When reflux affects your baby’s sleep

If your baby has gastro-oesophageal reflux (GOR), it may be a contributing factor to her lack of sleep. GOR is usually caused by an underdeveloped valve between your baby’s stomach and her oesophagus (the food pipe to her stomach). This valve will strengthen with age, but meanwhile the acidic content of her stomach (milk) is constantly being regurgitated into the oesophagus. Most babies simply possett or vomit a good deal, and if your baby is happy and content, sleeping and growing well, there is no reason to worry.  However, if your little one is constantly fretful and unhappy, especially after a feed, she may have “silent” reflux, which can cause extreme nausea and discomfort, similar to heartburn or indigestion.  She may also have a sore throat, which may interfere with her ability to feed well, which in turn may affect her growth and development. There is little or no vomiting present as the acid contents are simply sitting in the oesophagus causing pain and burning, and in some cases, flowing back into the trachea (breathing pipe) causing a really sore and red throat. Severe reflux can also cause coughing, and chest infections as the acid stomach contents end up in the lungs. Constant sinus infections can also be as a result of reflux.

Your baby may have reflux if she

• Resists lying flat to go to sleep, especially after a feed
• Is constantly niggly, especially after a feed
• Is worse at night
• Is happiest when held in the upright position
• Swallows and gags more than normal
• Is a fussy feeder
• Sleeps better if held in the upright position, or when she lies on her tummy
• Possetts frequently and/or has frequent projectile vomiting.

Some tips to get you through this difficult time

• Reflux is hard to manage while it lasts but take comfort in the knowledge that it will pass with time.
• Keep your baby upright after a feed, and handle her gently (avoid vigorous winding).
• Try not to be in too much of a rush to put her back into her cot after the night feeds – spend a little extra time holding her in the upright position.
• Raise the head of your baby’s cot mattress with a wedge.
• Don’t worry if you have to hold your baby in the upright position to sleep – you can’t spoil her at this young age. Assist her in any way to achieve sleep, even if it means holding her. Try to put her into her bed when she is comfortable, but don’t be in too much of a rush!
• Research suggests that increased acidity in the stomach, which may aggravate GOR, may be due to a ph imbalance. This imbalance is due to decreased levels of good bacteria in the stomach, which are essential for healthy gut function to prevent digestive disturbances such as lactose sensitivity and candida, which may make GOR worse. If your baby was born by caesarean section, or she has been exposed to antibiotics (even through your breast milk), there is a chance that some of these good bacteria have been destroyed. Ask your pharmacist for a suitable pro-biotic medication that contains bifidum bacterium to give to your baby to restore healthy gut function.
• If your little one is vomiting with discomfort and unhappiness, she may need her milk to be thickened. This is easy to do if she is being formula fed.  There are special anti-reflux formulas available, so ask your clinic sister to recommend one for you to try, or to advise you on alternate methods of thickening your baby’s milk to prevent regurgitation.
• If you suspect that your baby may have “silent” reflux, speak to your paediatrician about special medication available to neutralize the acid levels in her stomach. This medication is only suitable for use in babies who are really in extreme discomfort and pain as a result of “silent”reflux.
• Feed in a quiet sensory environment. Over-stimulation increases the likelihood of possetting.

Most of the time, reflux is nothing to worry about, and if your baby is happy and healthy, simply manage her possetting and vomiting by having many changes of clothing on hand, and a permanent “mop up” cloth handy! This constant “happy” vomiting usually starts to improve from the age of 6 months, and by the time your baby is walking, the vomiting has completely stopped.

By Sr Ann Richardson