I was already well aware of the prominence of reflux among babies before I read "Why Infant Reflux Matters" by Carol Smyth but this book really showed me to what extent a biologically and developmentally normal infant behaviour is often unnecessarily medicalised. 

Reflux, medically referred to as "Gastro-Oesophageal Reflux" is the developmentally normal movement of stomach contents back up from the stomach into the oesophagus - sometimes exiting the mouth visibly and other times being swallowed back down (known as silent reflux). 

It occurs for a variety of reasons, largely based on biology, development and the way we interact with babies in the modern day. Some studies have shown 90% of babies have overt reflux and it is generally noted that instances and severity decline as babies grow and become stronger and more mobile, noticeably by 6 months at the latest. This common, standard reflux doesn't require treatment or medication with changes here and there to baby-care being possible to reduce episodes and the discomfort they cause.

Gastro-Oesophageal Reflux Disease (or GORD) on the other hand is an increasingly diagnosed and medicated 'condition' which officially should only be diagnosed by having several (out of a list of) additional symptoms alongside spitting up. Examples of these additional symptoms may be Apnoea, Hoarseness, Unexplained Feeding difficulties, Ear Infections, Lower Respiratory Infections like Pneumonia, Faltering Growth, a Chronic Cough, Dental Erosion and Asthma. Although the medical concerns within that list definitely should be explored anyway by a medical expert, most diagnoses - and treatment - of reflux comes from the symptoms that could be explained by other things, such as Marked Distress, the Unexplained Feeding Difficulties and Faltering Growth. Medications for GORD are then prescribed based on the 'acid hypothesis' - the, not very well proven guess that the distress these refluxy babies are feeling is from the acidity of the stomach contents returning through the system. 

Medications given for reflux (GORD) diagnoses will either focus on thickening feeds so they are heavier and less able to be regurgitated, using Alginate Therapy that aims to combine with stomach contents, thickens it and produces Carbon Dioxide to send the alginate gel resultant product to the top of the stomach to act as a bodyguard blocking the exit for stomach contents back into the oesophagus. You might have heard of Gaviscon as the most popular one. The final type of treatment prescribed are Acid Suppressors, the most common being Omeprazole. All of these may have their goals but they also contribute to other problems, such as giving babies unsafely prepared formula (due to the use of thickeners),  increasing how full babies feel so they don't take in as much milk and reducing important stomach acid that is important for metabolism.

So, if reflux is normal infant behaviour, and we're not medicating it as much, are there ways we can reduce it to help babies spit up less (because, even if it's normal, it can't be all that fun!)...? Yes!

• Feed smaller quantities more often (the formula-industry touted 8-12 feeds/24hrs is a minimum!) - it takes roughly 45 mins for a newborn's stomach to empty so, it wouldn't be that surprising if they were hungry again closer to this point after a feed!

• Keep baby upright more rather than laid down or in containers. Babywearing is a great option for enabling this while having hands free! A baby not wanting to be laid down on their back, does not signal they must have reflux...it is in fact just that baby being a baby. They would rather be held. 

• Don't actively wind unnecessarily as babies will most likely let you know when they have wind and may get more distressed, spit up more, and require feeding again, if unnecessarily patted on the back. Simply holding them upright against your check, angled slightly to your right (their left) can help naturally bring up any gas - this is called Wonky Winding!

• Reduce baby's stress because a stressed baby regurgitates more easily, perhaps because they cry more and crying causes the valve at the top of the tummy to relax and open...Holding baby close (again...babywearing is great for this!) is a great option for calming baby

• Ensure any Formula-Feeding is done so responsively and safely as those fed formula have been found to struggle more with reflux than breastfed babies! Seeking feeding support if concerned about how your baby is feeding or responding to feeds could help rule out any underlying causes of discomfort

• Check any feeding (breast or bottle) is optimised because, whether breast or bottle, breastmilk or formula, there are ways these can be done to ensure minimal air intake, for example or not overfeeding...

Additionally, it's important to consider that some 'symptoms' you (or someone else) may be putting down to reflux, may be caused by other things...or, dare I say it, be your baby...being a baby:

• Crying before, during or after feeds...can happen for a number of reaons. Perhaps they are struggling to latch and getting hungry and frustrated, perhaps they're trying to communicate the flow of milk is too fast or too slow. Perhaps a tingue-tie is causing a problem, an allergy or food intolerance is causing pain or they're too full or too hungry due to under- or over-feeding

• Back Arching has been put down to a variety of reasons not limited to: needing to pee/poo, needing to burp, or the after-effects of having been squashed in a smaller space for 9 months and then emerging through a narrow opening causing moulding of the skull, tightness and other side-effects

• Poor Weight Gain may be down to a feeding issue such as poor milk transfer, less than optimal latch or a medical issue not reflux related that is impacted their ability to digest or metabolise

• Waking often at night is built into the newborn design to keep them safe when living out in the wild (not that your baby does...but their ancestors may have)...Yes, overly frequent waking, and distress when awake, may be a sign of something going on, but waking frequently, on it's own, is not necessarily a clear signpost to reflux

• Gassy babies may simply be struggling to release the natural gasses that we, as adults, can easily dislodge with a burp...or other exit routes...as we move around. Being less mobile, young babies can simply benefit from being more assistance in changing positions and encouraging any trapped gases to escape (one way or the other...)

In conclusion....as you can see, there is a lot going on for babies, in terms of reasons why feeding may not be optimal, and general causes of discomfort or so-called "symptoms". 

Of course, if your baby is showing worrying medical signs, like those listed earlier in this post, you should see your doctor. Whether or not these are caused by Reflux, they're not optimal for your baby...

However, in instances where less worrying signs are present, perhaps some spit-up, several daily loads of washing, and some crying around feeding...instead of rushing to the pharmacy or the GP for a medical solution...try looking at what other parts of your baby's day-to-day could be optimised, from positioning, to feeding, to responsiveness....

And, if you want more information on optimising feeding, whether breast, breastmilk or formula...I've got other blogs here that may help! Or you can contact me and we can work on improving things together.