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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Reflux

baby reflux smReflux occurs when the baby's stomach contents rise into the oesophagus or regurgitate into the baby's mouth. All babies have a weak oesophageal sphincter valve, which is found where the oesophagus joins into the stomach. This causes most babies to spit up or posset, the amount can vary from a few dribbles to what appears to be most of their feed. There is usually very little effort, unlike vomiting, and it seems to be spontaneous.

Most babies have it very mildly, they are cheerful, eat well and gain weight appropriately. It can persist for 6 months and gradually resolve itself by one year and no treatment is required.

There can be a more serious side to reflux in babies. When the reflux causes complications or long term problems, it is considered to be Gastro-oesophageal Reflux Disease or GORD. It persists despite simple lifestyle measures and can, at times, be a serious medical problem. Medical diagnosis and intervention is often necessary, baby may require investigations and then be prescribed medication.

There is a lot of confusion and misunderstanding surrounding gastro-oesophageal reflux disease because of the varying degrees of severity and it is generally referred to as 'reflux'. As a result, GORD families often struggle to cope.

Signs and Symptoms
Reflux commonly presents with frequent regurgitation or posseting. Some babies reflux without it coming out of their mouths (termed silent reflux) which can cause more damage, but be more difficult to diagnose.

Below are some of the many symptoms a baby can present with, however, they do not need to have all of them for the reflux to be severe;

  • Irritability/crying/screaming
  • Regurgitation or posseting or seemingly effortless vomiting
  • Appearing to be in pain
  • Repeated hiccups
  • Hoarse cry
  • Feeding problems include-
  • refusal to feed or only taking a small amount despite being hungry
  • comfort feeding - feeding frequently
  • pulling away and arching their back
  • crying/screaming during or after feeds
  • gagging/spluttering
  • Sleeping issues-
  • catnapping during the day
  • frequent night waking (though some refluxers do sleep well at night)
  • easily disturbed from sleep, or restless
  • Respiratory issues-
  • Persistent runny or blocked nose
  • Wheezing or chronic cough
  • Recurrent chest infections
  • Recurrent sinus infections
  • Sour breath
  • Inadequate weight gain due to small feeds and persistent regurgitation
  • Too much weight gain from comfort feeding

Dealing with Reflux

  • Feed your baby in as upright a position as possible
  • Keep your baby upright for at least 30 minutes after a feed
  • Use products that help you to keep your baby upright as much as possible during the day; such as a baby sling, or pouch, which keeps your hands free. Don't let baby 'slump'
  • Try elevating the head of the cot/bassinet
  • Consider using a dummy
  • Avoid vigorous movements or bouncing the baby
  • The best time to lay your baby on the floor is when baby's tummy is empty, i.e. before a feed
  • Change nappy before a feed. Take care to elevate the baby's head and shoulders. Avoid lifting the legs too high, and turn to the side if possible
  • Avoid any tight clothing around the waist, such as tight nappies, elastic waistbands
  • Avoid overfeeding - if the baby vomits, wait until the next feeding rather than feeding them again
  • If the baby is formula fed, it may be worthwhile trying AR (anti-reflux) formula, or a hypoallergenic one
  • If breastfeeding, avoid foods that can aggravate reflux such as citrus, fatty foods, spicy foods, chocolate and carbonated drinks
  • Avoid exposure to tobacco smoke

Effects on Families
Reflux is so common it is almost seen as 'normal', or even trivial, and most people just don't understand how difficult life can be for many families, or understand the impact reflux can have on their lives. They may think of it erroneously as 'just a bit of vomiting', or 'just a behavioural issue'. They don't see how it impacts on the child's eating, sleeping, growth, behaviour or quality of life; or on the family's quality of life, relationships between partners, siblings or other children; finances; and even leisure time. The truth is, only families who have experienced it for themselves really understand.
Many families;

  • Have difficulty getting people to believe just how bad the vomiting and/or the screaming really are
  • receive conflicting and confusing advice
  • become socially isolated
  • feel like failures as parents
  • have family and friends who just didn't understand

Even when a baby is suffering from relatively uncomplicated reflux, families often need reassurance, and enjoy talking to someone who understands. For the families whose infants suffer complications, it is even more important that they can talk to other parents, and have the support, reassurance and understanding they need to get through this stressful experience.

Survival Tips
Don't expect that you have all the answers from the beginning - it is a really steep learning curve, and chances are you didn't know much about reflux before this!
These babies are not born with a manual, and there are generally no right or wrong answers on how to best handle this. They are all individuals, and what works for one may not work for another. It really is a matter of trial and error until you find something that works for you and your family.
Accept you are doing your best, and try not to be too hard on yourself.
Get as much support as you can from knowledgeable and experienced people.
And always carry plenty of clean cloths.

References:
The Ultimate Survival Guide Reflux, Angela Nieuwoudt
rch.org.au/clinical guide/guideline_index/gastrooesophagealreflux
www.nct.org.uk › Parenting