Baby Reflux or Routine?
Does your baby have suspected reflux or CMPA with symptoms such as spitting up, bloating, vomiting and crying during and after a feed? Does your baby cry towards the end of the day or hard to settle in the evenings or for day naps?
If yes to all of the above, these are common signs of complicated digestion but also signs of many other resolvable issues such as very fast let down, low milk supply and intake, over supply, gassy milk, build up of wind, lack of structure/ routine with time awake, feeds and burping.
Reflux and CMPA seems to have replaced the word Colic of late. Colic being a term used for an undiagnosed digestive issue.
Having a better understanding of newborn digestion and reflux, the word reflux is now used as freely as Colic by doctors, pediatricians and health visitors, without properly investigating the individual situation.
Over the years I’ve seen so many babies misdiagnosed and put on medication for reflux without investigating the symptoms.
Digestive issues are common in newborn babies simply because the gut of a newborn is unable to bring up air/wind without aid for the first two to three months of life.
Regurgitation and spitting up is also normal for babies especially surrounding winding/ burping or simply, not being burped enough!
A great way to tell if you are burping effectively is whether your newborn is farting a lot. Most newborn babies in my care rarely fart because they bring up air by burping throughout and after feeds during digestion.
With frequent feeding and on demand, a newborn is fed to sleep or whenever they cry which is not always due to hunger. If feeds are too frequent and the stomach is constantly being topped up without enough time to empty and rest, this can result in digestive discomfort. Therefore there are many reasons for a baby to appear uncomfortable during digestion other than reflux.
Some are easy to resolve such as winding more frequently, feeding larger amounts less often and managing the type of food eaten when breastfeeding. Other solutions can be more complicated such as lactose and/or milk protein sensitivity or intolerance, all of which a baby will grow out in time but making sure your baby is digesting comfortably is important for a happy baby and family.
When breastfeeding, more often than not a mothers milk supply depletes throughout the day which can cause upset, frustration and unable to settle due to hunger. The 7pm to 7am Sleeping Baby Routine features a split feed before bed to combat this common issue with milk supply, along with expressing to increase your supply.
I also encourage larger active day feeds which focus on digestion and making sure your baby is wind free between meals. All of these techniques iron out a lot of normal digestive issues, but can also help make reflux and CMPA more manageable and your baby more comfortable.
Fast let down can cause excessive wind, pain and fussy feeding. Breasts working ahead of your newborns gut development means they are faced with very fast flowing milk but that doesn’t necessarily determine milk supply or intake, it just means what your milk is released quickly. A newborn can only handle small amounts of milk before needing to be burped, too much too soon can result in bloating and vomiting which is down to a build up of air, not over feeding.
Having too much fore milk and not reaching the hind milk and draining breasts can cause discomfort and will not sustain your baby’s appetite. To help combat this, express of a small amount of milk ahead of feed. The amount needed to express will depend on your personal milk supply but start with 1oz.
With reflux it’s important to consider what your newborn is eating. When breastfeeding, certain food can intensify gas and symptoms, much like adding fuel to the fire, the less wind forming your milk is, the less gas is created. If formula feeding and reflux, working out if your baby is reacting to the milk and changing to a more suitable one if needed. I try not to use an extensively hydrolysed milk unless a baby has diagnosed CMPA which is not immaturity as these can create other feeding issues due to the taste and sometimes flow. There are particularly hydrolysed formulas which often work as well or a lactose free.
I would always look at changing the routine to iron out symptoms before changing milk, this way you get more of a sense of what’s working to improve things.
When bottle-feeding or if you have had a caesarean birth I also advise supplementing with a good quality infant probiotic powder which will help strengthen the gut and boost digestion and immunity.
The best test for reflux is to see a regular pattern surrounding feeds such as noting if your baby is getting upset at a certain point
/time or quantity of during the feed but only once you have implemented a feeding plan in which you keep a detailed diary to help you see this pattern. Stopping to wind regularly, 3-10 minutes on the breast, active sucking, wake your baby to burp if they have fallen asleep, offer both breasts at each feed, and increase milk supply.
If you are formula feeding, make sure your newborn is comfortable digesting the formula you use, wind every 15/30mls, warm the milk before and during the feed, gradually increase milk intake so you are able to space daily feeds to 3-4 hourly. The teat of a bottle and how it fits in your baby’s mouth and their suck can make all the difference to your baby’s comfort by taking in less air. Feeds should be wakeful and active to allow the milk to digest properly.
By allowing time awake after feeds to digest milk and winding/ burping every 10-15 minutes during this time will make sure your baby is gas free before a nap. Structured time awake also helps your baby recognise the difference between night and day and of course sleep better for naps and overnight.
Acid reflux or silent reflux can be managed with an antacid such as ranitidine or an acid blocker such as omeprozole which will help until your baby stomach has developed, strengthened and moved onto solid food.
My method and my book is based on newborn digestion and the above advice will help keep your new baby content and comfortable regardless of any digestive issue but also help you investigate if your baby truly does have reflux.
For more information check out chapter one of my book the 7pm to 7am Sleeping Baby Routine or head over to my Consultancy page and book in for a chat