Breastfeeding a Baby With Acid Reflux

Tracy Behr -

What is acid reflux? Adults usually refer to it as heartburn. Acid reflux in babies, also called Gastroesophageal Reflux (GER), occurs when the muscle at the entrance of the stomach is not strong enough to keep the acids inside. This leads to pain and results in a baby spitting up a lot more than usual.

This problem is regularly dismissed as colic; fortunately, nowadays, we can do something about acid reflux. Acid reflux is usually worse for around 1 – 4 months and stops between 6 months to a year.

What Causes Infant Reflux

  • A baby's reflux may be due to an oversupply of milk or a forceful letdown. Mom will need to express some of her milk before breastfeeding so that her baby does not swallow air while feeding.
  • Reflux is sometimes due to the muscle of the baby’s stomach not being mature enough yet. Premature babies are at increased risk of reflux.
  • Food allergies can also cause acid reflux in babies.
  • Infant formula and some medication, including herbal MEDs, may cause acid reflux symptoms.
  • Swallowing unnecessary air can cause acid reflux in babies; this usually happens when a baby is restless while breastfeeding. It is always a good idea to breastfeed your baby in calm, quiet surroundings and to minimize distractions. Always feed your baby before they get too hungry.
  • Your baby might be experiencing a growth spurt and, therefore, is drinking at a faster pace and feeding more often than usual.
  • Hereditary factors can also increase the occurrence of acid reflux in babies.
  • A typical acid reflux cause: When the introduction of solids occurs before the baby is ready.
Photo by Ana Tablas / Unsplash

Should I Still Breastfeed?

So, should a Mother continue to breastfeed if her baby has GER?

Yes, she should continue to breastfeed. It has been found that acid reflux in breastfed babies is less severe and painful. There has also been evidence that some breastfed GER babies have no symptoms at all.

Breastfeeding triggers a movement in the gastrointestinal tract that helps move food within the intestines. Breast milk digests much easier than formula, reducing the chances of acid reflux in a breastfed baby.

Another reason breastfeeding is a superior option: breastfed babies are held more upright when fed, which in turn keeps the acid down.

Symptoms of Acid Reflux in Babies

  • Frequent burping and hiccups in babies.
  • Frequent spitting up.
  • Reflux causes poor sleep.
  • Poor weight gain.
  • Fussiness can be a sign of acid reflux.
  • Difficulty swallowing.
  • Wanting to nurse more frequently or less frequently. See the Cluster feeding video below.
  • Bad breath.
  • Arching the neck and back as if in pain.
  • A child with acid reflux may experience many chest and ear infections.

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Signs of Severe Reflux

(GERD – infant acid reflux disease)

A baby with GERD will need reflux treatment or therapy.

  • Uncontrollable crying and fussing.
  • Poor weight gain or excessive weight loss.
  • In Severe acid reflux cases, children vomit up blood.
  • Breathing problems.

Tips and Advice

Helping Baby with GER and Preventing Acid Reflux in Babies

  • Get your baby positioned as upright as possible while nursing; this will keep the acid down. Try walking while nursing. Try breastfeeding in a reclined breastfeeding position; this will automatically place your baby at an incline and allow for relief. Your baby can lie on your tummy or sit next to you while breastfeeding. Skin-to-skin contact will soothe your baby too.
  • Hold your baby upright after breastfeeding, for at least fifteen to twenty minutes, to allow all the air to escape and for your baby’s tummy to settle after a feed. Keep reflux infants motionless for a few minutes after feedings; this will keep most of the milk from coming up. Avoid any pressure on your baby’s abdomen. Also, notice your baby’s breathing. Acid reflux breathing is associated with a wheezing sound from spitting up and coughing.
  • Reflux in babies can often be prevented by burping them often and efficiently. The air build-up in a baby’s tummy will be less if they are burped more often during a feed.
  • Breastfeed more frequently and for no longer than 10 minutes at a time; the more milk your baby has in their stomach, the more discomfort they will experience.
  • Ensure a good latch to guarantee less air intake.
  • Breastfeed your baby at times when they are more relaxed.
  • Do not smoke or keep your baby in the vicinity of tobacco smoke. It causes irritability and colic symptoms.
  • Caffeine intake should be reduced.
  • Thickening feeds to reduce stomach reflux is not advised, as it results in: increased coughing after feedings, is less nutritive, increases the chances of diabetes in babies, increases the chances of infections, and can lead to a low breast milk supply.
  • Babies with acid reflux sleep better on their tummies propped up at a 30-degree angle. Acid reflux infants experience pain when they are left to lie on their backs at night. A Wedge Pillow can help to lift the baby’s upper body about thirty degrees while they sleep so that the milk and stomach acid in their tummies stays down. Many types of wedge pillows are available, and some medical insurances cover the cost.
  • Carrying your baby in a breastfeeding sling can help keep them in an upright position, near their source of food, and feel comforted.
  • Change Baby’s diaper before feedings, as this will ensure less movement after a feeding.
  • Acid reflux babies should wear loose clothing to prevent pressure on their tummies.
  • Avoid long trips in a car seat. The slouched-over position can worsen GER. Any pressure on your baby’s belly will aggravate the reflux.
  • Infant massage has been found to help. Gentle massage can help to alleviate pain and discomfort. Massaging your baby's skin will stimulate the nervous system, including the Vagus nerve. This nerve controls the digestive system—our page on massage advantages, techniques, and step-by-step videos.
Babywearing

The Importance of Frequent, Light Meals and Babywearing

Most colic issues are caused by oversupply and acid reflux. Both issues are amplified when a baby is fed large meals that are widely spaced during the day. Frequent, small meals will help to reduce colic symptoms. Babies who are carried in upright positions also experience fewer colic symptoms.

The Soothing Magic Baby Hold

Also called the "colic hold." This hold has two variations. You can keep your baby's back against your tummy or the length of your arm. Both work well. You can try both and decide for yourself.

Using your left arm puts your baby on their left side, which is incredibly soothing to a baby with acid reflux.

Once you have your baby in this position, you can add some swaying motion.

Dr. Harvey has come up with a technique called the cuddle cure. It involves Swaddling, shhh sounds, motion, sucking, and the colic hold.

Comments

Breastfed and Choking
by Scared Momma

“My 3 1/2 week son is vomiting after being breastfed and choking on it. I have acid reflux, so I will talk to his dr. to see what they think, but I think that it may be his overeating and something else altogether. I know that when he has these episodes, it scares me to death. I have an older son who never did this when he was an infant."

Comments for breastfed and choking
Acid Reflux Baby
by Anonymous

"Hi, it could also just be a fast letdown reflex?"

Acid Reflux in Newborns
by Zelda Behr

"Try feeding baby in a more upright position to prevent the acid from pushing back up.

Feeding slings are great; try to walk while feeding. Also, feed the baby in a quiet environment with no distractions to minimize the air the baby swallows. Keep the baby still and his head slightly raised after a feed. Burp baby at regular intervals. Swallowed air can cause the baby to spit up as well.

Hope these help, and good luck with your new bundle of joy."

Acid reflux or foremilk-hindmilk imbalance
by Tracy

"Hi, this sounds like either acid reflux or foremilk-hindmilk imbalance (it could also be a little bit of both). Some babies with acid reflux nurse frequently because drinking comforts them.

Remember that spitting up in the first few weeks is normal baby development."

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New Mommy Gladis
(Riverview, FL)

“I have a month-old daughter who is suffering terribly. I have been breastfeeding since she was born in November 2011. I decided to pump vs. actual breastfeeding (BF) because I always think she's not getting enough food. Since I started BF, she has had all the foremilk-hindmilk imbalance symptoms, except not gaining weight. She has been gaining weight appropriately. Because of diarrhea, we took her to the doctor, who found microscopic blood. Also, they said she had acid reflux and wanted us to start her on Zantax. We said No to Zantax because she wasn't spitting up much.

They told me to stop bf and start her on formula. (Similac - alimentum) She has been in pain for the past two days, and her spit-ups have stopped. However, she has severe pains, can't sleep, is very tired, and has no fever. We have called the doctor 2x, and due to the holiday - we have been speaking to a nurse who tells us not to BF and to talk to the physician when they are open.


I don't know what to do. All the information I have read and from friends stated that I just continue to BF. Any advice..?"

Don’t stop breastfeeding by Just another mom.
“Hi Gladis

I think you should continue breastfeeding. Breast milk is the best for the baby.

I think it is wrong when the doctors tell moms to stop breastfeeding as if those formulas will be better than breast milk! It just doesn't make sense to me.

I heard that most doctors only get about an hour of training on breastfeeding! So they are ignorant about it.

Try using the advice on foremilk-hindmilk imbalance and see how things go. That's what I would do."

Response to Gladis by Katie

"My son is having the same problems as your daughter.

While I don't know if he has reflux, he does exhibit all symptoms of a hindmilk-foremilk imbalance. Very gassy and fussy after feedings, green liquidy poop, explosive poop while breastfeeding, and feeding quite often.

I read somewhere that you can try to pump out some of the foremilk before feeding so that the baby is getting more hindmilk and leave the baby on one breast as long as possible- basically, let the baby control the feeding. This is what I'm going to try...I hope it works!

I ran out and bought a cheap manual pump today. (I have been and am planning on exclusively breastfeeding from the breast, so I don't need a fancy electric pump.) I went with the Tommee Tippee/ Closer to Nature brand- mainly because the bottle nipple that comes with the kit is shaped like a breast/nipple. Good luck!"

Dairy Sensitivity?
by Anonymous

"Hi, Gladis,

I wonder if the blood in the stool is because your baby has a sensitivity to the dairy in your diet. My baby was having acid reflux issues, and once I cut out dairy (it takes about a week to get all of the dairy proteins out of your system), she was a much happier baby, spit up less, slept better, etc.

A word of warning: dairy is hidden in many food items.

Best of luck to you."

Maybe it is reflux, after all?
by Katie

"Gladis,

Because I was concerned about the foremilk-hindmilk imbalance, I decided to call a lactation consultant. After two hours of observing my son feed (and what he was like after feeding), she concluded that I have an overactive letdown (causing him to choke and swallow air (making him very gassy) but also that he has mild reflux. She guessed reflux because after feeding, he'd become very uncomfortable, and that discomfort would worsen as time went on. He'd make a swallowing noise and get the hiccups, breathing sounded wheezy, etc. Not all babies with reflux spit up...the milder type is mostly just the stomach acid rising in their esophagus, causing them pain.

The formula would probably make this worse - that's my guess. It sounds like your doc isn't very supportive of breastfeeding. I would urge you not to stop breastfeeding. Have you thought about a lactation consultant? They can observe the situation from start to finish, whereas the doctor does not. Though I know an LC can be costly. Or, call your local La Leche league leader. They are very knowledgeable and will gladly listen to your issues and try to help you. Their advice is free!"

Baby girl has GED and only sleeps like 6 hours a day.
By Anonymous.

“My daughter has GED, and she will only sleep, maybe 6 hours. If we hold her, she will sleep some, but if we put her in her crib, within 5 mins, she starts crying.

This is the second night of this. She is also cluster feeding for the past two or three days. We are at our wit's end. HELP!"

Response to "Baby girl has GED and only sleeps like 6 hours a day."
Acid reflux in infants
by Pumeza

"Hi, I also have the same problem. My baby girl is now three weeks and two days.

So please try this. Maybe it can also help you.

First, feed her before you bath her. After her bath, feed her again; if she is eating like mine, then put her on your chest for about 10-15 minutes and put her on a bed slowly and quietly.

Make sure that her pillow is very comfy for her. Her stomach or chest must position down, or you put her on her side but not on her back. Good luck, dear, I hope all of this will help you."

Acid reflux in infant
by Zelda Behr

"Coping with little sleep can make having a fussy baby very difficult, but there are a few things you can do to help.

I'm not sure if your baby is breast or formula fed, so I'll give advice that works for both.

Try feeding your Baby as upright as possible, walking while feeding, or carrying in a baby sling.

Burp your baby regularly while feeding.

Keep baby still and her head slightly raised after feeding.

Give her shorter feeds regularly, as an overfull tummy can cause discomfort.

If you are breastfeeding, let her finish one breast. Don't do 5 min one side, 5 min another side, this will cause your baby to get too much foremilk which can make the GER worse.

Dress her in loose-fitting clothing to minimize pressure."

Acid Reflux Treatment
Elevating at a 30-degree angle
by Kristen
(United States)

"Hi, this page on acid reflux was very helpful.

I believe my little 3-week-old girl has acid reflux. She gets hiccups often, has trouble burping, curls her legs in, and clenches fists... I've noticed that during the day, when I am up and she takes naps, she sleeps much better when her head is elevated on a pillow. For instance, right now, she is sleeping on her boppy pillow with her butt on the ground.

At night, I swaddle her and lay her on her back, but she doesn't sleep well and fusses, it said elevating at a 30-degree angle can help, but I am scared of SIDS... I don't want to let her sleep like that if I am going to sleep... Is it safe to let her sleep like that to help her reflux? Thank you"

Acid reflux pillow wedge
by: Elsabe
(South Africa)

"One of my twincesses had silent reflux and slept much better when she didn't lie down flat. I place a pillow or wedge under the cot mattress to elevate it. That way, there is nothing in the cot she could suffocate against, but she's still elevated and more comfortable.

I hope that will help a bit. Good luck, Mama!"

Acid reflux pillows
by: Stacey

"I bought an acid reflux pillow for my newborn, who was recently diagnosed with acid reflux. It works very well and helps for less spitting up and vomiting. I now have peace of mind that she won't choke if she spits up at night. You can find these pillows on Amazon... search for wedge pillow for acid reflux."