REFLUX: everything you need to know

Does my baby really need medication for reflux?
​What to do before you head down the medication path.

by Jen Milligan

​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.

REFLUX DISEASE
​Reflux disease is a medical problem, requiring further intervention than simple colic management. However, it does not mean medication is necessarily the answer. You need the support of a good GP, paediatrician or health professional who is ready to help you manage the reflux from many angles, not just through medication. You may be dealing with a serious illness that the following tips may not be able to solve, so the trust of a reliable GP and paediatrician is essential.

• Reflux is when the stomach acid is travelling up into the oesophagus. We need to find the underlying cause of that and fix that cause (there are many different causes).
• Possible causes include tongue tie, physical gastrointestinal tract and stomach issues, poor latch, food intolerance and other more serious medical conditions.
• Symptoms may include:
  • Vomiting - often a large amount, after most feeds. NB: not all babies with reflux disease will vomit.
  • Sleep problems.
  • Respiratory symptoms - coughing, wheezing, snuffling or choking, hoarse voice (this is from acid inflaming the larynx).
  • Inconsolable crying and irritability.
  • Back arching at the breast, and other times such as lying on their back for a nappy change.
  • Bowel motions may contain mucus, or appear slimy (this can also be a sign of dairy intolerance).
  • Feeding problems - ranging from very frequent feeds to breast refusal, sometimes in the same baby!
  • Wind - including burping, gurgling noises, gas, hiccups or even trouble with burping.
  • Symptoms may be worse after a feed.
  • Baby doesn’t gain weight as they should, or even loses weight.
  • Blood or bile in vomit.
• Parents of babies with reflux require lots of support. There are good days and bad days. Reflux Support Groups may be a good option.
• Reflux usually calms by 12 months, but can continue on for longer. It lessens when the part of the oesophagus in the abdomen, which includes the sphincter, gets longer. The shorter the oesophagus, the worse the reflux symptoms. 

This article will discuss help for reflux, assuming that you have followed our Colic blog. It is essential that you use the colic help for your reflux baby; it is a critical part of the reflux journey.

ADDITIONAL THINGS TO TRY BEFORE MEDICATION

1. Gut health plays a significant part in our lives from the moment we are born until the day we die. We want to give your little baby the best gut health we can. You can try a probiotic to help balance their gut microbiome. This is especially helpful if they have been on medications or have colic symptoms. The probiotic BioGaia™ has helped many babies with the relief of colic symptoms. Some mothers have this probiotic naturally occurring in their breast milk, so it will not be as effective in those babies as they already have a wonderful supply!
2. As a mum, if you know you have 'leaky gut' issues and/or food intolerances, be aware that this can play a significant role in your baby's gut. When a mum with 'leaky gut' is breastfeeding, large molecules, proteins and sugars can cross the gut barrier, move to the blood stream and into the breast milk. Babies guts are not mature enough to break these large molecules down. They then ferment in their little gut and cause pain. Homer, A. (2018). Gut health is a blog for another day, but in short, decreasing your gluten, dairy and sugar intake (all of which feed your bad gut bacteria) will improve both yours and your baby’s gut health.
3. Try having your baby upright for 30 minutes after a feed. The stomach contracts about 30 minutes and 90 minutes after a feed, so it is helpful to get your little one through that first contraction and bout of reflux before lying them down to sleep.
4. Try looser clothing and nappies around their little belly.
5. Sleeping with the cot on a tilt can be very helpful. However, you must be very mindful of SIDS risks. Sleep your baby at the bottom of the cot so they cannot slip further down and under bed covers. Follow all other SIDS advice about cot bumpers, smoking, toys, etc.
6. Try frequent burping during the feed. Remember that wind plays a significant role in reflux. Your little one may not be happy with you taking them off regularly during the feed but it really can be in their best interests.
7. You may need to try a stricter diet than the colic ideas we discussed in our Colic blog. This may include eliminating gluten, egg and nuts as well as dairy. It will be different for every mum and baby. At this point you may feel it’s all too hard and medication is the way to go! Please read on so that you can make an informed decision with a good understanding of what medication entails.

• NB: there will be health professionals that will say that your diet does not affect your baby’s breastfeeding journey. My years of experience with clients strongly suggests otherwise.)
• In her book, 'The Baby Reflux Lady's Survival Guide' (2018), Aine Homer gives a very comprehensive list of foods for children who have allergy and reflux issues. I highly recommend reading her book.

1. If you try all these things and you still have a very sad baby, you will need to seek further professional medical help.

​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.