baby breastfeeding

Breastfeeding challenges

There may be times when breastfeeding is challenging. Never ignore any issues you may have – talk to your health visitor, midwife, GP or breastfeeding specialist as soon as possible, they will be able to help you sort it out quickly.

Here are some common breastfeeding issues, and tips on what to do.

Reflux

When your baby brings milk back up during, or just after a feed, this is known as reflux (it's also referred to as possetting or spitting up). Reflux is different to vomiting – if your baby vomits, their muscles contract noticeably. With reflux, the milk travels back up the food pipe (oesophagus) very easily.

What is baby reflux?

newborn baby crying

The muscle at the bottom of the food pipe acts as a kind of door into the stomach – so when food or milk travels down, the muscle opens allowing the food into the stomach. However, while this muscle is still developing in the first year, it can open when it shouldn't (usually when your baby's tummy is full) allowing some food and stomach acid to travel back up again. Acid in the stomach is normal and a necessary part of the digestion process – it helps break down food.

In most babies, reflux is nothing to worry about (as long as they are healthy and gaining weight as expected). However, in some cases (though very few) reflux can cause a lot of pain when strong acid travels up into the food pipe. When reflux becomes painful and it happens frequently, this is known as 'gastro-oesophageal reflux disease' (GORD).

GORD

GORD stands for gastro-oesophageal reflux disease. It's more serious than mild, everyday reflux. The strong stomach acid can irritate and make the oesophagus (food pipe) sore and inflamed, which is painful for your baby and may result in them needing medication.

The main signs and symptoms of GORD in your baby are:

  • spitting up frequently
  • abdominal pain
  • feeding difficulties
  • seeming unsettled and grizzly after a feed

These symptoms can lead to your baby not gaining weight, or even losing weight.

Silent reflux

Silent reflux can be confusing as there are no obvious signs or clues (such as spitting up). It's when the food travels back up the food pipe – but it's swallowed rather than spat out so is harder to identify. But your baby may display similar symptoms to those of regular reflux.

Reflux is very common in the first 3 months, and usually stops by the time your baby is 12 months.

Baby reflux symptoms

Baby reflux symptoms include:

  • constant or sudden crying when feeding
  • bringing up milk during or after feeds (regularly)
  • frequent ear infections
  • lots of hiccups or coughing
  • refusing, gagging or choking during feeds
  • poor weight gain
  • frequent waking at night

Try to keep your baby upright (for at least an hour) after feeding – this should help keep the milk down.

When should I go to the doctor?

If your baby has difficulty feeding or refuses to feed, regularly brings milk back up and seems uncomfortable after a feed, talk to your pharmacist, GP, or health visitor. They'll be able to give you practical advice on how to ease the symptoms and manage it – they may also need to rule out other causes (such as cow's milk allergy).

It might be helpful to keep a record of when your baby feeds, with details of how often and how much your baby brings the food back up, and how often your baby cries or seems distressed. This will help your health visitor or GP decide if your baby needs treatment.

Helping your baby with reflux

While there aren't really any remedies, you can help your baby's reflux by feeding little and often (smaller feeds stop their tummy getting too full) and burping them frequently during feeds. Try to keep your baby upright, for at least an hour, after feeding, this should help keep the milk down.

If you're using first infant formula, your doctor or health visitor may advise you to use a thicker formula (that's less likely to be brought up), or one that does not contain cows' milk if your baby is allergic to cows' milk.

Treatment and medication

If your baby is putting on weight normally and is otherwise healthy despite the reflux, no treatment is necessary. However, if your doctor feels the reflux is a problem, they may offer medication.

The Breastfeeding Friend from Start4Life, available 24 / 7, has lots of useful information and expert advice to share with you.
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