All babies have reflux. Some babies have acid reflux.
Reflux: backwards flow of milk (when it goes up instead of down). Think “Happy Spitter.”
Acid Reflux: when stomach acid flows back along with the milk up the esophagus, causing heartburn-like pain. This is an “Unhappy Spitter.”
Silent Reflux: acid or non acid spit up that you don’t see come out baby’s mouth. He may seem to throw up in his mouth, then swallow it back down. This may or may not be painful for him.
(By the way, I should mention that I have a comprehensive set of online courses on everything breastfeeding, if you’re interested 😉
A baby with normal reflux:
- Has a small to moderate amount of spit.
- Is rarely bothered by spitting up.
- Sometimes chokes on his puke little and it might come out his nose. It bothers him and he may get upset for a minute, but that was probably just because he was scared that he couldn’t breathe for a second. This kid is upset because he seems startled, not in pain.
- Has spit up that looks like chunky “curdled” looking milk or it may look exactly like freshly pumped milk. Neither really mean anything, one was just in his tummy a little longer than the other.
- May or may not be hungry after spitting up. More often than not, he would be interested in sucking, but not eating after spitting up (i.e. on a pacifier). This may surprise you since it looked like he just threw up the entirety of his feeding!
- Doesn’t mind laying flat on his back (not for too long, Mom, jeez!).
The baby with normal reflux we will refer to as a “Happy Spitter.” The spitting up bothers you more than it bothers your baby. The worst problem you have is a laundry problem. Sorry, this seems to be particularly annoying in the summer months when everything smells like well-aged cheese.
A baby with excessive reflux:
- Has a moderate to very large amount of spit.
- Is rarely bothered by spitting up.
Now, there are two categories here: the well gaining spitter and the poorly gaining spitter. Pay attention. The advice I am about to give it for the well gaining spitter. If you have a poorly gaining spitter, do not follow the following advice. Instead, see “unhappy spitter” below, because a poor gainer is not a happy baby.
If you have a well gaining spitter, I am going to bet you have a heavy milk supply. When your baby eats, it is fast and furious. Like, it reminds you of chugging a beer in college. Five minutes of chugging and he is done. The problem is that everything you have read (not on this blog, of course) says that babies are supposed to nurse for 15 minutes to get the good milk, right? So you coax your baby to nurse longer. He does it begrudgingly because boob juice is soooo good and he really wants to suck, but then he gets even more milk and gets even more full in another two minutes.
So, if your baby shows you signs that he has taken in a lot very quickly and needs a break, give him a break. Let him digest a little! If he is looking to suck, offer him a pacifier and hold him upright so he can let his brain catch up with his belly.
A baby with acid reflux:
- Seems to be in pain after spitting up.
Sometimes, a baby will spit and then scream. The main difference here is that a mom/dad almost always says, “My baby seems like he is in pain.” This is the most important identifying factor of acid reflux. Mama’s gut really kicks in and says that something is not right. If this is the case, it is time to get your baby’s health care provider involved in the conversation.
What to do about reflux:
- Keep the baby upright.
Babies have immature digestive tracts. The muscles and flaps that are supposed to keep his food down tend to not work so well all the time and the food just sloshes back up into his throat. Holding a baby upright helps keep the food in his tummy and out of his throat.
During feedings, try to angle the pillow while feeding so baby’s head is higher than his hips. If you think you have too much milk or a fast let down, check out those techniques here.
A realistic word to the wise: There is no exact number of minutes that a baby should be held upright in order to decrease the risk of spitting up. Pediatricians will recommend holding baby upright for as long as thirty minutes after feeding! However much this might be helpful, it is rarely reasonable. Try this: if 30 minutes works, try 25 minutes. Then, try 20. You get the point.
- Lessen the acidity of the spit up:
Meds. Acid reflux hurts! It is heartburn, after all, so if your baby is having painful spit ups, strongly consider talking to your doctor about medication.
FYI: Sometimes you need to try a few different types and strengths of reflux medication for it to work. Also, this medication is weight dependent, so as baby gets bigger, the medication may need to be increased in order for it to work better.
Also, your pediatrician will most likely only be able to handle the basics of managing reflux, so if the first few tries of medication aren’t working, you or he should suggest visiting a pediatric GI specialist.
Remember: reflux and food intolerance are different. I DO NOT recommend taking a whole bunch of foods out of your diet and also treating the reflux with medication. Why? Because then you will have no idea which worked. You will be left without ice cream at night when you might not have needed to inflict that unnecessary torture on yourself.
Still not sure what is up with your unhappy baby?