Breastfeeding
the Baby with Gastroesophageal Reflux
Modified from: NEW BEGINNINGS, Vol.
15 No. 6, November-December 1998, pp. 175-76
Laura Barmby
Davis, California, USA
For most babies, spitting up is just part
of a normal day's activities. "In a healthy
baby," says LLL Medical Advisor Dr. Gregory
White, "Spitting up is a laundry problem,
not a medical problem." However, in an
infant with the medical condition called gastroesophageal
reflux (GER), spitting up may be frequent
and painful. GER occurs when the muscle at
the entrance to the stomach fails to keep
the stomach contents in the stomach. The milk
or food, along with acid from the stomach,
backs up into the lower esophagus and irritates
the tissues there. Adults recognize this feeling
as heartburn. Babies just know that they are
miserable. Some spit up. Others cry or act
as if they are in pain. Physicians used to
dismiss these symptoms as colic, something
which they could not explain and parents just
had to survive. Now they believe that at least
some cases of unexplained, inconsolable crying
may actually be reflux.
Most babies outgrow GER by their first birthday,
and for many, symptoms begin to improve around
six months of age, as they learn to sit up.
Breastfeeding can and should continue when
a baby has reflux. Research has shown that
breastfed infants have fewer and less severe
episodes of GER. Some breastfed babies with
reflux may not even have any symptoms.
Most physicians diagnose GER based on a parent's
description of a baby's symptoms. GER shows
itself in different ways in different babies
and having one or more of the following symptoms
may or may not mean a baby has GER. Parents
and doctors have to look at the whole situation
to decide what is bothering the baby and what
should be done about it.
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Symptoms
of GER in an infant may include one or more of
the following: frequent burping or hiccuping,
frequent spitting up or non-projectile vomiting,
frequent night waking, poor weight gain, difficulty
swallowing, sudden or inconsolable crying, arching
during feeding, constant nursing, or disinterest
in nursing. Medical testing for reflux in a baby
under a year old is rarely indicated unless the
baby shows signs of poor growth, severe choking,
or lung disease. Testing can involve barium swallow
x- ray exam, endoscopy with biopsy, pH probe,
and other invasive techniques. These tests should
be used cautiously. They may interfere with breastfeeding
and do not always provide conclusive results.
Breastfed babies seem to cope better with GER
than artificially fed babies. During breastfeeding,
the motion of the baby's tongue triggers peristaltic
waves along the gastrointestinal tract. These
muscular contractions help to move the food down
into the stomach and on to the small intestine.
Human milk digests more completely and almost
twice as fast as formula. The less time the milk
spends in the stomach, the less opportunity there
is for it to back up into the esophagus. In addition,
breastfed babies are generally fed in a upright
position than artificially fed babies, and gravity
may help to keep the milk and gastric acid in
the stomach where they belong.
Parenting an infant made unhappy by GER can be
stressful. Mothers of babies who are hurting need
support as they try to comfort their babies and
take care of themselves. Continuing to breastfeed
provides many benefits to the baby and the mother:
improved health, development, and most importantly,
a strong bond that  can
help get you both through this difficult time.
Here are some things to try to reduce the baby's
discomfort:
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Upright positioning.
By keeping the baby in an upright position
both during and after breastfeeding, gravity
can help keep the milk from coming back
up. Use a sling or front carrier to position
the baby at breast level and nurse while
standing or walking. Nurse lying down, side
by side, with baby elevated on mother's
arm. Try feeding in a recliner or reclining
on pillows on a bed. Put baby chest to chest
with mother, facing in to the breast, head
slightly higher than the nipple. |
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Thorough
burping. The baby can be carried upright
on one's shoulder till he burps. |
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Small, frequent
feeds. One way to do this is to nurse on
only one breast at each feeding. As the
lactating breast never truly empties, the
baby will be rewarded with a slower flow
of milk that may soothe a burning throat,
but not overfill his stomach. A strong rush
of milk may cause the baby to gulp and swallow
more air, which can trigger more spitting
up.
Holding and comforting is important to a
baby hurting from reflux. Babies who are
upset and who are crying hard are more likely
to experience episodes of reflux. A parent's
loving arms really do make a difference.
Thickening milk feeds with cereal is often
suggested as a strategy to minimize reflux,
on the theory that heavier food will stay
down better. If a breastfeeding mother wanted
to try this she could express her milk and
feed it to her baby with a spoon after adding
cereal. However, research has not proven
this strategy to be helpful in relieving
the problem. In a baby younger than six
months, the cereal may replace rather than
supplement human milk in the baby diet,
and this can lead to a decrease in the mother's
milk supply; cereal is not as nourishing
as human milk. Also regurgitated solids
are more irritating than regurgitated human
milk. They might be aspirated into the baby's
lungs causing pneumonia or the baby may
develop an allergic reaction to the food.
Some babies with reflux may want to breastfeed
frequently because the milk acts as a natural
antacid and suckling itself can be soothing.
However, if the baby overfills his stomach
capacity, reflux symptoms can worsen. In
this case, it may be helpful to limit nursings
to one breast for a two to three hour period
before switching to the other side. This
way the milk flows more slowly.
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Other
babies with reflux quickly learn that pain
follows eating so they refuse to nurse.
These babies may benefit from techniques
such as varying positions, nursing while
baby is sleeping, eliminating distractions,
or walking while nursing. Expressing before
a feeding to start the milk flow before
putting baby to breast may make nursing
less frustrating for this baby and keep
him from swallowing air when the milk lets
down. Warm baths, skin-to-skin contact,
and infant massage may help to calm a distraught
baby.
It may be tempting to consider artificial
feeding for a baby with reflux in hopes
that the symptoms will improve. Mothers
often worry that their milk is at fault.
Remember that human milk is the best possible
nutrition for babies. Experts knowledgeable
about both GER and breastfeeding believe
that changing to artificial formula makes
the problem worse instead of better. In
most cases, time and maturity will take
care of refluxOther babies with reflux quickly
learn that pain follows eating so they refuse
to nurse. These babies may benefit from
techniques such as varying positions, nursing
while baby is sleeping, eliminating distractions,
or walking while nursing. Expressing before
a feeding to start the milk flow before
putting baby to breast may make nursing
less frustrating for this baby and keep
him from swallowing air when the milk lets
down. Warm baths, skin-to-skin contact,
and infant massage may help to calm a distraught
baby.
It may be tempting to consider artificial
feeding for a baby with reflux in hopes
that the symptoms will improve. Mothers
often worry that their milk is at fault.
Remember that human milk is the best possible
nutrition for babies. Experts knowledgeable
about both GER and breastfeeding believe
that changing to artificial formula makes
the problem worse instead of better. In
most cases, time and maturity will take
care of reflux
In
the meantime, mothers of babies with GER
can reassure themselves that by breastfeeding
they are giving their baby the best start
in life.
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