Breastfeeding the Baby with Gastroesophageal Reflux
Laura Barmby
Damascus, Maryland, USA
From: NEW BEGINNINGS, Vol. 15 No. 6, November-December 1998, pp. 175-76
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.
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're 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 (Lawrence 1994).
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.
Symptoms of GER in an infant
may include one or more of the following: frequent burping or hiccupping,
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 (Lawrence 1994). 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 more 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:
- 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.
- Thorough burping. See THE WOMANLY ART OF BREASTFEEDING, pg 58, for information about burping baby gently.
- 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.
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 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.
This article was edited in May, 2004, to reflect the most up-to-date information available.
References
Lawrence, R. Breastfeeding: A Guide for the Medical Professional, 4th edition. St. Louis: Mosby. 1994.
Mohrbacher, N. and Stock. J. THE BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: LLL1, 1997.
Resources for Parents
Jones, S. Crying Babies, Sleepless Nights. Harvard Common Press, 1992.
Sears, W. THE FUSSY BABY. Schaumburg, Illinois: LLLI, 1985.
Sears, W and Sears, M. The Baby Book. Boston: Little, Brown, 1993.
For more information on GER, contact:
Pediatric / Adolescent Gastroesophageal Reflux Association (PAGER)
PO Box 486 Buckeystown, MD 21717-0486
Phone: (301) 601-9541
Web Site: http://www.reflux.org
Laura Barmby is the author
of a new LLLI Booklet, Breastfeeding a Baby with Reflux (No 524-24, $2.50).
Last updated Wednesday, October 11, 2006 by njb.
Page last edited Sun Oct 14 09:30:29 UTC 2007.
