Infant reflux in association with baby sleep has evolved over the years so it’s important to stay up to date. No more propping mattresses or sleeping upright. Let’s take a closer look at what exactly is reflux and how can you get your baby to sleep soundly and safely.
As a general rule, a baby with infant reflux/GERD should be held upright for 30 minutes after a feed and placed safely on their back to sleep.
What is infant reflux or GERD (gastroesophageal reflux disease)?
Infant reflux is when the stomach contents come back up the feeding tube (esophagus) with baby sometimes spitting up/coming through the nose. It is common for healthy infants to have episodes of reflux even multiple times a day. In this case, it is considered GER, not GERD (meaning it’s not a disease). According to the American Academy of Pediatrics, infant reflux begins around 2-3 weeks and can last until 4 or 5 months, when the lower esophageal sphincter is matured.
Quick movements after a feeding or a stomach that is too full can trigger reflux. How does it do that? When breastmilk/formula is mixed with stomach acid and hits the valve (lower esophageal sphincter) that keeps the food in the stomach, sometimes it can prematurely open. Simply put, the sphincter is not fully developed and doesn’t always know when to open or stay closed.
GER becomes GERD (a disease) when there are complications from the reflux. You’ll find out more about complications in the next section.
What does GERD look like in my baby?
Here is a list of symptoms of GERD.
- Spit up or vomit sometimes coming through the nose/mouth (this is usually the only symptom of a happy spitter = GER)
- Hiccups
- Fussy around feedings/refusing to eat
- Arching or crying during feeds (painful) or up to 45 minutes after a feed
- Increase in frequency of projectile vomiting
- Slow or no weight gain with projectile vomiting (you may notice decrease in number of wet diapers)
- Wheezing or coughing with feeds
- Blood or greenish color in spit up
- Baby’s belly feels swollen/hard when not crying
- Gagging or choking
What is the safest way for my baby with infant reflux or GERD to sleep?
The safest way for a baby with reflux sleep is to hold them upright for 30 minutes after a feed and then placed back to bed on a flat firm surface. Many people think baby needs to sleep upright or on an incline and recent studies have shown that it’s just not necessary anymore. Added bonus, it helps with mom and dad’s mental health while they sleep knowing their infant sleeping safely.
A quick review of the ABCs of safe sleep for babies includes Alone, on their Back in a Crib (or bassinet). No plush bumpers, loose bedding or toys to be a risk.
Why can’t my baby sleep on an incline?
One common misconception with babies who have GERD is to sleep with a wedge under their mattress OR to incline their mattress. This poses a huge risk and here’s why.
Babies have poor head control. The biggest risk includes baby’s head falling forward with their chin to chest, significantly obstructing their airway. Babies can potentially reposition or roll themselves over finding their face on mattress padding unable to shift themselves back.
When parents are awake and supervising their baby on an incline, they can see if baby needs to be repositioned. However, when your baby is unsupervised there is no way to know if your baby has repositioned themselves.
Treatments for infant reflux/GERD
Your doctor may order some test like an ultrasound to check for any narrowing of the GI tract, lab tests (blood and urine), pH monitoring (checking the acid level in your baby’s esophagus), x-ray (to check if there are any blockages in the intestines) or an endoscopy (camera down esophagus into stomach to possibly takes samples of tissue to test).
Try keeping a food diary of your baby’s symptoms and your feeding schedule to show your doctor. There is no such thing as stupid questions so whatever you’re thinking, ask your doctor!
Generally speaking, making adjustments to feeds or a feeding schedule for your baby and TIME will help resolve reflux. However, when this does not do the trick, medications can be prescribed. A specialty formula may also be needed to relieve reflux.
Tips to minimize reflux include;
- Feed baby in an upright position (paced feeding, see video below) making sure any caregivers who feed your baby are on the same page with positioning
- Smaller more frequent feedings
- Frequent burping during and after feeds to prevent buildup of air
- Avoid quick movements and quick position changes after feeds
- Hold baby upright for 30 minutes after a feed
- Decrease stimulation
One last interesting take away. Check out this table comparing a few symptoms of GERD and overtiredness. If you are struggling with getting your little one to nap or sleep longer stretches at night, I would love to touch base to see if there is anything I can do to help. Overtiredness could potentially be misinterpreted as reflux. You can email me at clementineparent2020@gmail.com with any questions.
| GERD | Overtiredness |
| Persistent vomiting with arching/pain | Poor nighttime sleeper |
| Inability to settle | Inability to settle |
| Persistent fussiness | Persistent fussiness |
| Slow or no weight gain | Diagnosed with colic |
| Fussy around feedings/refusing to eat | Fussy around feedings/refusing to eat |
If you like this blog, you might enjoy these:
- The Importance of Tummy Time in Babies – Clementine Parent
- A Newborn Bedtime Routine is Beneficial: Here’s Why. – Clementine Parent
Do not make any medical decisions based off this information before consulting with your own doctor. This is presented to help educate and empower you to make the best possible decision for your baby.