be “SO alert!”
Dislike laying down or sleeping flat
Smelly saliva (acidic smell)
Appears “serious” or is even mistaken for grumpy
Has delayed holding of head/neck control
Congestion/appearing “snuffly” (often overnight)
Difficulty sleeping including settling and day time naps
If your baby is experiencing even just a handful of these symptoms and your gut has been telling you for some time that your baby is not ok, it is worth persevering with trying to get a reflux diagnosis. There are various people that can help with this including your health visitor, a baby feeding specialist, a maternity consultant (someone such as myself) or a GP. It is worth noting that many GPs do not have experience or training in reflux or feeding issues so you may often find yourself fighting against comments such as “this is just normal baby behaviour” or “if he is gaining weight there is no problem”, however this is not the case for many and if your gut is telling you otherwise then it is worth persevering. Just because your baby is putting on weight, it does not mean that he does not have reflux. From experience, I had the happiest baby in my arms but he rarely cried and yet I knew full well from my experience that he had reflux. If I was any other mother in the GP surgery, I am more than sure that I would have been sent home with no answers or help for my baby.
When diagnosing reflux, stay confident and make sure that you explore all options and if needs be ask for a second opinion. There are many good websites that can help you along the way including;