Reflux and Posseting and what to do about it
It’s not unusual for someone to call or message me because they are worried about reflux. One of the first things I ask is, what makes you think it’s reflux? Usually Google is involved in the story and that is totally fine. That’s probably why you are reading this post. But what’s really important is your baby’s mood.
It is very very normal for babies to bring up a small amount of milk after their feed. This is called posseting and is usually about a teaspoon of milk, or a mouthful. Whilst it can be upsetting to see your baby bring up some milk, if your baby is happy it is usually not a cause for concern, other than the extra washing!
Reflux in babies, often referred to as gastroesophageal reflux (GER), is a condition in which stomach contents flow back into the oesophagus. This is common in babies as the muscle that separates the stomach from the oesophagus is not yet fully developed.
Your baby may bring up varying amounts of the feed and this can occur immediately after feeding or between feeds. You may even notice that the milk has been partly digested and appears lumpy. In a newborn baby symptoms can improve rapidly over a few weeks and in most cases your baby will outgrow the condition by the time they are 1 year old.
Be it posseting or reflux, if your baby is happy, is gaining weight appropriately and has normal amounts of wet and dirty nappies then it is usually not a concern. The term ‘Happy Spitters’ has been coined for these babies.
Symptoms of Reflux
Symptoms of reflux in babies can include:
- Frequent spitting up or vomiting after feeding
- Coughing, choking, or gagging
- Irritability or fussiness, especially after meals
- Arching of the back or neck during or after feedings
- Poor feeding or refusal to eat
Silent Reflux
Some babies will experience the discomfort of reflux but may not actually spit any milk out. This is referred to as silent reflux and will be managed in the same way.
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Management and Treatment of Reflux
For most infants, reflux is manageable and may resolve on its own. There are some strategies that may help your baby.
Feeding Techniques
- Feed smaller amounts more frequently.
- Hold the baby in an upright position during and after feedings. Upright positions can include a koala hold, a slightly reclined cross cradle or rugby hold or a slightly raised laid back breastfeeding position
- Allow your baby time to take a break or burp during and after the feed.
A free preview of the koala feeding position lesson is available from my online breastfeeding course. Alternatively you can view my blog post on the koala feeding position.
- If your let down is particularly fast or voluminous for your baby you can encourage them to feed until the let down occurs. Then remove your baby from your breast and catch the milk either in a clean container for storage or in a cloth. When the milk ejection has become less forceful you can bring your baby back to your breast.
- Ensure upright paced feeding with a slow flow teat if feeding from a bottle.
Positioning
- Keep your baby upright for about 30 minutes after feeding to allow them to digest the milk. You can hold your baby in your arms, use a sling or a bouncy chair.
- Avoid vigorous activity after meals.
- Avoid tight clothing around your baby’s tummy.
- Some newborn cots have the ability to lower the feet slightly allowing a very gently incline of the cot.
- Roll to the side for nappy changes rather than bringing your baby’s knees up towards their chest. Video here.
Medication
Occasionally, medications or thickened formulas are prescribed that may help reduce symptoms.
If you are breastfeeding your baby you can consider eliminating dairy and caffeine from your diet as in some cases this can improve symptoms in your baby.
Gastroesophageal Reflux Disease (GERD)
GERD is a more severe form of reflux that can cause significant discomfort or complications. GERD may require medical evaluation and intervention and your GP or specialist may prescribe medications to reduce stomach acidity or improve motility.
If your baby has severe reflux you may find this post from GOSH helpful.
When to seek Medical Attention
It’s important to consult a healthcare professional if reflux is severe, causing discomfort or complications, or if your baby is not gaining weight appropriately.
You should consult your midwife, health visitor or GP if your baby:
- Spits up a lot and seems uncomfortable.
- Is not gaining weight appropriately.
- Is experiencing projectile vomiting.
- Shows signs of dehydration (e.g. fewer wet nappies).
- If you are worried about your baby.
While reflux and silent reflux in babies can be distressing, many children outgrow it as their digestive systems mature. With appropriate management and support, symptoms can often be alleviated, allowing for a more comfortable feeding experience for both parent and baby.
If you are concerned about your baby please do not hesitate to get in touch.
