Solving Reflux in Babies
Reflux. Ohhhhh, reflux. This is quite the subject for me, between my role as a pediatric triage RN, as well as my own experience as a mother.
Both of my children had reflux as babies, but my daughter was not bothered by it. She spit up a lot, but she was what we call a "happy spitter".
My son, on the other hand, was quite an unhappy spitter. What struck me the most about him was that he WOULD have been such a happy, easy going baby, had he not been in pain so frequently. He had a jolly, sparkling personality when he wasn't in pain! The diagnosis in his medical chart would have been "GERD", which stands for Gastrointestinal Reflux Disease.
Parents of babies with GERD will know what I'm talking about. I know they do, because they call me all the time, distraught about it, when I'm at work! GERD is somewhat interchangeable with "colic", and leads to a constantly crying baby. Often the baby is up at all hours of the night, because the reflux acts up at night.
Why is the baby crying? Because he or she is in pain! The stomach acid is refluxing up into their esophagus, causing heartburn. In addition, babies with reflux are often very gassy. My son's poop was literally frothy, like foam from a latte, he was so gassy!
In severe cases, a baby spits up so much that the baby doesn't gain weight well. So, as you can clearly see, GERD can be a serious issue.
Back when my son was born in 2009, probiotics really had not come onto the scene yet. I had no idea what to do, and, seeing our baby in pain, plus none of us getting any sleep (except my daughter, who was a toddler at the time), led us to a point of complete desperation.
To my pediatrician's credit, she did advise me to consider removing dairy from my diet. I was breastfeeding my son, and planned to continue, so I removed dairy 100%. I also removed soy, since soy and dairy were known to have a high rate of "cross-reactivity". Removing these foods was definitely on the right track, and it helped some, but not nearly enough.
Our son still had a horrible time sleeping and staying asleep, and often cried for hours on end. We could tell he was in pain, and it was awful to see. We were completely beside ourselves, between the knowledge that our baby was in pain, and the reality that we were completely losing our minds between all the crying and the lack of sleep.
And, in that time of desperation, we moved forward with the reflux medications. First Zantac (Ranitidine), and then Prevacid (now, Prilosec/Omeprazole is most commonly used). What none of us realized then, though, was that these medications can seriously alter gut flora, which can lead to health problems down the road. Medications that alter gut flora are associated with a myriad of chronic health problems. To gain an understanding why, you can read Part 2 of my Gut Health Series.
Acid-blocking medications are now proven to be associated with asthma and allergies. Guess what my son has had? Asthma and allergies.
There are SO many things I would do differently, knowing what I know now. I want to share these with you, in case they resonate with you more than putting your baby on medications does!
What are the Risk Factors for Reflux in Babies?
Developmental Structural issues. There is no denying that babies have "floppy esophageal sphincters". The Esophageal Sphincter is a flap that allows food to go into the stomach when swallowing, and it is supposed to stay closed when not swallowing.
In babies, the Esophageal Sphincter is often underdeveloped, causing it to be floppy, and opening even when the baby is not swallowing. This then allows the contents of the stomach to regurgitate into the throat, mouth, and sometimes out of the body (as in, spitting up).
I want to emphasize though, that while a "floppy esophageal sphincter" is normal in an infant, GERD is NOT normal. There is clearly more going on, here. Meaning, there is something more that is causing abnormal levels of stomach acid.
Gut Health Issues in the Mother. This would be the number one cause of GERD in a baby. Again, I'm not talking about the "happy spitter". I'm talking about the poor baby who screams after feeding, arches his or her back, and, in general, is constantly uncomfortable, and even in pain.
According to Chris Kresser, "the status of the mother’s gut health, both prior to pregnancy and during pregnancy, is providing the initial imprint of the baby’s gut flora". This means that the mother's gut flora and gut health are directly related to the baby's gut flora and gut health.
If the mother has poor gut health prior to and during pregnancy, these issues directly affect the baby. The baby can then develop the same food intolerances as the mother, as well as have the same gut flora imbalances as the mother.
One contributor is in the mother taking antibiotics before or during pregnancy. This alters her gut flora, which, in turn, alters the baby's gut flora.
I did not take antibiotics during pregnancy, but I took two rounds in a row in between my pregnancy with my daughter and my son. My gut health was definitely in much worse shape, looking back, during my pregnancy with my son.
Finally, if a mother is experiencing food intolerances during pregnancy, the baby will receive all of the antibodies to those same foods that the mother has developed. Meaning, the baby will react to the same foods that the mother is reacting to.
Caesarean Sections. First off, I am completely aware that many C-sections are necessary, and can be life-saving for the mother, the baby, or maybe both. When I talk about C-Sections being a potential cause of reflux in a baby, it is so that we can recognize the connection, not to cause any shame about the actual C-Section.
The reason C-Sections are a potential cause of gut problems and reflux in babies, is that during a vaginal birth, the baby is exposed to vital probiotics that are in the birth canal. These colonize in the baby's gut, setting the baby up for a healthy and functioning gut. When a C-Section has happened, this process gets completely bypassed.
The good news is, there is a lot that can be done to help support the baby's gut moving forward, so awareness is the key point. And as a side note, my sweet son had absolutely horrible reflux (up there with the worst our pediatrician had seen), and I did NOT have a C-Section.
What To Do?
I want to start by saying, I GET that some of what I'm about to suggest is a lot harder than just giving your baby an acid blocker like Prevacid or Prilosec (Omeprazole). But please, hear me when I say, it is well worth it. I am on the other end of having a baby who was given an acid blocker, and we are in the midst of YEARS of solving the issues it caused (I'm happy to report, my son no longer has asthma listed as a diagnosis in his medical chart! We're still working on the seasonal and food allergies).
Positioning. OK, OK, I know. I rolled my eyes about the positioning when I was advised to do it for my son, because it seemed that none of that helped. However, it did become worse when we did NOT do the positioning. The last thing he needed was worse reflux. So, positioning truly is the place to start. You can do all the other stuff I'm going to discuss, but if your baby's head is higher than his or her stomach, that "floppy esophageal sphincter" is going to cause problems.
Your baby's head should be higher than his or her stomach during feedings.
Gravity is a sucker when it comes to reflux, so position your baby upright for 30-60 minutes after each feeding.
Over your shoulder, or upright in a front carrier, is the best position.
Next best would be in a secure bouncy chair type of contraption. Note: Carseats cause TOO MUCH of a bend in the waist, so don't use a carseat for the upright positioning.
Incline the baby's mattress by placing a rolled up towel underneath the whole mattress. This incline should be slight; it doesn't have to be a big incline, otherwise your baby will slide down to the bottom of the mattress!
Tummy Time and Diapers. Tummy Time does wonders for your baby's muscular (and cognitive of course) development. The encouragement of this development will strengthen core muscles that are involved in eventually helping to alleviate reflux. In addition, being on the tummy can help alleviate reflux symptoms in the moment. Provide safe, supervised tummy time for your baby at regular intervals.
Secure diapers loosely around your baby's waist. This will reduce pressure on your baby's abdomen, which can help prevent unnecessary reflux.
Breastfeed when Possible. Breastmilk contains probiotics and prebiotics that are ideal for a baby's gut health. Again, according to Chris Kresser, breastmilk "contains galactooligosaccharides, which are prebiotic molecules that selectively stimulate the growth of bifidobacteria, which is one of the most important species of beneficial bacteria in the gut."
Breastmilk is also the absolute easiest thing for a baby to digest, because it is specifically designed for human babies. Formula companies are doing amazing research to mimic the make-up of breastmilk, and rightfully so! But they will never quite be able to replicate it.
Of course, there are situations when breastfeeding is not possible. If that's the case, we would focus on the highest quality formula possible, as well as some of the strategies I'll discuss as you read on.
Improve the Breastfeeding Mother's Gut Health. A breastfeeding mother who has a baby with reflux should continue to breastfeed the baby if at all possible. But, there are some things she can do herself to help with the baby's reflux.
1. Probiotics and Prebiotics. The mom can take probiotics and prebiotics to help restore her own gut flora. There are many different high quality probiotics; look for one that contains a prebiotic already, such as this one.
2. Identify any food intolerances, and remove them. Remember when we talked about how the baby is going to react to any foods that the mom is reacting to? If the mom can identify those foods and remove them, the baby will stop reacting! This is why I was on the right track by removing dairy and soy from my diet. The problem was, they were not the only foods I was reacting to.
You can get IgG testing from a naturopath to identify foods you might be reacting to, or you can do an elimination type of diet. The most common food allergies are to wheat, dairy, soy, sugar, and eggs, but I see people react to various grains and specific nuts, as well. If many food allergies are identified, you'll want to consider a gut healing protocol. You can read my Gut Health Series here.
Improve the Baby's Gut Health. Just as improving the mother's gut health can help with reflux, so can improving the baby's gut health. A breastfed baby can't have one without the other!
1. Probiotics and Prebiotics for the Baby. You can give your baby probiotics and prebiotics, as well! Doctors at my clinic recommend 5 billion CFU per day babies. Try this one from Klaire Labs, as it includes a prebiotic. Prebiotics feed probiotics, helping the probiotics to become established in the gut.
To give the baby the probiotic, you can combine it with several drops of breastmilk or formula to make a paste, and then finger feed it to your baby. Wash your hands well, first, of course! You can do this once per day.
2. When starting solids, focus on gut healthy foods. I'll discuss this in detail in the next section, but in a nutshell, give your kids real, whole, unprocessed foods. Companies market "kid friendly" (i.e. highly processed) foods to parents just as much as they do to kids, and it starts when they are babies. If we start our babies off right, then they will not have preferences for these types of foods in the first place.
Introducing Solid Foods to Your Baby
I want to start by saying, I am not a pediatrician and you should do your own research, and talk to your doctor about this subject. Some of this approach is based on what we advise at the pediatric clinic where I work, and some is based on my own research and opinions. The average age to start solids is 6 months old, but you can talk to your doctor to see if earlier might be beneficial for your baby.
The best possible approach to feeding your baby to optimize gut health and to minimize reflux, is to feed your baby real, whole, unprocessed foods. Goldfish, puffs, crackers, and other similar foods do not fit into this category. Those types foods do not provide much nutrition for your baby, are harder on the gut, and develop your baby's taste to prefer processed foods at a young age. So, my recommendations are based on this approach.
Always introduce new foods one at a time. Try adding one new food every 3-4 days. This will help you to identify which foods your baby may be reacting negatively to. Reactions could include rashes around the mouth, vomiting, or increased spitting up/GERD symptoms.
If your baby does have a reaction to an otherwise healthy food, don't despair! Just reintroduce it in a month or two, and chances are, it will go better the next time. Obviously, if your baby has a more serious reaction, call your doctor right away. Or, if he or she continues to react to the same foods despite removing them and reintroducing them, then by all means, discuss this with the pediatrician.
Use purees from your own cooked organic fruits and vegetables. Reserve the baby food jars and pouches for when you are traveling, or just out and do not have access to your homemade food. Making baby food yourself will ensure food is fresh and from known sourcing, and it will help develop your baby's taste for real, unprocessed foods. This device has great reviews, and, while pricey, may make your life easier!
Give cooked fruits and vegetables in whole forms as soon as your baby can tolerate them. What I mean by "whole forms", is very soft, small chunks. Make sure they are soft enough and small enough for your baby not to choke on them, of course. This helps them to develop a taste for a bigger variety of foods, and also helps their guts to continue to mature.
Try giving your baby fermented foods. You'd be surprised that your baby can love foods like raw sauerkraut, if you just give him or her the chance! Fermented foods are wonderful at helping to establish a healthy microbiome, even more than a probiotic supplement can. Obviously hold off until your baby can manage to chew and swallow a food like this properly.
Meats. The best way to provide high quality meat for your baby is to cook it and grind it yourself. Use the best quality meats possible, meaning, grass-fed and pasture-raised.
Fish. Start your baby on high quality fish like pureed wild-caught salmon as early as 6 months old (as soon as they can swallow it safely)! Fish is not just a grown up food, and is so ideal for your baby's growth and development. Between the high quality protein and Omega-3 fatty acids which are so crucial to brain development, you can't go wrong!
Ditch the grain cereals, and consider ditching wheat altogether. I personally do not believe that the rice, oatmeal, multigrain, or wheat baby cereals are necessary. They are constipating, for one thing, and not very high in nutrition. (Note: many of these cereals are fortified with iron, so talk to your doctor about your baby receiving adequate amounts of iron. Leafy greens are rich in iron, so you can focus on pureed and well cooked versions of these!).
It is my belief, based on my own research, that wheat is very difficult to tolerate in recent decades, because it has been modified so greatly, in order to produce higher yields. For a baby with GERD, it is very likely that both the mom and the baby are intolerant to wheat.
Instead, try foods like sweet potatoes, white potatoes, and squashes; mashed or in very soft, small chunks, as tolerated by your baby.
If and when you introduce grains, try soaked ancient grains first. See how your baby reacts, and proceed accordingly. Soaked ancient grains would be much easier for a baby with compromised gut health to tolerate.
Nuts, Eggs, and Dairy. It's true that pediatricians are recommending starting these foods earlier than they used to, in order to reduce incidence of reactions. Follow your pediatrician's recommendations, and take extra care to introduce these foods only one at a time. Do introduce the peanuts/peanut butter as recommended, but don't necessarily make this a routine food. Peanuts are known to have mold content, and can often cause gut problems.
Regarding dairy, full fat is always easier to digest, and full fat is necessary for your baby's brain development. If dairy is well tolerated, one should continue with full fat dairy throughout life. This is another subject altogether, though! It is always recommended to wait on milk until 12 months old; cheese and yogurt can be introduced earlier per your pediatrician recommendation. However, in a baby with GERD who has been established to not tolerate dairy well, you'll have to hold off on even yogurt and cheese. Do your research on quality and sourcing of dairy products; milk from grass-fed and pasture-raised cows is the best place to start.
Egg yolks should be introduce first, then egg whites. Eggs are a very nutrition-rich food, but don't get discouraged if your baby doesn't tolerate them at first. If not, wait a month and then re-introduce. Again, focus on the highest quality possible; meaning, pasture-raised eggs.
Can't I Just Push the Easy Button?
As I mentioned, this approach to solving reflux is not going to be like "pushing the easy button". And, some babies might improve by simply adding in probiotics! These are all the things I wish I had known when my kids were babies. If I could have done it all over again, I would have used this approach a million times over before putting my son on a reflux medication.
Of course, I don't beat myself up over it! I did the very best for my kids that I knew how at the time, and so much of this research came about just after the time that they were born. The great news is, kids are resilient and heal quickly, so now we are taking measure to help them through that process!
What are your thoughts about infant reflux? Are you knee deep in this issue right now? If so, be encouraged! There is so much you can do to help your baby!
Disclaimer: I am not a doctor. Always be sure to call your primary care provider, or other medical professional, if you have concerns. Proceed with caution, and do your own research!