GER, GERD, and Your Baby’s Sleep

Please, note that I am not a medical professional. This article is not giving medical advice, rather general information and tips that might help. If you suspect that your baby is suffering from serious reflux, you need to see your paediatrician and get a diagnosis. Your medical professional can also help guide you with medications if necessary, and what to do to ease your baby’s discomfort and pain.

Babies spit up often! It’s why you can always see parents with a muslin cloth thrown over their shoulders. You do not go anywhere without a muslin cloth to catch the spit-up. You learn only to wear white so that the incessant milk spew just blends easily into your wardrobe. The baby milk smell seems to permeate every article of your clothing and the house in general.  

My boys had horrible reflux for months. Just after they fed, they would power spew everywhere. It would come out forcefully in an arc, spraying all over the lucky person feeding them, the couch, the floor, and the mat with complete disregard for anyone or anything that got in the way. It sometimes felt as if the whole feed had come right back up and landed right on my shirt. All that wonderful breastmilk I had been diligently pumping, spat up, and out onto the floor in seconds. It’s heartbreaking, frustrating, and sometimes painful and uncomfortable for baby as well.

There are not many things that are worse than the vicious, exhausting, and painful cycle of reflux.

It’s a horrible rotation of hunger, difficult-feeding, spitting up, tummy discomfort, tiredness, trouble sleeping, overtiredness and then repeat. When your baby is suffering from reflux, it can be difficult for everyone. It’s hard to enjoy the new wonders of parenthood when you see your baby is uncomfortable and in pain. It’s also hard to get the much-needed rest that you both need. Sleeplessness just makes everything a whole lot more challenging.

What is Reflux or GER?

Reflux is an abbreviation of Gastroesophageal Reflux or GER. It can also be called acid reflux and heartburn. It is very common in infants and affects up to half of all babies. At some stage, nearly all babies will spit up, where the contents of their stomach come back up their esophagus and out through their mouth and nose. This happens because the ring of muscles at the top of the stomach where it meets the esophagus is weak or underdeveloped. This ring of muscles is called the lower esophageal sphincter (LES).

This ring of muscles opens to let food enter the stomach and then tightens to stop the food from flowing back up the esophagus. When the muscles are weak or immature, the swallowed food can easily move back out of the stomach. Reflux can also occur from overfeeding and a slow digestive system. It is very common and generally not something to be worried about.

Babies with reflux and not pain or discomfort are often called ‘Happy Spitters.’ Reflux in babies usually begins in the first few weeks of life and resolves itself between the ages of 12 and 18 months. It is generally at its worst around 4 months of age.      

GERD and LPR 

GERD

Although GER or reflux (as it is more formally known) is very common, babies can also suffer from GERD or Gastroesophageal Reflux Disease. GERD occurs when the LES becomes weak or begins to relax when it should be tightening. It is similar to GER, except that many babies experience symptoms that are much more intense and prolonged.

How Do You Know If Your Baby Is Suffering From GERD?

There are several tell-tale signs that your baby is suffering from GERD, and you are most likely well aware that something is making your baby feel very unhappy. The following are the symptoms:

  • Constant spit-up and projectile vomiting
  • Burping
  • Hiccupping
  • Fussy and refusing to feed
  • Trouble gaining weight and weight loss
  • Coughing
  • Gagging
  • Choking
  • Difficulty breathing
  • Wheezing
  • Arching back
  • Chest pain
  • Trouble sleeping
  • Abdominal discomfort
  • Irritability and inconsolable crying – colic 
  • Pneumonia 

If you have felt that horrible sensation of heartburn, it is easy to sympathize with your baby. It is painful and unpleasant. I suffered from a bit of heartburn while I was pregnant, and there is nothing fun about it. I used to get it when I was trying to go to sleep, and it made sleep impossible. I was so uncomfortable.

LPR

LPR (Laryngopharyngeal Reflux) is also called silent reflux. Silent reflux is similar to GERD, where the stomach contents come back up the esophagus, but the same symptoms that you would see with GERD are not present. With silent reflux, the stomach contents travel upwards and into the larynx (the voice box) and nose before flowing back down to the tummy. The contents don’t spill out of the baby’s mouth or nose, making it difficult to detect. Babies can have both GERD and LPR.

LPR Symptoms Include: 
  • Difficult breathing
  • Wheezing
  • Congestion
  • Coughing
  • Respiratory problems
  • Trouble feeding
  • Not gaining weight

When to See Your Doctor

If you think that your baby has more than simple GER and has any of the symptoms listed above, you should book an appointment with your doctor. GERD needs to be diagnosed by your doctor. 

Make sure to see your doctor straight away if:

  • Your baby is vomiting in very large amounts.
  • They are projectile vomiting and are under 8 weeks of age.
  • You can see green, yellow, or blood in the vomit.
  • Your baby is having difficulty breathing.
  • Your baby is not gaining weight.
  • They are not feeding and showing signs of dehydration. Signs of dehydration include no tears when crying, dry mouth, dry nappies, sunken looking eyes. Your baby will be irritable, drowsy, and dizzy.

Reflux and Sleep 

With the pain and discomfort of reflux comes difficulties in sleeping. Lying down can often make the symptoms of reflux worse as it is easy for food to flow back up the esophagus. What can you do to help your baby sleep when they suffer from GER or GERD? First, get a proper medical diagnosis and follow your doctor’s directions. Other things you can do at home include the following:

1. Adapt Your Routine 

Leave time some between when you feed your baby and when you put them down for a nap. A gap of 30 minutes can help the contents of your baby’s stomach settle and help reduce the symptoms of reflux. An eat, play, sleep routine may really help a baby who has reflux.

2. Upright Position 

Keep your baby in an upright position for feeding and for some time after their feed. This way, you can use gravity to help your baby keep their food in their tummy where it belongs. Sitting your baby in a bouncer or swing seat in an upright position after they have fed can help too.

3. Smaller and More Frequent Feeds  

Babies with reflux often respond well to smaller and more frequent feeds during the day. This can also help with potential overfeeding and help your baby to slow down. To give a split feed, you give your baby half their normal feed, then carry on with other parts of your routine before offering the second half of their feed.

4. Slowing Down Feeding Time 

You can slow down your baby’s feeding time by giving lots of breaks for burping. This is an excellent idea for formula-fed babies. Babies on formula can often finish a bottle quite quickly. Stopping frequently for breaks and burping can help reduce reflux symptoms.

5. Change Your Baby Before Their Feed

Get your baby ready for naps or their next activity before they feed. This means that after their feeding, they won’t be jostled around too much, causing their reflux to get worse.

6. Burping—Lots of Burping 

Newborn babies need lots of help with burping.  Burping helps your baby release gas that has been building up in their tummy.  Babies who drink from bottles usually need more burping as they swallow more air while feeding.  Babies with reflux can benefit from consistent and frequent burping.  

7. Be Prepared With Clothes and Towels

Even with lots of burping, some of your baby’s stomach contents can creep back up the esophagus and out of your baby’s mouth. Most babies will spit up a bit anyway, so having clothes and towels in hand and ready to catch the spills can ease the mess. Before feeding my projectile vomiting boys, I would cover myself in a towel, ready for a small or big mess.

8. Naps in the Front Pack 

Having a nap or two in the front pack can be a great way to keep your baby in an elevated position, thus alleviating their reflux symptoms.

9. Use Wedges for Changing and Dressing 

Do not use wedges for sleep, but they can be handy for changing diapers and clothes. Even though you got your baby all changed and dressed before their feed, they might still end up with a dirty nappy or vomit-covered clothes. To help keep reflux at bay, use a wedge when changing your baby. This will keep your baby’s head higher and allow gravity to help keep your baby’s food in their tummy.

10. Fast or Strong Let Down—Hyperlactation

Babies can struggle to feed when their mother has hyperlactation. Hyperlactation is when a mom has a strong or fast let-down. This fast and heavy let-down can cause the baby to take in too much milk too quickly. If you have a strong let-down, you can ease the flow by pumping a little milk before you put your baby to the breast.

11. Bottle Teats 

If formula feeding, check the teat size you are using. If the hole size is too small for your baby, they may be working too hard to get their milk. This extra sucking and swallowing mean they will swallow more air, leading to more gas into their tummies and reflux issues.

12. Use a Pacifier 

Pacifiers are wonderful to use with your newborn for many reasons. They can help calm a fussy and tired baby. They also stimulate the production of saliva in your baby’s mouth. This saliva travels down the esophagus and helps the stomach contents to stay in the stomach.

13. Split Feed Before Bedtime

Bedtime can be tricky with babies who suffer from reflux. Putting them down too soon after a big bedtime feed can cause an upset tummy and the food to come back up. Split feeding at bedtime can help your baby still get a nice, big bedtime feed. Give your baby half their feed at 5 pm, then give them a 30-minute rest before giving the remaining half of the feed at 6 pm before bed.

14. Change Bottles 

There are specific bottles that can help your baby with their reflux symptoms.  Some bottles that have been manufacturers specifically to help with reflux are:

  • Dr. Brown’s Bottles – These natural flow bottles have a system that helps to remove the air from the formula and create a feeding experience similar to breastfeeding.
  • Tommee Tippee Closer to Nature Baby Bottles – These teats are designed to mimic the feel and shape of a breast, making it more comfortable and natural for your baby. They are also designed with a slow flow to help babies who suffer from reflux.
  • Comotomo – These bottles look and feel like a breast, which makes the transition from breast to bottle much more comfortable. They also have two vents to ensure that your baby only drinks with new air. This reduces gas and reflux symptoms for your baby.

What Not to Do

Incline Sleeping, Wedges, or Sleep Positioners 

Do not sleep your baby on an incline or use positioners to help your baby sleep. According to the American Academy of Pediatrics (AAP), babies should sleep on a firm, flat surface. Positioners and sleeping on an incline increase the risk of SIDS. Just recently, the Fisher-Price Rock and Play Infant Sleeper was recalled due to reported infant deaths. We all want our babies to feel comfortable and to sleep well, but not at the expense of their safety.

Tummy Sleeping 

Tummy sleeping has been demonstrated to be a dangerous sleeping position for babies. You should never place your baby to sleep on their tummy. You should always put your baby to sleep on their back. This position is the safest for your baby to sleep in and does not increase the risk of aspiration. Aspiration is when food enters the lungs. In terms of your baby’s anatomy, it is easier for them aspirate in a tummy position. The safe back sleeping position makes it difficult for spit-up to enter the lungs.  


Image courtesy of the Safe to Sleep® campaign, for educational purposes only; Eunice Kennedy Shriver National Institute of Child Health and Human Development, http://www.nichd.nih.gov/sids; Safe to Sleep® is a registered trademark of the U.S. Department of Health and Human Services.

In a back sleeping position, regurgitated food flows back down the esophagus and not down the trachea to the lungs. When your baby is sleeping on their back, the trachea lies on top of the esophagus. This position makes it much more difficult for spit-up to enter the lungs. In a tummy sleeping position, the regurgitated food can collect around the trachea, making it easier for your baby to choke or aspirate. Always place your baby to sleep on their backs.

Great Sleep Hygiene for Babies with GER

Sleep is hard for babies who suffer from reflux. Ensuring that you have great sleep hygiene will help your baby get the rest they need. Consider the following factors for excellent sleep hygiene.

1. Sleep Environment 

The perfect environment for your baby to sleep in is dark, cool, and with white noise playing. Darkness helps in the production of melatonin which is a sleep hormone. It also provides a space free from stimulation and helps when babies are overtired or stressed. The recommended room temperature is between 18 to 20 degrees. This temperature might seem cold, but it is the optimal temperature for sleep. Your baby will be wrapped in their swaddle, which provides layers of warmth.

To check your baby’s temperature, feel their core, which is their chest and back. They should feel comfortable, not cold or hot. Meanwhile, white noise is calming for babies and helps mask outside noise from disturbing them.

2. Timing

Good and healthy sleep is all about timing. Catch the end of your baby’s sleep window perfectly, and it will be much easier for them to fall asleep. Good timing comes with knowledge and practice. Keeping consistent times for naps and bedtime can help your baby fall asleep and stay asleep. Doing this can be difficult with newborns whose sleep systems and patterns are still immature and developing. Nonetheless, you can still start with good habits.

3. Wind Down and Bedtime Routines 

Help your baby to settle and calm before their nap times and bedtime with consistent and calming routines. Reading, singing, swaddling, cuddling, and going into a darkened space can all help to settle your baby into their nap time.

4. Understanding Your Baby

Learning to understand your baby’s cries and signals will help you understand and better meet their sleep needs. It comes with time and practice; don’t feel pressured or like a failure if you can’t tell your 5-weeks-old’s cries apart yet. But with time and patience, getting to know your baby and their tired signals will help you put them down for a nap easier and quicker. My husband was much better and distinguishing different cries.

5. Consistency

Babies and children love routine and consistency. They thrive on knowing when to expect their next sleep and their next feed. This consistency helps them to feel safe—safe in the knowledge that they know what to expect. Having consistency in the first months can be difficult, but do your best to maintain some of it throughout the day.

6. Don’t Forget to Swaddle

Swaddling is a wonderful way to help calm and settle your baby when they are ready for their nap.

Erin Waldron, Mommy to Benjamin

My wee boy was born really early, so he started his life with a substantial stay in NICU. Early on, he began to get quite spilly. Unfortunately, it often triggered an event where his heart rate and oxygen levels would drop and all the nurses and often doctors would leap to attention to stabilize him. This meant that they were pretty motivated to deal with his reflux!!

He was put on hydrolyzed formula (to break down the cow’s milk proteins) while I eliminated dairy from my diet, as we suspected this could be a trigger. He was also put on both Gaviscon before every feed and Omeprazole once a day. He was angled, so his head was higher than his feet, and his feeds were given over a longer period to try and minimize the chance of spilling.

Now that he’s home, he’s still on the medications. We keep his head raised and make small changes like making sure he has floor time and nappy changes before a feed rather than straight after. We make sure his feeds are still given slowly (generally over about 45 minutes), and he’s still dairy-free. Generally, it’s keeping the reflux at bay, and on the whole, he’s a happy thriving bubba. I know meds aren’t right for everyone, but they’ve been a Godsend for us.

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