The topic of reflux is a bit of a sore spot for me. As a mother, I felt very dismissed with my concerns about my little ones and their reflux. There is nothing more distressing then seeing your baby in pain. When you know in your gut that something is wrong, but concerns fall on deaf ears. Looking back, I am certain all three of my babies had reflux, but only my boys were treated for it. My Dr (who I absolutely adore) told me that my boys were gaining weight, and that they would grow out of it. He also used the term colic, another self limiting “phase” for a baby. I always felt like there was something more, how could he be in so much pain. There were many tears, from my son and I simultaneously.
During my sleep certification, I was able to take a course on Reflux and I found it so helpful! It didn’t approach reflux from the stance that it needs to be medicated, instead it looked at the underlying causes. Something that is often over looked. There is no single cause for it, and its important to remember that reflux is a symptom. Yes, reflux is a “term” to describe a cluster of symptoms, but it is also a symptom of another concern. The purpose of this article is to help you navigate some of the underlying causes of reflux. I always recommend that you discuss these concerns with your family Dr or Paediatrician, this does not replace their assessment! (I will not be covering serious medical conditions related to reflux including CMPA, FPIES, and pyloric stenosis)
Brief Anatomy Review
For the purpose of this discussion, you will need to know basic anatomy, see the picture below of the stomach and esophagus, and lower esophageal sphincter.
Air vs Perception
There are two main culprits driving reflux. Air in the stomach and gastric perception. Air in the stomach causes the contents of the stomach to be pushed up into the esophagus. The other cause is when the stomach perceives the contents of the stomach to be unfit, and attempts to evacuate, again usually through the esophagus.
What reflux looked like in my house
I was repeatedly told that the cause of my son’s reflux was insufficiency of the lower esophageal sphincter, which is developmentally normal for young babies. Which is true, but there was also an excessive amount of air in his abdomen. Air gets into the stomach when babies cry, laugh, eat, and drink. One of the big factors that was overlooked was the severity of my middle sons tongue tie. When he would feed, he was unable to get a good latch and was taking in more air. He didn’t spit up very much, it was very rare. He nursed often, every hour around the clock sometimes more. Now, I understand that all of this sucking was to soothe the pain he was experiencing from stomach contents regurgitated up the esophagus. He learned that sucking and drinking more milk helped soothe his pain. He was also 99th percentile for weight, and that was my Dr’s main concern with regards to reflux. So it was a bit of a double edge sword, his excessive weight gain put more pressure on his lower esophageal sphincter also contributing to his reflux.
My youngest son also had reflux. He was even bigger and off of the chart for weight. He nursed hourly as well, but as not as “colicky” as my middle son. So he wasn’t swallowing the air that my middle son was with coughing, but he also had a tongue tie. He spit up A LOT!!! I have no idea how he continued to gain weight with the amount of milk this kid spit up every day! What is interesting about his case, was that his was also liked to gastric perception. Over the last few years, information around maternal diet and breastmilk has become more widely available. This time my Dr recommended going dairy free, all traces in food to help alleviate his reflux. I joined a facebook group called “dairy free breastfeeding” and I learned so much! It was also a great community of support while navigating this tough transition. Going dairy free made a HUGE difference in his reflux. He was still spitting up, but not quite as much, and you could just tell he was much more comfortable and content.
Ultimately, both of my boys needed medication for their reflux, it was the only thing that truly helped alleviate their symptoms. I wish I had access to an International Board Certified Lactation Consultant (IBCLC) for a thorough tongue tie assessment, or a Paediatric dentist that specializes in revisions. Unfortunately, I live in a rural area with limited resources, so medication was our last resort. As they say, knowledge is power, and my hope is that this article helps other mama’s find the cause of their little ones reflux.
Here is a *small* list of common reflux signs:
– frequent feeds
– pushing breast away after letdown
– coughing, choking, sputtering on milk
– vomiting milk through the nose
– turning head during feed
– clawing or hitting breast while feeding
– clicking sound during feeding
– arching back
– appears to be in pain
– vomiting, frequently or infrequently
– frequent night waking
– seems to really enjoy motion to fall asleep
– stuffed up nose with no apparent signs of illness
-congestion again with no other signs of illness
– tender abdomen
– mucous in stool
– blood in stool
– frequent passing of gas
– prefers one position for feeding
– frequent plugged ducts or mastitis in mom
– wanting to be held upright
– seems to sleep better being propped up
Looking back, I can see clearly that reflux is indeed a symptom of something else. At the time, I thought reflux was the “problem” and I was trying to address that. If you feel that you are struggling, please reach out! Sometimes it helps to just talk to another mama who has been through a similar struggle. Reflux does get better! My middle son was on medication until he was about 2, and my youngest until just over one year. Both are thriving now, and are symptom free!