Your baby is irritable, grizzly, hates lying on his back, spits up or vomits often, has hiccups constantly and he is a nightmare to feed: he starts to feed voraciously, then he wriggles, squirms and ‘throws’ himself off the breast or when he isn’t doing this, he wants to be permanently attached to your breast. He screams after and between feeds – waking from a deep sleep suddenly screaming as though somebody has poked him with a pin!
Take heart – it’s not your fault. Your baby is unhappy because he is uncomfortable or in pain. The symptoms just listed can be a red flag that your baby may be suffering from Gastro-oesophageal Reflux or ‘reflux’ as it’s common called by mums.
At first, all babies will have ‘reflux’ to some degree, because their digestive systems are immature. At the bottom of the oesophagus (the swallowing tube), there is a ring of muscle that helps keep contents in the stomach. In babies, this sphincter cannot squeeze shut as effectively as it can in a child or adult, and it relaxes randomly, quite frequently. As well as letting swallowed wind be released, these relaxations allow food (milk) to flow back into the oesophagus. For some babies – the ‘happy chuckers’ – this will just mean a few spills that don’t seem to affect their wellbeing. At the other end of the spectrum, it can cause heart-burn like pain, abdominal pain, and/or frequent vomiting and can result in some of the symptoms just listed. Of course, as babies are all individuals, symptoms will vary from one baby to another. For instance, constantly wanting to feed may be comforting because the natural antacid effects of breast milk will soothe your baby’s discomfort or he may need more feeds to make up for the milk he lost when he vomited. For another baby, if their tummy hurts as they feed, they will squirm and pull off the breast and may not feed well. Babies with reflux may also be diagnosed with low weight gain or breathing problems.
According to paediatric gastroenterologist, Dr Bryan Vartabedian, from Texas Children’s Hospital, author of ‘Colic Solved’ and father of two babies with acid reflux, babies at extreme ends of this spectrum (happy chuckers or babies who are very unwell) are easily diagnosed, but the babies who are between extremes can be more challenging to treat, and even doctors can vary in their opinions as to when or how to treat baby heartburn.
What can you do?
Firstly, have your baby checked by a doctor – your GP or paediatrician or ask for a referral to a paediatric gastroenterologist (if you are ‘blown off’ remember, you know your baby best; persist until you get answers to your baby’s distress). A proper diagnosis can involve a treadmill of tests which often compounds your baby’s (and your own) distress. So, if other medical causes for your baby’s distress have been ruled out, before you embark on invasive testing, consider whether his symptoms could be caused by conditions such as lactose overload (sometimes called fore milk intolerance), food intolerance or allergy, including reactions to foods that may pass through your breast milk. Milk protein allergy can present with very similar symptoms as gastro-oesophageal reflux disease and is more likely if you have family history of allergies, asthma or excema If you are breastfeeding, these conditions can be simply addressed by eliminating offending foods from your own diet rather than weaning: a child health nurse, dietician or lactation consultant can advise you.
When considering changes to your own diet, also consider gut health as a factor in your baby’s discomfort. Consult your health care provider about an appropriate probiotic for yourself and your baby. By taking a probiotic yourself, the benefits will be passed to your baby.
Could it be tongue tie?
Another thing to have checked is, could your baby have a physical issue such as a tongue tie? This can affect your baby’s ability to latch and suck effectively so he may suck in a lot of air as he feeds, causing discomfort both while he is feeding (Because it is hard work for him to stay attached to the breast) and afterwards as his tiny tummy is distended with wind. The baby with tongue or lip tie may need to feed frequently due to a disordered ability to coordinate sucking, swallowing and breathing. This can contribute to a temporarily overabundant milk supply with symptoms of lactose overload and/or reflux. The good news is that if tongue tie is the cause of your baby’s ‘reflux’ symptoms, this can be corrected quite simply either surgically or be laser, depending on the treating specialist and will make feeding so much easier. Note: although tongue ties present differently (i.e. they don’t all look or feel the same on oral examination), the photo in this blog shows a baby with a tongue tie – see how the tongue cups at the sides and the centre is restricted.
Positions to help
Until your baby’s system matures, improving the positions he lies during feeding and sleeping will be helpful to reduce his discomfort: holding your baby upright after feeds will aid digestion. However, young babies without much control of their abdominal or chest muscles tend to slump when placed in infant or car seats (reflux babies usually hate car seats). This increases pressure in their stomachs so worsens the reflux. Try using a baby carrier that supports your baby firmly in an upright position, comforting him, as well as leaving you ‘hands free’ or use an infant seat that reclines a bit.
For sleeping, try utilising gravity to aid digestion by raising the head end of the cot: place phone books under the cot legs or place a folded towel under the mattress (never use a pillow on a baby under 12 months). Placing your baby on his left side closes off the sphincter between the stomach and oesophagus and positions the sphincter above the stomach contents so that regurgitation is less likely. As a result, your baby may sleep more soundly on his left side – however as this is not advised by SIDS, please check with your health care provider and only do this when you are able to watch that your baby doesn’t roll onto his tummy while sleeping.
Meanwhile, please don’t blame yourself for your high needs baby. It’s not your fault he cries (and cries!). You are never ‘spoiling’ your baby by helping him feel safe and comfortable, and even if he cries despite your best efforts to help him, at least he will know you are there for him, through it all. This is an investment in his security and your relationship with your little one. And that will last long beyond these tough weeks and months.