Before I was pregnant I’d had minimal contact with reflux, and to be honest hadn’t given it a great detail of thought. I’d had friends and clients with reflux babies and if they asked for help I would just drop the ‘higher the head of the cot’ line and ‘feed little and often’. I, along with a lot of other Nannies was of the opinion that reflux was very much the ‘new colic’ ie, anyone with a squawking baby would be keen to blame it on reflux when they just didn’t want to hear their babies cry. Little did I know.
So what is reflux? Reflux occurs when the muscle at the bottom of the oesophagus is not fully formed, allowing the contents of a babies stomach to travel back up. This is extremely common in babies and nothing to worry about especially if the baby is not bothered by it.
However, GORD or gastro-oesophageal reflux disease is a completely different ball game. This is when the baby’s stomach acid travels up the oesophagus, irritating or burning them and causing them a lot of pain. There can be a number of causes/factors that contribute to this form of reflux including a milk allergy. (Sonny is allergic to cows milk, however this is not the root cause of his reflux, when we had his allergy treated, it did not really make much difference to his reflux symptoms)
Our experience with GORD has been quite a drawn out one, and please note that this is OUR experience (I am not a DR and you should always seek medical advice if you think your baby is suffering from GORD) – I am only just starting to reduce Sonny’s medication as we approach his first birthday and even now I am not sure if we are ready to reduce it completely. Since I have hit on the minimal dose we have had a few ‘arching’ episodes and last night he woke up screaming – while this could be down to any number of factors (babies really are a minefield), he has generally been super good at night. I have mentioned this before but I have also been managing Sonny’s symptoms through a controlled diet. In addition to medication I have eliminated anything acidic such as onions, strawberries, peppers, and tomatoes. Yesterday we had an amazing afternoon with friends at a PYO farm, after picking raspberries I thought I would let Sonny try one, his little eyes lit up, he loved it so I let him eat a few. Whether this caused his discomfort at night I am not sure but to me it seems like more than a coincidence so I will continue to steer clear of anything acidic for a little while yet.
Some GP’s and Health Visitors can be quite dismissive of GORD, being slow about referring you onto a paediatrician and prescribing medication. Again if you are convinced that there is something wrong with your baby you should press this – Mothers instinct isn’t called that for any other reason than it exists – you know your baby.
Signs of reflux to look out for are below and while this list is not exhaustive and your baby may not show all of these symptoms there are key signs here that could show things are not 100%
Arching of the back, particularly when laid flat or feeding.
Crying when being laid flat
Pulling away from the bottle/refusing feeds
Appearing to be in pain and distress – not being able to comfort
Not smiling often
Appearing agitated and very rarely relaxed
Bubbles round mouth
Hard to wind
Rigid and stiff body
Head thrashing when feeding
Vomit/spitting up for an hour or possibly longer after feeds (although this isn’t the case with silent reflux)
Pulling off breast or bottle
Constant clenched fists
Often the GP or Paediatrician’s first step will be to try your baby on Gaviscon. This is an antacid and works by neutralising the stomach contents immediately when taken, it also thickens the contents of your babies stomach not allowing it to travel up the oesophagus so easily. This did absolutely nothing for Sonny bar make him extremely constipated. We were also prescribed ranitidine at the same time – ranitidine works by blocking acid production, it usually takes 6 days to kick in – again this did nothing for Sonny. I then requested Omeprazole – this is quite a new drug with regards to babies – I knew friends who had used it and actually I was prescribed this when pregnant – I remember the relief being instantanious. The same went for Sonny – within 24 hours he was much more comfortable. Although he would still bring up some milk it did not seem to distress him at all and he was a much calmer baby. He could now lie in his pram without screaming and would actually be laid down rather than being constantly held upright. Omeprazole is a PPI (Proton Pump Inhibitor) , it works by almost completely shutting down the acid pumps in the stomach reducing gastric acid by 90%.
When Omeprazole (or Losec Mups) is prescribed, the dosage changes with your baby’s weight. Often Sonny’s reflux symptoms would suddenly reappear only for us to realise that he had gone through a growth spurt therefor the dosage was no longer working and needed increasing.
Introducing solids also made a difference – we did this early (see weaning 1) and it helped to keep a lot of his milk down. Up until this time Sonny had been gaining weight quite slowly – he was around the 7th centile. Soon after starting solids he went up to the 75th!
Reflux is so complex that things like sleep training and self soothing just don’t apply. I am all for letting babies grizzle a bit and agree that learning to settle themselves to sleep is a really important life skill, however, I was obviously not going to leave Sonny to scream himself to sleep in pain, I knew that cuddling probably wouldn’t make a difference to the reflux but if it helped soothe him a little then I would lay aside all my Nanny ideas and cuddle and comfort him for however long it took! (And often this meant pacing the floors singing ‘5 little ducks’ on repeat – I am sure the neighbours were thrilled!!).
I had a small taste of just how painful acid reflux could be when I was pregnant, having to prop myself upright to sleep and even then would wake up with vomit in my mouth a few times a night (nice) . The thought of my little baby having to go through this every day was too much to bear.
I often heard comments that I was spoiling my baby at these times but I just chose to ignore them. Like I said earlier there is a real lack of understanding about GORD as it is a relatively recent discovery. While in the past the crying would be dismissed as ‘colic’ or just having a ‘fussy’ baby we now have the knowledge to empathise and treat little ones. If you are suffering then do what works and don’t listen to people who have limited understanding. I know when Sonny was screaming and rigid with pain, well meaning people would think it would help to bounce him up and down or rock him on his back and thought I was being hysterical when I wouldn’t allow it.
A brief summary of things that have helped us along the way have been;
A relatively early correct diagnosis,
Introduction to solids at 4 months
A controlled diet (no acidic foods)
Feeding upright and winding every oz when Sonny was small,
Not jigging him around/bouncing/rocking him – but instead holding him upright
Propping up the head of the moses basket/cot (using a towel or blanket under the mattress so baby sleeps at an angle rather than flat on their back).
It goes without saying that each baby and all symptoms are individual. Medication is given to manage and not cure GORD as children tend to simply grow out of it. While we are not out of the woods yet, we seem to be well on our way and I really hope that when Sonny starts walking his reflux will completely go.
The whole process is not only terribly painful and distressing for a baby, it can also be terribly painful and distressing for you! When pregnant I envisaged breastfeeding calmly at baby groups and pushing my baby round in his pram. The reality was very different as often during the early days Sonny was very distressed and I just couldn’t face people asking me if he was hungry/tired/spoilt etc, so we didn’t go out. A baby with GORD can be a terribly isolating experience for a new mum and I can imagine, if you do not know what is wrong with your baby, can also be very scary and may well affect the bond you have.
If you are experiencing this currently please know that you are not alone, I have spoken to many parents who have been through the same and they have all expressed just how helpless they felt and how they questioned their parenting skills. I promise it will get better. It is only in writing this post that I realise just how far we have come.
The fact that Sonny is almost one brings tears to my eyes. We now have a happy, content, social and settled little boy, he is extremely smiley, starting to show signs of a wicked sense of humour and most importantly of all enjoys food and meal times. We are extremely close and those horrific refluxy weeks and months now seem like a distant memory.
They will soon for you too – I promise – please do not hesitate about asking for help if you are struggling xx