Reflux

What is reflux?

‘Reflux’ is short for Gastro-oesophageal reflux – which is basically regurgitation of stomach contents. It occurs in many babies and for by far the majority, who suffer from ‘reflux’, is actually not something to worry about.

Many babies posset or bring up milk curds and stomach acid. Some actually vomit or spit this up and others simply swallow it down and you would hardly know they have posseted if you didn’t notice a little swallow or gasp as the curds come up. In fact, so many babies regurgitate small amounts of milk curds that we could almost consider it ‘normal’ in the population. By far the majority of these babies continue to gain weight and thrive, even though they are bringing up a portion of each feed.

For other babies, the ‘reflux’ is a medical condition (GERD – GastroEsophageal Reflux Disease), which does require intervention. These babies are not thriving and are very unwell, many suffering from repeated lung infections and significant discomfort and pain due to the oesophagitis that develops when stomach acid burns the food pipe. These are the cut and dried cases and very unusual.

A number of babies, however, are not ill with the reflux but are irritable and it is hard to discern if they are simply irritable babies or if the reflux is causing such great discomfort that it needs to be treated. These babies are thriving and not ill but are miserable. They fall into a very grey area and the question arises about whether they should be treated medically.

Should we be medicating?

The medical treatments for reflux generally involve neutralising or blocking stomach acid production or thickening the milk that the baby ingests. In cases where babies are unwell, not thriving and have breathing problems or lung infections, due to the GERD, treatment is necessary.

For all other reflux, in otherwise well babies, the new thought is not to medicate as the treatments that alter stomach acid may lead to other issues with digestion. If you can manage reflux conservatively in these babies, it is a way better route to go:

• Smaller feeds
• Limiting length of feed
• Interrupting feed to burp your baby
• Keeping baby upright for a little period of time after the feed
• Raising the head of the cot for sleep time

Sensory threshold

Looking at reflux from a sensory perspective can be useful.

Sensory sensitive babies have a tendency to hyper respond to all sensory input – they are easily woken by sounds, cranky at bath time due to the change in temperature, fussy with new teats and dummies, become over stimulated in a busy setting etc. These babies have a low threshold for all sensory input. It stands to reason that interoception (sensory input from within the body) will also cause these babies to react.

For babies with a low threshold, the mild burning or discomfort of ‘normal’ reflux makes them very irritable and they hyper respond to interoception from the esophagus that another baby may not notice. Sensitive babies are more likely to over react to reflux.

Before jumping to medical treatment, if your baby is generally well, do the following:

• If your baby is thriving, try not to medicate but rather manage the discomfort by not overfeeding and by raising the head of the cot.
• If your baby is irritable look to the sensory world to calm them, before skipping to meds.