Reflux

You may notice that your baby is bringing up milk during feeding or shortly afterwards – this is a normal occurrence called reflux and in most cases presents no reason for concern.

Reflux happens whenever your baby swallows more milk than their little oesophagus can take, causing the excessive milk to go back into the mouth. Statistics say that 50% of newborns have reflux daily, but the majority outgrow it by the time they turn one year old. Both breastfed and bottle-fed babies can experience reflux.

Reflux can also be silent – in this case, your baby may be swallowing the milk that has come up instead of spitting it out. If you notice that your baby is swallowing even after feeding is over, that may be the first cue that silent reflux is the main suspect.

If your baby is very hungry and starts nursing quickly, if your breasts are overfilled, or if your baby swallows too much air by often dropping the nipple, reflux is likely to occur.

In some cases, reflux may be a symptom of some other conditions, such as cow’s milk intolerance or gastroesophageal reflux disease. However, if your baby is steadily gaining weight and has no other symptoms of discomfort, chances are that reflux is just a bit of a nuisance for you because of all the cleaning up it requires, but it doesn’t present a medical issue.

If reflux happens several times a day or if there are any other symptoms, such as gagging, having trouble swallowing, irritability, constant crying, green or yellow looking vomit, if your baby is arching their back while feeding or they’re not gaining weight, you should seek medical advice.

How to help your baby with reflux

General recommendations that should ease the discomfort caused by reflux include:

  • Feeding your baby by holding them upright
  • Burping your baby after each feeding
  • Holding your baby upright for 20 minutes or so after nursing
  • Avoiding long breaks between feedings to prevent your baby from nursing aggressively
  • If you are bottle-feeding your baby, make sure that the hole in the teat is not too large, causing too much milk to come out too quickly
  • Raising the end of the mattress where your baby’s head lies - having their head slightly higher than the feet - may help with regurgitation

If your baby’s reflux is severe, your physician may recommend one of the common approaches to relieving reflux. The first step would be to check whether your baby has an allergy to cow’s milk. Cut out milk and dairy products, such as cheese and yoghurt, and observe if your baby’s condition changes. If it turns out that protein from cow’s milk is not the cause of reflux, your physician may recommend an infant antacid, which will help neutralize the stomach acid that may be causing pain and throat irritation. Adding a thickener to expressed breast milk or formula might be suggested too. Using thickeners for reflux is an old method that hasn’t got much scientific evidence to back it up, so do consult with your physician before trying it out.

How can I stimulate the let down reflex?

To encourage the let down process, try these tips:
  • Breastfeed in a quiet environment where you won't be disturbed.
  • Prepare for a feed by gently massaging your breasts. Breast massage helps stimulate your let down reflex and it will help prevent blocked milk ducts which can lead to more serious problems. Wash your hands and use the opposite hand to your breast. Start your massage in the armpit and move across and down your breast.
  • If you're having problems getting a let down, try leaning forward and letting your breasts hang so that you can feel their full weight. Then swing gently from side to side.
  • Cuddle your baby. The skin-on-skin contact helps stimulate oxytocin which is the hormone involved in let down.
  • Make sure that you're comfortable and that your baby is correctly positioned to achieve a good latch.
  • Have a glass of water near by - breastfeeding can make you thirsty too!
  • Look at your baby while feeding. This stimulates oxytocin and builds your bond.
  • Wear comfortable clothing and a nursing bra that fits well.
  • Don’t get stressed about breastfeeding – stress can inhibit your let down reflex so try to relax when you breastfeed and remember that making and delivering milk is one of your body's natural functions.

If you continue to have problems with let down, don’t hesitate to ask your lactation specialist, midwife or physician for advice.