Reflux exists – but not as much as you think!
Before you continue reading, I want everyone to approach the topics of reflux, reflux diagnosis and reflux and sleep with caution.
A reflux diagnosis in babies is a really serious condition that needs to be treated.
We’ll discuss in this article what I believe to be a widespread misunderstanding of the condition of reflux and an overdiagnosis and in my opinion an over medication of the condition.
Infant reflux has wrongly become the go-to, rapid explainer of unsettled behavior in babies.
A true diagnosis of gastro-oesophageal reflux disease (GORD) or gastroesophageal reflux disease (GERD) depending where you are is not particularly common and there’s some really terrible language we use around babies and newborns that adds to this confusion and leads to the overdiagnosis/medication.
The difference between “refluxed milk” and a diagnosis of “gastro-oesophageal reflux disease” (GORD)
Many people incorrectly refer to small amounts of “refluxed milk” or “spills,” or “up chucks,” or “possets” of milk as a reflux diagnosis or signs of reflux in babies.
Small spills or possets of milk by a happy, growing baby are completely normal. They don’t cause unsettledness and don’t require specific investigation or management.
Nearly all babies will posset milk from time to time (see why babies reflux milk below).
Some healthy babies posset LOTS of milk – you’ll identify their parents with a cloth over their shoulder or up chucked milk down the front of their shirts – these babies are gaining weight and are settled – you may hear me refer to these babies as “happy spitters”.
Why babies ‘reflux’ milk
When a baby feeds, the stomach becomes over-stretched, especially if it is full of milk and wind. Any muscle in the body desires to return to its original size, and will therefore rebound back, much the way an untied balloon will deflate rapidly when released.
In babies who reflux a significant amount of milk, the lower esophageal sphincter muscle is often not fully developed and lets the stomach contents back up the esophagus.
This can often result in a column of milk rising up the oesophagus (feeding tube) and spilling out, causing your baby to spit up (or “reflux” milk).
The terms “refluxed milk” and a diagnosis of “gastro-oesophageal reflux disease” (GORD) are used interchangeably and they shouldn’t be.
Your baby’s reflux may not need any treatment at all. It is important not to medicate a baby for “gastroesophageal reflux disease” (GERD) if it is not the cause of their unsettled behaviour.
A wonderful 2006 study led by Australian paediatricians showed no link between these milk ‘spills’ or ‘possets’ and symptoms we would see in babies experiencing genuine discomfort i.e. crying time or back-arching.
“Reflux” has become the go-to, rapid explainer of unsettled behaviour, becoming synonymous with colic and it shouldn’t be.
Colic is estimated to impact up to 20% of babies but it isn’t a diagnosis it’s a describing term – I’ve written lots on this.
You can also download my FREE leaps and colic video.
Dismissing your baby’s unsettled behaviour as reflux is problematic
This is dangerous for two simple reasons:
- First, the medication prescribed for reflux is not without its side-effects, and
- Second, the true cause of that baby’s unsettled behaviour is being missed.
Many parents get distressed when their baby brings up milk, but not every spill of milk is a true vomit and not all refluxed milk means your baby has reflux.
True gastro-oesophageal reflux disease (GORD) has very serious symptoms
True gastro-oesophageal reflux disease is not common and babies have very different symptoms to simply refluxing milk – the process of refluxing the milk/stomach acid can irritate the esophagus and cause a number of problems including:
- weight loss (if you think this is an issue you can always make extra appointments with your Child health nurse to get your baby weighed)
- severe feeding difficulties
- bloody vomit
- Bile (Green or yellow fluid) in vomit
- Chronic cough, wheeze
Babies with these symptoms may need to take medication or even have surgery – it’s a rare but serious diagnosis.
Gastro-oesophageal reflux disease (GERD) can be painful for babies, causing irritability and discomfort; and like anything that causes discomfort with your baby this can make it difficult for them to fall or stay asleep. If you’re having trouble getting your infant with GERD to sleep here are my tips.
Managing Sleep & Gastro-oesophageal reflux disease (GORD)
- While your baby is experiencing genuine discomfort babies (just like us) they will have trouble sleeping – we can’t expect them to to self settle and nod off independently, these babies until the discomfort is removed will often want to be rocked and cuddled to sleep (always remember your safe sleep guidelines)
- Baby’s suffering from GERD will also prefer to be upright – sleeping on your baby upright in the carrier may be something that happens regularly.
- Often these babies will want to sleep on your chest – this is only considered safe if you are monitoring them the entire time, if you feel like you may fall asleep yourself you need to move them to a safe sleeping space
Avoid sleep devices or advice designed to maintain head elevation in their cot.
Elevating the head of a baby’s cot is not effective in reducing GERD. It’s also not safe as it increases the risk of the baby rolling to the foot of the bed or into a position that may cause serious of breathing problems and increase the risk of SIDS
This recommendation is supported by the AAP, the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition, and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
Should I sleep a baby with Gastro-oesophageal reflux disease (GORD) on their back? Could this increase the risk of choking with up chucks or refluxed milk?
Even if your baby is suffering from GERD ALL babies should sleep on their back – this is core the the Red Nose SIDS guidelines.
Sleeping your baby on their back is the safest position and does NOT increase the risk of choking.
The AAP says this: “Sleep position does not increase the risk of choking and aspiration in infants, even those with gastroesophageal reflux, because infants have airway anatomy and mechanisms that protect against aspiration.”
Silent reflux is a myth
As discussed people incorrectly refer to this spillage or possets of milk as reflux.
But even worse is the diagnosis silent reflux – which is a massive myth!!
Some people believe that an unsettled baby who does not vomit or posset may suffer from ‘silent reflux’.
However, this is not a medical diagnosis. The term is very controversial as there is no scientific evidence to support this in paediatrics.
Like the misdiagnosis of possets of milk, silent reflux is dangerous as it is important not to medicate a baby for reflux when it is not the cause of their unsettled behavior.
Incorrect diagnosis of reflux lead to unnecessary medications and an undesirable spiral of ‘medicalisation’ which we need to avoid.
Are there medications to treat Gastro-oesophageal reflux disease (GORD)?
We now know that not all babies who reflux milk need medication,
But is you have a GERD diagnosis you may.
If your baby does need treatment, you will need to work closely with your paediatrician/paediatric GI specialist to find the correct medication and dosage for your baby.
If you are not seeing improvement, please keep in constant communication with the doctor. Finding the correct medication and dosage for your baby may take time.
Anti-reflux medication have risks & side effects
From 2000-2003 there was a 400% increase in the prescribing of anti-reflux medication to infant reflux, yet no reduction in the incidence of colic – which speaks volumes about the true incidence of reflux.
Anti-reflux medications have risks and very real long-term side-effects, including respiratory and gastrointestinal infections as well as poor bone health.
We know that the two most commonly prescribed groups of medicines
- H2 receptor antagonists and
- Proton pump inhibitors
Had no effect when compared with a placebo medicine.
Please resist the urge to blame reflux for your baby’s unsettled behaviour. The treatments can be harmful and often worsen the colic.
REMEMBER: As you work through the Dr Golly Sleep Program and content, please always remember that this does not take the place of medical advice and if in doubt, always consult your doctor.