Feeding infants with gastro-oesophageal reflux

What is gastro-oesophageal reflux?

Gastro-oesophageal reflux (GOR) is a normal process where the contents of the stomach can come back up out of the stomach into the oesophagus and mouth. This affects babies, children and adults. In babies this can look like the effortless positing and regurgitation of feeds. In some cases, the symptoms are much more severe and may need treatment of some kind. This is known as Gastro-oesophageal reflux disease (GORD).

What are the symptoms of reflux?

Symptoms may or may not include regurgitation and vomiting. In the absence of obvious regurgitation or vomiting it may be referred to as silent reflux. GORD symptoms are multiple and persistent they include a combination of more than one of the following… (NICE 2015).

• Unexplained feeding difficulties

• Distressed behaviour

• Faltering growth

• Chronic cough

• Hoarseness

• One episode of pneumonia

What feeding difficulties do babies with reflux have?

• Feed refusal /feeding aversion

• Difficult to feed. E.g. only wanting to feed in certain circumstances for example when drowsy or asleep, in a darkened room, when being rocked or jiggled, orin a bouncer chair.

• Coughing during or after feeds.

• Vomiting and regurgitation during or after feeds.

• Gagging and retching during feeds.

• Wet and gurgly breath sounds during feeding – typically increasing over the course of a feed

How can I help my reflux baby’s feeding?

• Responsive bottle feeding. This usually leads to a ‘little and often’ feeding pattern which can help reduce the amounts of milk in the gut at any one time and therefore help with symptoms. When your baby is a difficult or sensitive feeder, growth and volume is often a worry, therefore the thought of your baby just taking a small bottle can be stressful. Do, however try follow their lead on this and see what happens. They may still take the same overall volume but over 24 hours and the little and often feeding may reduce symptoms. That said there is ‘little and often’ and there is all day and all night! I am not advocating for feeding your baby hourly around the clock and if you find yourself in this position then you do need to seek additional feeding support.

• Paced bottle feeding. The milk is delivered more slowly using this method which prevents large volumes of milk being swallowed in a short space of time. See video in my Instagram highlights.

• In a breastfed baby who is being fed responsively and who is gaining weight, reducing cluster feeding can sometimes be helpful. Whilst cluster feeding really helps to comfort your baby it can exacerbate reflux as it doesn’t leave much opportunity for gastric emptying. After a feed your baby can be comforted in other ways, these include use of a dummy (once breastfeeding is established), baby wearing and skin to skin contact.

• Positioning your baby in an upright position during bottle feeding or feeding on their left side may help with symptoms of reflux during and after feeding. Placing your baby on their left side increases the distance from where the milk sits in the stomach to the opening to the oesophagus, thus making GOR less likely.

• Breast fed babies can be fed in a prone position (on their stomach) by using the laidback nursing position in left side lying by using the side-lying position and in an upright position by using the Koala hold.

Left side lying

Laid back nursing

Thickening feeds can sometimes help bottle fed infants. In my experience the feeds usually need to be at least IDDSI Level 2 thickness and tend to work best for infants who are regurgitating and vomiting during and after feeds with or without coughing.

• Managing feeding an infant who is refusing bottles or the breast can be really difficult. These babies often need to be medicated in order to stop the pain / sensation of the reflux. Once treated they can relearn that feeding can be a pleasant experience. In the meantime, they often feed better if they are distracted, drowsy or sleepy. I usually work with families to undo these feeding associations and get babies back to feeding in an awake and present state.

• Reflux can be a symptom of a Cow’s milk protein allergy. If this is the case your baby will likely have other symptoms too.

Faltering growth

Faltering growth can be an issue for infants with reflux, but not always. If your baby is presenting with more than one of the symptoms listed and is growing well, they may still need help. I often encounter families who have struggled with feeding challenges such as not being able to feed outside of their home and who spend all their time feeding their infants, only to be told by health professionals that because their baby is growing well they don’t need any help. This is not true, and in this instance, I urge you to explain to your GP the burden and stress you are under and your need for support.

If you are reading this and are struggling to feed your baby who you think may have reflux then seek professional support. stacey@feedeatspeak.co.uk