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Reflux & Sleep

Reflux is a condition that is most common in the first six months to one year of life. What we call ‘reflux’ is actually ‘gastro-oesophageal reflux’ [GORD or GERD in America.]  

The lower oesophageal sphincter, which is the valve between the oesophagus and the stomach sometimes doesn’t work very well when babies are little. With maturity, it becomes more efficient and usually, reflux gets better after about 6 months. Sometimes, but rarely, it can take a year or a little longer.

Reflux is when the contents of a baby’s stomach leak back into their oesophagus (food pipe or gullet) and cause posseting (bringing up small amounts of milk), vomiting and/or burning pain (heartburn) due to the acidity in the stomach. 

Some babies with reflux don’t vomit or posset and this is called “silent reflux.” 

Diagnosis can sometimes be difficult, as reflux is easily confused with colic, but common symptoms are:

  • Vomiting or posseting [although in “silent” reflux this might not happen.]
  • Crying, especially when they are lying flat.
  • Coughing.
  • Swallowing & gulping.
  • Their vomit and/or breath can smell a little bit sour and acidic because of the acidity in their stomach.
  • Poor weight gain because of not keeping their feeds down.

Sometimes reflux is caused by a CMPA [cows milk protein allergy.] This isn’t the case for every baby who has reflux, however. Equally, not all babies who have CMPA have reflux!

CMPA has other symptoms such as skin rashes,  blood in their poo and constipation.

If a baby has a milk allergy, you may be advised to cut dairy from your diet if you are breastfeeding, or if you are formula feeding, your baby will probably be prescribed a special non-dairy feed.

They might also be prescribed medicine to limit their stomach acid production or to neutralise their stomach acid. Some reflux medicines can cause constipation so you will have to make sure to give them plenty of fluids and fibre in the form of fruit & vegetables.

Babies who have had reflux [or colic] in the early weeks, whether simple “mechanical” reflux or caused by CMPA often develop sleep problems later.

The reason is that they have usually needed to be held and comforted to sleep, and now they don’t know any other way.

Whether your baby is still suffering from reflux or is better now but has sleep problems, here are some tips to help them:

  • For the first 3 or 4 months, try not to worry about holding your baby too much or getting into bad habits if they can only sleep on you. You’ll find more information about settling younger babies in my new babies and sleep article.
  • Get a comfortable baby carrier so that you can keep them upright for naps if that helps.
  • After the first few weeks, try to separate feeding from sleeping.
  • Start their bedtime routine early enough so that you have the time to hold them upright for 20 minutes or so without them falling asleep on you.
  • Give their milk about half an hour before bath time and then by the time they go to bed, the milk should no longer be sitting heavily in their stomach.
  • Older babies who are over about 7 kg in weight, don’t need a tummy full of milk to see them through the night, so long as they are generally well-fed and hydrated during the day.
  • Elevate the top of the cot, so that it slopes down at the foot, and place younger babies with their feet to the foot of the cot.
  • Give any prescribed medication in good time for it to work before bedtime.
  • Drop night feeds as soon as possible, so that they are not struggling to digest unnecessary feeds when they are lying down during the night.
  • Follow the principles of good sleeping generally, with a familiar and well-timed routine, and when they are over 3 or 4 months, support them to fall asleep aware that they are in their sleep space. See my guidance on bedtime routines.

Most importantly, please ask for and accept help from your family & friends. Having a baby with reflux means that your circumstances are special and you will need more support than most parents.

There is more information about reflux and all things sleep related in my gentle sleep course.

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