This article was first published in the September/October 2015 edition of the BCT’s Small Talk magazine.
By Sharon Levrez, BCT Experiences Register coordinator
When I had my third baby, she was very often sick. Sicker than the other two. The paediatrician diagnosed her with reflux. A lady at my weekly postnatal kiné classes dismissed it, however. “All babies are a little bit sick,” she said. “You have a word for it in English. It’s called possetting.” There is a difference, however. I knew this, despite what this lady said. After all, this was my third child. I did have some experience.
Most babies will spit up a little bit of milk after feeding. This is quite normal and shouldn’t be of great concern. However, some babies may vomit larger amounts, more frequently and often some time after feeding. This can be a sign of a more serious condition, gastro-oesophageal reflux, or GOR. Gastrooesophageal reflux disease (GORD) is GOR leading to complications.
According to the UK’s National Health Service (NHS), gastro-oesophageal reflux happens when the oesophageal muscles are weak or haven’t properly developed. A ring of muscle at the bottom of the oesophagus acts like a valve, opening to let food fall into the stomach, then closing to prevent acid leaking out of the stomach. In GORD, this muscle becomes weak or relaxes when it shouldn’t, and doesn’t close properly. This allows the acidic stomach contents to rise up and irritate the lining of the oesophagus.
Both breastfed and bottle fed babies can have reflux. It is more common in babies who were born prematurely, had a very low birth weight, are allergic to cows’ milk or have a muscle or nerve disorder.
Common signs and symptoms
Common signs and symptoms of reflux include:
- the baby brings up larger quantities of milk several hours after feeding
- the baby coughs, gags or has trouble swallowing
- the baby arches its back or appears to be in pain
- the baby is fussy during feeding or refuses feeds
- the baby is generally irritable and cries a lot
- the baby brings up its legs to its stomach
These last two can also be a sign of colic. Generally, though, colic does not start until about three weeks, whereas reflux maybe apparent much earlier.
Sarah’s baby showed signs of reflux almost from birth. “From day one, Sophie wouldn’t latch on to the breast properly and she would bring up most of the colostrum she did take,” she says. “At first the nurses said it may be due to her swallowing a lot of amniotic fluid during the birth. They tried to express colostrum onto a spoon and feed it to her that way, but it wasn’t a great success.”
Sophie gained weight very slowly, was generally fussy and irritable and would often vomit for a few hours after a feed. “Luckily my paediatrician had herself had two children with reflux and quickly diagnosed the condition,” says Sarah.
For Gráinne, the experience was more traumatic as the reflux affected her baby’s breathing. “He started a pattern of stopping breathing while he was feeding,” she says. “As we were in hospital, they sent him to the neonatal unit, where he remained having tests for one week until they were satisfied he was healthy. About part-way through the week, they knew it was at least partly reflux.” Happily this kind of extreme reaction is rare, and in Gráinne’s baby’s case it only lasted for a few days.
In some cases, babies with reflux swallow the milk that comes up their oesophagus, rather than spitting it out. In others, the milk doesn’t get as far as the mouth. This is often referred to as silent reflux, as the symptoms are not so easy to spot. The name is slightly misleading, however, as babies with this condition generally cry a lot and will be in pain.
“Because our son had silent reflux, the most obvious symptom (the baby being sick regularly) had been missing,” says Jo. As a result, the diagnosis came later, at 10 weeks. “It turned out that his acidic milk was coming back up, but not all the way, before returning to his stomach. Apparently this can actually be worse than when the baby is sick as it the acid burns twice, not just once.”
In rare cases, reflux can be caused by a blockage in the baby’s digestive tract. Their oesophagus may be blocked or narrowed (oesophageal stricture), or there may be a blockage between the baby’s stomach and small intestine (“pyloric stenosis”). Both these conditions would require further investigation and treatment by a specialist paediatrician.
How it feels for the mother
Dealing with a baby with reflux can be tough on parents. First there is the endless washing. Then there is the guilt of having a baby that seems constantly hungry, unhappy, or in pain. Often, until a baby is diagnosed with GOR, parents think they are to blame for the baby’s troubles.
“It was very hard not knowing what was wrong, and it was at the age when all the other babies in the play dates were gurgling and smiling,” says BCT mum Bethan. “My baby had not smiled for weeks and she could not stop screaming.”
Well-meaning mothers with advice don’t often help the situation either. Some with a healthy, normal baby who doesn’t cry a lot might misread another’s crying and possetting. “I’d had one person say something about ‘a calm mother makes a calm baby,’” Bethan says. “This is possibly the least helpful thing you can say to someone with a sick baby – I was genuinely worried that my worrying about my baby was making her scream!”
Generally it gets better, though, once the reflux is treated. Treatments can range from the practical to the medical. Practical tips include feeding your baby in an upright position, giving smaller amounts of feed more regularly, propping up one end of the baby’s mattress, holding up the baby for 20 to 30 minutes after each feed, and in the case of bottle-fed babies burping more regularly during feeds. Doctors may also prescribe an infant antacid to alleviate symptoms or may suggest cutting out cow’s milk from the mother’s diet, if she is breastfeeding. This is because intolerance to cow’s milk can cause infant reflux. According to Babycentre, “In up to 30 per cent of cases, babies with severe reflux are found to be allergic to cow’s milk (RISA 2014).”
In the case of bottle-fed babies, doctors may suggest trying a hypoallergenic formula, or one that is not based on cow’s milk. The UK’s NHS suggests mothers should always talk to their paediatrician or general practitioner first, however, before using hypoallergenic or soya-based infant formula. “Babies who are allergic to cow’s milk may also be allergic to soya,” it says, adding that “if your baby continues to vomit despite cutting out cows’ milk, it’s unlikely that an allergy is the problem.”
The good news that generally the baby’s reflux will disappear with time, as his or her oesophageal muscles develop. “As your baby grows older, the muscle should open only when he or she swallows, and remain tightly closed at all other times to prevent stomach contents escaping,” says the UK’s NHS. “This is why most babies grow out of reflux by 18 months.” 
Some parents see a marked improvement once their baby starts taking solid foods. Paediatricians may suggest babies with reflux start solids earlier for this reason.
“For me, hitting 17 weeks was like a kind of miracle,” says Gráinne. “I felt I could feed without hurting them – and feeding is one of the main bonding mechanisms when they are that small – so it felt like a whole new way of getting to know my babies, seeing them take pleasure in eating.”
Just because you have one baby with reflux doesn’t mean you will have another, although most of the BCT mums we spoke to had more than one child with reflux.
“When my daughter was born, I was so paranoid about reflux that I spent all my time looking for signs – and much to my amazement there were none… until she was a few months old,” says Jo. “However, my daughter’s reflux was never as bad as my son’s: not only did it start later, but it seemed to be less painful and also ended earlier (at around 7 months)”
As always, babies are all different, and no two cases are the same. BCT mum Nicky also cautions about taking the normal and making it a disease too quickly. “Cerys fed and fed and then projectile vomited a while later – several times! My caring KInd & Gezin lady told me it was the worst case of GORD she had ever seen and to see the paediatrician quickly. Alarmed, off we sped, only to find he was quite happy with her – her weight gain and hydration levels were all fine. Conclusion: we had a greedy baby who loved to suckle: if I gave her a dummy instead of my breast she was equally happy and didn’t vomit! No GORD after all ! ”