​As parents we put a lot of trust in our health professionals, as we should, but it is also important to be well-educated ourselves in what is happening with our baby and the very best ways to help them. This blog will give you the tools and confidence to manage reflux to the best of your ability, alongside your health professional. Here are the facts...
 
SIMPLE REFLUX
Simple reflux is when the contents of the stomach are brought back up/regurgitated either into the oesophagus or mouth.

• It is very common in infants, and usually resolves itself over time.
• Some vomit more than others, and it doesn’t necessarily mean anything is wrong, or that they’ll have problems later in life.
• Switching from breast to bottle is unlikely to have any effect. It’s simply a matter of waiting for your baby to outgrow it. BUT, we can help you manage that road as smoothly as possible.

Colic is often incorrectly diagnosed as reflux and many babies unfortunately end up on medication when it is not the best solution, nor is it in the best interests of their baby. See our blog on Colic when beginning your reflux journey. This may be all you need to make a significant difference for you and your baby.

​STOMACH ACID ISN'T ALWAYS THE ENEMY!

• Stomach acid is often the assumed cause of a baby's reflux pain, but very rarely is the issue an overproduction of acid.  Homer, A. (2018).
• According to a study of 1,300 babies, 60% of babies continued to have reflux issues despite taking medication. Only 22% noted a dramatic change once on medication. Homer, A. (2018).
• We need our gastric acid to build our immune system, trigger the digestion process of proteins and absorb nutrients. Journal of Paediatrics UK (2012). It is not in our baby’s best interest to suppress that acid if that is not the cause of the reflux.
• Many reflux medications are designed to decrease stomach acid in the hope of reducing pain. This means those babies that are medicated have a decreased ability to digest food in the stomach. Protein is mainly digested in the stomach through a process requiring stomach acid. Partially digested protein in the intestines can trigger allergic reactions that may not have occurred if the protein had been allowed to be properly digested in the stomach. How? The immune system in the intestines mistakes undigested protein as harmful and launch an attack. The body then learns to have an allergic response. Homer, A. (2018)
• A study in 2013 of children on gastric acid suppressing medication showed a 367% increase in allergies, compared to those not on the medication. All studies come with an assumption of appropriate controls and research, but this definitely provides food for thought. (Researchgate.net - Development of food allergies in patients with Gastroesophageal reflux disease treated with gastric acid suppressive medications).

​FOODS FOR REFLUX BABIES AFTER 6 MONTHS OF AGE

• Aine Homer helps us to understand the production of acid in the stomach. The types of foods we eat controls the amount of hormones we produce, which in turn affects the amount of acid we produce. So, a baby’s stomach produces acid in response to the hormones released, which was in response to the food ingested. We need to be mindful of what foods we are giving to our little one as they may be either easing or increasing reflux symptoms. This is good to keep in mind when a baby starts solids. Parents often notice an increase in reflux symptoms when solids start.
• Remember that our food is for energy, nutrients and enjoyment. It is not just to fill their little tummies up. Foods such as rice, pasta, bread and cereals can flare up reflux symptoms as little ones don’t have the appropriate enzymes to digest these heavy foods. Homer, A. (2018).
• Instead, focus on nutritionally dense foods, e.g. an egg compared to a piece of white bread. Fats are also essential for brain development (e.g. avocado, fish and nuts) and they wont ferment in the gut like simple carbs like white bread can. Homer, A. (2018).
• 0-2 year olds digest simple proteins well. Cows' milk is a complex protein. Simple proteins include chicken, eggs (unless allergic), lamb, nuts, oily fish, pork and cheese (if no cow’s milk protein allergy).

​FURTHER NOTES REGARDING REFLUX MEDICATION
The concern is that medication may be treating the symptoms, not the cause. If you can eliminate the cause, then you eliminate the need for medication. My heart breaks when a child is put onto reflux medication when they are actually just an overtired baby.

It is essential to explore other options before resorting to medication, as:

1. The medication may not help the cause of your baby’s reflux, but rather just mask the underlying issue.
2. The medication can sometimes be a harm not a help.

We are so very careful with how we care for our babies - our alcohol intake, the creams we put on their skin, the first foods we give them. We then trust a chemical medication to solve their pain without first trying to solve the problem in a simpler and possibly safer way. Reflux medication has a place, but perhaps not to the extent it’s being prescribed.

Gastric acid suppression medications have been blamed for stopping the effective absorption of magnesium which is essential for:

• the absorption of other minerals
• the body’s use of some vitamins
• many essential metabolic processes
• the absorption of vitamin D and calcium

Is it wise to have medication as a first line of treatment? In her book, as referenced above, Aine Homer covers some useful information on different reflux medications. Here is a brief summary, but her book provides a more comprehensive helpful guide.

• Alginate medications (e.g. Gaviscon) are very mild and are not necessarily very effective. They draw  water out of the body to form a gel. This can dehydrate and constipate your baby and cause bloating.
• Antacids neutralise the stomach acid. They do not help with wind or bloating and may cause stomach cramps, diarrhoea and wind.
• H-2 Blockers (e.g. Zantac) reduce the amount of acid produced (which is not always a good thing). They can cause bloating and wind due to the sugars in the medications not being able to be digested. They can cause diarrhoea and headaches.
• Proton Pump Inhibitors (PPIs) - The US Food and Drug Administration have issued safety warnings for these medications due to increased risk of fractures, cause of vitamin and mineral deficiencies, constipation, wind and gastrointestinal disturbances.
• Be aware that when weaning from medication there can be rebound acid production from some medications. This means symptoms may be worse for a few days before they improve. 

The world of reflux disease is very complex, and you can see that it is very wise to have reliable health professionals by your side guiding you as you navigate this very tiring disease. Ingrid and I at The Nurtury are here to support you either over the phone or in person as you navigate this journey. We would also be more than happy to connect you with like-minded health professionals.

​Mums often come to see us at The Nurtury saying that they have been to other health professionals who have said “It’s just colic; they’ll grow out of it”. The poor mum is then left to manage a very sad, tired and hurting baby whilst trying to manage her own sleep deprivation. There are many things you can do about colic. It is real; there is a cause, so let’s find the solution.

Colic is defined as:

• Uncontrollable, extended crying in a baby who is otherwise well. They scream for at least 3 hours per day, at least 3 times per week, for at least 3 weeks.
• It’s often described as a ‘mystery’ and many doctors are unable to find the cause.

Baby appears to be in pain, have a tight tummy, pull their knees up, pass a lot of wind, often have green, frothy poos and scream, writhe and grunt.

​SO WHAT DO WE DO?
Ingrid and I follow a simple checklist before we jump to anything more serious. This simple checklist has made a significant difference to so many mums and babies. See our blog on Reflux for further help beyond this list, or give us a call.

Colic is almost certainly a feeding issue…that causes a sleeping issue…that affects the feeding issue (in cases of reflux, it could be a food intolerance or may be a more serious illness).

• Knowing your baby’s cues and responding appropriately is KEY.
• If your baby is tired then he needs help getting to sleep. What he doesn’t need is more food, as this will compound the problem.
• If your baby is hungry, he needs to have an effective feed.
• This is where demand feeding may be problematic.

We want to ensure that your baby is getting a full feed from one breast before you move them onto the other breast. If they are just getting a short feed from each breast or you have an oversupply of milk, their little belly may have an issue with lactose overload.

LACTOSE OVERLOAD
Lactose overload does NOT mean your baby is lactose intolerant (that’s a cow’s milk issue); it just means an excess of foremilk in their little tummy.
If your baby has lactose overload, they:

• Will be unsettled
• May often scream
• May pull knees up
• “Appear” hungry
• Want to suck
• Have good to large weight gain
• Have heavy, wet nappies
• Will often have explosive, green, frothy poo

The excess lactose from your oversupply, or excessive feeding from just the front milk (or ‘foremilk’ – the sugary milk), does not get digested and so it ferments in the bowel whilst drawing in water. This fermenting causes gas and fluid in the bowel, showing as tummy pain, screaming, pulling legs up and wanting to suck for comfort not food.

Remember - not all sucking means hunger; it can be a way of your baby saying “I need comfort”. 

OUR CHECKLIST

1. Try changing from “on demand” feeding to 1 breast per feed or block feeding. Allow the other breast to drip whilst feeding. Try and allow 2 ½ - 3 hours between feeds to allow the gut to settle. If this is not effective, there may be another issue requiring extra help.
   
   Pay attention to your baby’s nappies. Green, frothy poos can indicate that your baby is receiving too much foremilk and it can cause quite nasty tummy upsets. A good solution here is to express off some of the foremilk prior to a feed. Foremilk is not bad, but too much of it can cause issues.
   
   Having looked at lactose overload and changing to full feeds from one breast 3 hourly, try these other tips:
   
   
2. Have your baby in a more upright position to feed. This allows burps to come up more easily.
3. If you have an oversupply, you can try expressing off the first 30mL before the feed begins. It is wise to chat this through with us first.
4. When you feel a “letdown” or you notice your baby suddenly gulping, take them off the breast (much to their distress) and allow that milk to spray into a cloth nappy or bottle. This will help your little one to avoid swallowing too much air, which is a huge issue with colic and reflux.
5. Diet can also play a part. Many will tell you “Your food makes no difference!”. From years and years of experience, it can! If it gives YOU wind, it may well give your little one wind. It’s different for everyone and you will need to experiment. It may be broccoli, cauliflower, cabbage, onions, sultanas, grapes, fizzy drink, etc.
6. If these tips have not helped over a period of several days, it’s time to consider mum going off dairy. This includes all cheese, yoghurt, milk, chocolate, ice cream, etc. This can make a huge difference to babies and has prevented many babies from being unnecessarily put on reflux medication.
7. A tongue tie is also a significant consideration. When a baby cannot latch properly due to a tongue tie, they take in a significant amount of air. Unfortunately, very few health professionals are trained to correctly diagnose a tongue tie. Dr Steven Lin at Luminous Dentistry in Long Jetty, NSW, has a wonderful clinic for babies with tongue ties.
8. Is your baby actually hungry or are they overtired and just need help getting to sleep? Ingrid and I are just a home visit or phone consult away to help your baby (and you!) get some more sleep. It is very sad to hear that babies are on reflux medication when they are simply overtired and need help to get some sleep.

Ingrid and I have some beautiful sleep “training” techniques that will help you all to have a good night’s sleep, whilst never leaving your baby to cry for more than 2 minutes without comfort. See our packages page for further information on how to make a booking.
​
Jen Milligan is a midwife and co-founder of The Nurtury with Ingrid Clark.