When your baby won't sleep: is it reflux?
"Babies at extreme ends of the reflux spectrum are easily diagnosed; it's the babies in between that can be more challenging to treat" ... Pinky McKay
Your baby is irritable, grizzly, hates lying on her back, spits up or vomits often, and has hiccups constantly. She’s a nightmare to feed – she starts to feed voraciously, then wriggles, squirms and ‘throws’ herself off the breast; when she isn’t doing this, she wants to be permanently attached to your breast. She screams after and between feeds, even waking from a deep sleep screaming, as though somebody has suddenly poked her with a pin.
If this all seems familiar, your baby is unhappy because she’s uncomfortable or in pain. The symptoms listed can be a red flag that your baby may be suffering from gastro-oesophageal reflux, or, as it’s more simply put by most mums, reflux.
So take heart – it’s not your fault.
At first, all babies will have reflux to some degree, because their digestive systems are immature. At the bottom of the oesophagus (the swallowing tube), there’s a ring of muscle that helps keep stomach contents down. In babies, this can’t squeeze shut as effectively as it can in an older child or adult, making it relax randomly, and quite frequently. As well as letting swallowed wind be released, these relaxations allow food (milk) to flow back into the oesophagus. Babies with reflux may also be diagnosed with low weight gain or breathing problems.
For some babies – the ‘happy chuckers’ – these muscle relaxations just mean a few spills that don’t seem to affect their wellbeing. At the other end of the spectrum, however, it can cause heartburn-like pain, abdominal pain, and/or frequent vomiting, and can result in the behavioural symptoms listed above.
Of course, as babies are all individuals, symptoms will vary from one baby to another. For some babies, constantly wanting to feed may be a comfort thing, as the natural antacid effects of breast milk might soothe your baby’s tummy, or she may need more feeds to make up for the milk lost when vomitting. But for other babies, feeding can hurt the tummy, making them squirm, pull off the breast and not feed well.
According to paediatric gastroenterologist Dr Bryan Vartabedian, from Texas Children’s Hospital, author of Colic Solved and the father of two babies with acid reflux, babies at extreme ends of this spectrum – that is, the happy chuckers and the babies who are very unwell – are easily diagnosed. It’s the babies in between who can be more challenging to treat, and even doctors can’t agree on when or how to treat baby heartburn.
What can you do?
Firstly, have your baby checked by a doctor (either your GP or paediatrician), or ask for a referral to a paediatric gastroenterologist. If you are ‘blown off’, remember that you know your baby best – persist until you get answers to your baby’s distress.
A proper diagnosis can involve a treadmill of tests which can compound your baby’s distress – and your own. So, if other medical causes have been ruled out, and before you embark on invasive testing, you might want to consider whether the symptoms could be caused by conditions such as foremilk imbalance (check with a lactation consultant), or food intolerance or allergy (including reactions to foods that may pass through your breast milk). Milk protein allergy can present with very similar symptoms to gastro-oesophageal reflux disease, and is more likely if you have a family history of allergies, asthma or eczema. If you’re breastfeeding, these conditions can be simply addressed by eliminating offending foods from your own diet rather than weaning: a child health nurse, dietician or lactation consultant can advise you. If you’re formula feeding, ask your doctor for a prescription to trial a hypoallergenic formula.
Until your baby’s system matures, improving his position during feeding and sleeping can help reduce his discomfort. For a start, holding your baby upright after feeds will aid digestion. You may also notice that a baby with reflux hates using their car seat – this can be because young babies don’t have much control of their abdominal or chest muscles, making them slump when placed in infant or car seats; this increases pressure in their stomachs, making the reflux worse.
Instead, try using an infant seat that reclines a bit. When you’re out and about, you might want to use a baby carrier that supports your baby firmly in an upright position, giving her comfort, as well as leaving you ‘hands free’.
For sleeping, try using gravity to aid digestion by raising the head end of the cot. You can place phone books under the cot legs, or place a towel under the mattress (never use a pillow with a baby under 12 months).
Placing your baby on her left side closes off the muscle between the stomach and oesophagus and positions the sphincter above the stomach contents, making regurgitation less likely. As a result, your baby may sleep more soundly on her left side. Note that this is not advised by SIDS, so talk about it with your health care provider, and only do this when you’re able to watch that your baby doesn’t roll onto her tummy while sleeping.
Meanwhile, it’s important that you don’t blame yourself for your 'high needs baby' - it’s really not your fault that she cries (and cries!). You’re never ‘spoiling’ your baby by helping her feel safe and comfortable, and even if she cries, despite your best efforts to help her, at least she’ll know you’re there for her, through it all. This is an investment in her security and your relationship with your little one. And that will last long beyond these early tough weeks and months.
For more tips to help your unsettled baby, check out Pinky McKay’s books, Parenting By Heart, Sleeping Like a Baby and 100 Ways to Calm the Crying, at her website.