74: Physiological Reflux vs Red Flags
Reflux: Contents from the stomach moving upwards (backwards) out of the stomach.
How much spit up is considered “normal”? What are the signs that reflux may indicate a bigger issue? Today’s episode is about the differences, signs, and some possible causes for infant reflux.
With all the talk about infant reflux and its causes, I think it’s important to touch base on physiological reflux, which is normal spit up, versus potential GERD (Gastrointestinal Reflux Disease) or other issues. If you aren’t sure if your baby has problematic reflux or normal physiological reflux- this episode may give you some good food for thought.
In general, reflux is the flow of fluid (or stomach contents) in the opposite directions, up through the esophagus. As you know food and drink should be swallowed, travel downward through the esophagus and into the stomach and pretty much continue on.
Some babies experience what is called physiologic reflux (or normal spit up, usually around 1-2 tsp in volume, usually when they burp, and it does not bother the baby). When growth and feeding patterns are normal this type of “happy spit-up” is not typically considered a medical concern. Often they had a little trapped air, some external pressure on their belly, ate a little too quickly, or they were encouraged to finish a bottle even after they were satiated.
On the other hand, if you find your baby is spitting up more than a small amount or needing frequent wardrobe changes, there are often simple adjustments that can make a big difference. Examples might be, trying smaller, more frequent meals or slowing the feed down so they stop when they are full. If they are gulping while they eat, the milk is likely coming out too quickly and can be easily adjusted with a position change such as laid back breastfeeding or a simple bottle nipple swap. Trapped gas is also often mistaken for reflux because you can still experience reflux even if the stomach contents don’t go all the way back up to reach the mouth.
Frequent burp breaks can help babies who are spitting up, arching, fussy, or uncomfortable after feeding; as can being careful to not to lay them flat on their back or put extra pressure on their belly after they eat (especially if they are experiencing some reflux). I always say this and then right as I am saying it to a parent, their newborn will tuck their head, curl up into a rollie pollie position, do a little belly crunch, and make it even harder to get that belly in a nice elongated relaxed position to let the burp out, haha, but just do your best.
Here are some other potential causes for reflux or discomfort:
A food allergy or sensitivity
Constipation
Body tightness/muscle tension (called restrictions), which can create pressure on the baby’s stomach
Over feeding with too large of bottles which common when we feed by the clock and paper schedule rather than our baby’s cues
Babies who are breastfeeding and the mother has oversupply
It may also be helpful to consider if there has been recent stress such as new separation or significant routine changes
And of course structural issues that impede GI function which are usually accompanied by more severe symptoms/issues
If you feel your baby is experiencing more than physiological reflux or being fed a bit too much for their tummy at one feeding, you may also notice signs like: spitting up, vomiting, arching, fussy or uncomfortable behavior after feeding, coughing after or between feeds, wet burps, bad smelling breath, poor sleep, refusing or limiting the amount of milk they take with feeds, and even poor weight gain. These would be signs of something more than normal physiological spit up.
If this is your baby, check out episode 54: What You Must Know About Food Allergies, with Dr. Trill, episode 20: Surprising Symptoms of Oversupply, touch base with a lactation consultant if you are breastfeeding or speech language pathologist who specializes in infant feeding (if you are bottle feeding), and perhaps talk to the doctor if they are a good resource for you about who in your area might be able to help find the underlying cause as this is not a bandaid fix type situation. I always say it’s about finding the right person or resource that makes the difference.
Well mama, I hope this helps you if your baby is experiencing any type of reflux, and as always I encourage you to listen to your intuition. Because you don’t have to know it all, but you still know your baby best, even from day one.
If you know someone who’s baby may be experiencing reflux please share this episode or rate the show so more moms can get access to updated information to be their own advocate.
If you have a question for me or a topic that would help other moms please please email me! At Barbara@FeedingbyJanuary.com.