Breastfeeding and Reflux

By Dr Ananya Mandal, MD

Babies have a small esophagus and weaker muscle tone than adults. This means that the valve that guards the lower end of their esophagus (lower esophageal sphincter or LES) where it connects to the stomach is weaker. This makes some babies susceptible to gastroesophageal reflux disease (GERD).

As the LES opens ingested milk can come back up the esophagus to the throat. This may cause coughing, gagging and choking in the baby.

Symptoms of reflux

Symptoms of reflux in a breastfed baby:-

  • Bringing up milk after every feed.

  • Spitting milk and gagging or choking on the milk that is brought up. There may be difficulty swallowing.

  • Forceful or projectile vomiting where the milk shoots out of the mouth.

  • Abdominal bloating and inconsolable crying. There may be arching of the back, pulling up of the legs to the abdomen along with crying. This signifies abdominal discomfort.

  • Frequent waking at night and refusal to feed.

  • Frequent hiccupping and burping.

  • Severe cases may develop frequent respiratory problems like wheezing, difficult  breathing, bronchial asthma, bronchitis, pneumonia, and apnea.

How long does reflux disorder last?

Reflux disorder may occur in healthy babies as well and is a phase that passes off. Some babies recover by the time they are six months old and some may continue to have these problems till they are one.

Reflux may rarely become a medical problem that needs medical treatment in babies.

Breastfeeding and reflux

Breastfed babies are less likely to develop reflux and even if they do the intensity may be less severe.

Mothers need to be counselled that breast milk is not causing reflux and breast milk is the best possible food for babies until they are six month old.

Diagnosis and treatment

Reflux is usually diagnosed by assessing the symptoms of the condition. Treatment may be achieved by simple measures at home. One of the first is to position the baby in an upright position. Gravity helps keep the food down.

If certain foods in the mother’s diet appear to be worsening the baby’s condition, they need to be avoided.

While continuing breastfeeding is the first step in a baby with reflux, it may be a challenge. Refusal to feed is a common symptom of reflux. In addition with vomiting and spitting put milk feeding and adequate weight gain of the baby becomes a further challenge.

Formula feed may cause more irritation to the esophagus and may do more harm than good. Thus switching to artificial infant formula does not help.

Some of the tips to feeding a baby with reflux includes holding the baby as upright as possible while feeding and burping him or her after feeds to prevent air being trapped in the stomach causing colic and pain.

The mother may sit up and lean back a bit (propped by pillows) so that the baby’s neck and throat are a little higher than the nipple. Letting the baby suck while lying belly-to-belly over the mother while she reclines on her back, may also be tried. The baby nurses with his face down into the breast in this position.

Nursing while standing up or walking may also keep the baby upright.

For some babies with reflux pacifiers may be helpful. For other babies, pacifier use does not help. It is better to avoid the pacifier. In any case pacifiers should never be used until breastfeeding is well established.

Severe cases of reflux may require medications to prevent vomiting, neutralize the stomach acid or cause the stomach to empty more quickly. These should be prescribed by a paediatrician.

Reviewed by , BA Hons (Cantab)

Further Reading

Last Updated: Feb 28, 2013

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