When expectant parents envision feeding their newborn child, they likely picture cozy moments of bonding with a sleepy, content infant. Nowhere in their minds is a picture of a scarlet-faced baby, screaming in agony, who refuses to eat.
And yet this can be the brutal reality for parents of a baby with reflux.
Whether you’re a first-time parent or a veteran, reflux may not be an immediate, obvious diagnosis. For our family, reflux pain was something we’d never experienced until we had our third daughter, Alayna.
She would take only a few ounces at each feeding and was consequently not gaining enough weight. We were puzzled.
It took a visit from Grandma to pinpoint the problem: She had observed the same symptoms — arching of the back, pained crying and refusal to feed — with my brother’s boys, who both had reflux issues.
What is reflux?
Gastroesophageal reflux (GER) is the movement of stomach contents into the esophagus, nose or mouth. And — according to the American Academy of Pediatrics (AAP) — it’s normal in infants.
Pediatric gastroenterologist Dr. Anthony Porto, writing on the American Academy of Pediatrics site, said GER in infants isn’t a disease.
In infants who are not born prematurely, it starts at about 2 or 3 weeks and resolves between 9 and 12 months old.
“These infants are known as ‘happy spitters,’ because they are not cranky and do not appear to be in a great deal of pain when spitting up,” he wrote. “In fact, your baby may feel better after a good spit-up.”
Dr. Carol Carlson of Southdale Pediatrics said gastric fluids may reflux into the esophagus 30 or more times per day in healthy infants.
Spit-up happens because the average infant has a weak or underdeveloped esophageal sphincter (the valve connecting the esophagus to the stomach). According to the Mayo Clinic, it’s unusual for infant reflux to continue after age 18 months.
However, when reflux is associated with complications, other troubling symptoms or if it persists beyond infancy, it’s considered a disease known as gastroesophageal reflux disease or GERD.
The AAP reports the number of GERD cases in people of all ages is increasing and researchers are still trying to determine the causes.
Symptoms and ‘silent reflux’
Jon and Lauren Tschida of Woodbury first attributed their baby Charlotte’s unhappy feeding sessions to latching problems, an issue that had come up with her older brother, Henry.
But when they started supplementing with a bottle, it became evident that Charlotte’s symptoms were different.
“When I held her during bottle feeding, she would often stiffen up a bit, her face would turn red and she would let out a piercing cry,” Jon Tschida said. “You could see on her face that she was in pain. There was something wrong.”
Lauren Tschida, looking back, realized she saw possible signs of reflux as early as her daughter’s second night in the hospital: Charlotte, during a nursing session, made a gurgling sound as she arched her back. She then screamed for the next hour, refusing to eat.
Jen Scott of Minneapolis and her husband, Pierre-Gilles Henry, noticed similar symptoms with their son, Leo.
He would eat, be very relaxed for about three minutes, and then he would start crying and would look extremely uncomfortable with lots of twisting and arching of his back.
Scott said she ultimately self-diagnosed her son’s reflux problems: “Basically, if you look up those symptoms on the Internet, you come to reflux.”
Charlotte and Leo spit up a significant amount of their milk during their episodes with reflux. However, some babies with reflux pain don’t spit up at all.
Our daughter, Alayna, rarely spit up. Instead she would suddenly gulp and choke while feeding, a phenomenon sometimes referred to as “silent reflux.” This can involve babies swallowing the milk that comes up from their stomachs, rather than spitting it out. In other cases, milk may come up, but might not travel all the way up the esophagus to the baby’s mouth.
Babies with reflux complications may also have difficulty sleeping and can become very uncomfortable riding in car seats.
Dr. Carlson said she sees reflux problems begin in babies at around 4 to 5 weeks old with most complications resolving by 6 months of age.
However, for the parents of struggling infants — especially babies who aren’t gaining weight — six months can be too long to wait for reflux pain to go away by itself. For babies with severe reflux pain or feeding complications related to reflux, there are treatment options.
The AAP strongly advises pediatricians and families — before prescribing medication — to try more frequent feeding sessions with smaller quantities and increased burping as well as holding Baby upright for 30 minutes after every feeding.
For bottle-fed babies, switching formulas or thickening milk with rice cereal or oatmeal may help. Enfamil offers an A.R. formula (added rice), which my family and the Tschidas used with some success.
If these changes aren’t effective, acid-suppressants such as ranitidine (Zantac) can be prescribed by a pediatrician.
Carlson said such medications aren’t harmful to babies and can be quite effective.
The Tschidas’ baby Charlotte was ultimately prescribed medication for reflux pain. By the time Charlotte was 4 months old, her reflux symptoms had vanished and she was able to stop taking the medication.
For some families, chiropractic treatments have been helpful for easing reflux pain.
Dr. Kimberly Capes of Healthpro Chiropractic in Burnsville said a typical course of care for an infant with reflux can be anywhere from a week to a few months, depending on the severity.
Jen Wittes, a certified postpartum doula based in St. Paul, said other strategies for fighting reflux include making sure to feed Baby “on demand,” meaning avoiding overly structured or scheduled feedings; administering probiotics (which come in powder form and can be given from birth); laid-back breastfeeding (learn more from La Leche League) and paced bottle feeding, which involves special positioning and pauses.
Hypoallergenic formulas such as Nutramigen, Wittes said, can make a big difference, thanks to more digestible proteins.
Wittes added: “Burping is important — and often isn’t done as effectively as it could be. I find the bubble (hard area) on the belly and work on the corresponding area on the back with a firm slide of the hand, rather than a pat, which can often make tummy problems worse.”
Hang in there!
Reflux is hard. Although it’s somewhat comforting knowing it won’t last forever, the day-to-day experience can be grueling.
“All you want to do is feed your baby,” Scott said. “But feeding your baby causes such pain and discomfort. It’s incredibly jarring, heartbreaking and exhausting.”
Reflux experiences aren’t the same for everyone, nor is there one ideal treatment. Talk with your pediatrician about recommended approaches to determine the best fit for you and your baby.
No matter how you choose to address reflux pain, know that it will get better with time. As your baby grows, her esophagus will continue to develop and mature until reflux pain is no longer a problem.
Laura Ramsborg lives in Bloomington, where she battles reflux, mothers three daughters and writes. Contact her at [email protected].