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What to Do About Infant Reflux?

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Sometimes a baby is generally miserable and rarely sleeps because some babies are like that. And sometimes it’s because they have reflux. If you suspect you’re dealing with reflux it’s time to talk to your pediatrician. However your pediatrician won’t be able to make a definitive diagnosis without doing something invasive (like an endoscopy which requires putting baby under anesthesia) so you guys will talk it over and make an educated guess.

Regardless of which conclusion you and your pediatrician come to, if you even REMOTELY suspect your baby may have reflux you’ll want take the following steps so that you and your baby can cry less and sleep more.

Cut Out Dairy

Research shows that up to 50% of refluxing babies also have a dairy intolerance. Further, in many instances, the reflux is even CAUSED by milk proteins. So, if you’re nursing, it’s time to cut out ALL MILK PROTEIN for at least 2 weeks. No lactose-free milk or cheese. For most babies the problem isn’t the lactose (milk sugar) it’s the milk protein, also known as casein, caseinate, calcium caseinate or milk protein. Start reading labels. Sadly you’ll likely find that just about all of your favorite foods have milk protein in them.

If your baby is taking a bottle you’ll want to try a milk protein free formula (such as Similac Alimentum

or Enfamil Nutramigen
). When you go to the store to buy these products you’ll quickly notice that they are stupid expensive. As an added bonus they taste yucky and babies hate them.

[pullquote type=”1″ align=”left”]
Anyone who suspects their baby is suffering from reflux should do a serious milk protein free trial for at least 2 weeks.
[/pullquote]So you may need to gradually wean your baby on to them. Start by blending the milk protein free formula in with your regular milk protein formula to get your baby used to the flavor. For example, if you’re making an 8 oz bottle of formula, you would use 3 scoops of your regular dairy formula and 1 scoop of the detestable but potentially medically necessary dairy-free formula. Wait a few days and then use 2 scoops old formula, 2 scoops dairy-free formula. Your two week “dairy-free” trial doesn’t officially begin until your baby is drinking 100% dairy-free formula (the mixed blend doesn’t count).

Getting rid of milk protein is a nightmare. But at least half of you will find your baby’s reflux symptoms vastly improve or even fully evaporate.

Keep Them Upright

If you want gravity to keep stomach contents out of the esophagus then you want to keep your baby perpendicular to the floor pretty much all of the time. This is especially true for ~30 minutes after every feeding. Generally this means an exhausting amount of baby carrying. A few other options include:
[list type=”checklist”]

  • Babywearing. Bjorn Baby Carriers
    and Moby Wraps
    are decent options. You’ll want to avoid traditional slings
    which tend to hold baby on their backs. Traditional slings also tend to squinch up baby’s body which often puts pressure on their stomach, and refluxing babies don’t respond well to being squinched.
  • Baby Bouncers
    are generally OK for refluxing babies as they hold baby at an angle. Avoid floor gyms
    . The less time lying flat on their backs, the better.
  • For older babies, exersaucers
    seem to work well to offer your arms a break while keeping baby happily upright for a few minutes.

[/list]

Layer on the Soothing

Refluxing babies are often called “sensitive”, “high-needs”, or even “fussy.” All of this means that they need EXTRA soothing. You’ll want to layer it on thick – loud white noise, swaddling, etc. Pacifier use is encouraged for all newborn babies but it is an ESPECIALLY powerful tool for refluxing babies. Pacifiers encourage saliva production and saliva is a natural antacid.

In my experience, all babies sleep better in swings. This is doubly true for refluxing babies. Swings the soothing motion they need while also holding them at an angle which helps minimize esophageal irritation from stomach acid. If you suspect you have a refluxing baby it’s time to invest in and embrace the swing.

Embrace Your Inner Sleep Nazi

If you’ve read ANYTHING on this site before you know that I’m pretty militant about kids and sleep. If you have a baby with reflux, you will be too. BECAUSE refluxing babies struggle with sleep and BECAUSE they tend to be fussy, sleep deprivation will just exacerbate everything. So it is EXTRA important that you make sure you aren’t keeping baby awake too long. That you keep the time between naps short. While your friends may safely skip a nap here and there to meet up for coffee or playdates, this is not a luxury you can afford. Sorry about that.

Things that Won’t Help

Thickeners. In case you aren’t familiar these are formulas with small amounts of rice added into them to make them “thicker”. These are really good at clogging bottle nipples and frustrating babies, but have little to no effect on reflux. It won’t hurt so you’re welcome to try, just keep your expectations low.

(edit 9/10/14)
Adding up to 1 tablespoon of rice cereal to each ounce of formula may help. It seems to reduce the amount/frequency of observed spitup and may provide some comfort to the symptoms. Discuss this strategy with your pediatrician first.

Bumbo seats

. While they’re advertised as “useful for refluxing babies” I’ve found that this baby seat actually puts added pressure on baby stomachs which can aggravate reflux.

Starting Solids Early. The theory is that heavier foods are more likely to stay down but this rarely works. Most newborn babies lack the gross motor skills necessary to eat so you’ll find very little goes in. As a result 98% of their daily intake will remain liquid so the “heavy food” doesn’t have much of an impact.

Car seats. Refluxing babies tend to have a hard time in the car seat. While they eventually outgrow the dreaded “scream whenever we’re in the car” phase, they often cry inconsolably and/or spit up during car rides. I think it’s because the seat buckles put pressure on the stomach which pushes contents up into their esophagus. Putting baby in the car on an empty belly seems to help somewhat, but short of never leaving the house (don’t do this – you have a refluxing baby – life is hard enough without total isolation) the only thing that seems to help is time.

Time for Medicine?

If you’re doing all these things and you and your baby are still generally miserable and sleeping poorly then it’s time to talk to your pediatrician about a drug trial. There are many drugs available to treat pediatric reflux but the two most commonly described are Zantac and Prevacid. In my experience Prevacid is more effective and is easier to get into your baby because it tastes better. However pediatricians tend to lean towards Zantac because it’s milder and has been FDA approved for pediatric use for kids under 1. Whichever drug you and your doctor decide to try there are two things you want to keep in mind.

[list type=”bignumlist”]

  1. Don’t Mix Trials

    Finish your 2 week dairy-free trial before beginning your drug trial. Otherwise if you see an improvement you won’t know which treatment (diary-free vs. drugs) is having an impact.

  2. Get the Dose Right

    Easier said than done. Especially if your pediatrician isn’t convinced that your baby really HAS reflux they may lean towards a low dose. I understand you may want to go with a low dose as nobody likes to give their baby drugs. However I’ve found that if you don’t give your baby enough medication to provide relief, you can mistakenly come to the conclusion that your baby doesn’t have reflux when in fact you’ve just not treated it sufficiently. Also depending on the drug you may need to make careful choices about WHEN you administer the medication. Many of the reflux message boards suggest that Prevacid (and other PPI drugs) need to be taken on an empty stomach (or 30 minutes prior to eating.)

[/list]

This is the sum of my reflux management expertise having had far more exposure to refluxing babies than I had ever hoped for. Any other reflux survivors have any survival strategies they want to share?

{photo credit: Meagan Jean Wooley}

Reader Interactions

Comments

  1. Good stuff – this all basically reflects our experience with our son who had reflux probs. We eventually found Alimentum, which I think helped — it’s literally 2x the cost of all other formulas as far as I can tell and does smell like dog food, but I kinda thought the other formulas we tried were pretty stinky also. We were lucky that our son didn’t have any issues with the taste (note to self – have his taste buds checked).

    Other than switching to Alimentum, putting him on meds, and using Dr. Browns bottles (just in case there was plain ol’ gas issues), we had good success with baby slings — they gave my wife a lot of additional freedom while she was on maternity leave. There are some sling stores in Manhattan run by militants that teach classes, show you every kind of technique, etc. and, just fyi, they refuse to sell the Baby Bjorn because, as I understand it, they’re convinced they cause babies to rest too much of their weight directly on the, uh, ‘taint area, rather than distributing their weight onto their butt and legs. Technically this might be called the perineum, but I’m no doctor. (I like to imagine the women at the store are a little like the women who run the Women & Women First store on Portlandia.)

    You still have to bounce the kid around a bit and find the ways you like to wear the sling, but they made life a lot easier for us. Until our son was big enough for the Ergo, we used a Mei Tai and he liked going out in it a lot.

    Was he held spread eagle for long periods of time? Yes. Apparently it’s not an issue for babies.

    Reply

    • I didn’t mention Dr. Brown’s bottles as I’m not convinced they work. But I also used them (and this Dr. Brown bubble-free mixing pitcher which also probably didn’t work). Frankly when we were struggling with reflux I would have bought pretty much anything that had even a remote chance of making things better 😉

      I didn’t like the Bjorn because it kills my back (Moby Wrap and Ergo were much back-friendlier). Although personally I’m not a huge baby-wearer. Wearing babies interferes with my ability to sleep when they’re napping 😉

      Reply

    • My second little girl had reflux very bad. I nursed her till almost 7 mos old. She was about 1 mo old when reflux got so bad. When we took our prescription in for Prevacid the pharmacist recommended giving half apple juice half water only about 1/2 oz about 1/2 hr before feeding or between feeding. I would make it room temperature, she seemed to like it a little cooler than warmer i guess like any irritation colder feels better This worked wonders for her. I did get prescription but stopped after 1 month. I kept up the apple juice and water until she was about 6 mos old. I definitely saw a difference if I thought she was doing better and skipped a dose. She would get real red and sweaty. I hope this helps as an alternative as well as it did for us. She just turned 1 yr old and still is sensitive to anything acidic. I always try new foods at lunch and blander foods at dinner.

      Reply

        • Yes I did before every feeding. Also I used real apple juice, I can’t remember the name but it comes in a glass container. Kind of expensive but goes a long way because you only need a little.

          Reply

          • Hi there- i have a 3 month old who is struggling with severe reflux. Just wondering what the purpose of the apple juice and water before feeding was? I would have thought the acidity in the apple juice would cause more harm than anything so am just curious. Willing to try anything that might help! 🙂

            Reply

    • Your story above sounds exactly like my babywearing experience. I was looking for ways to give my baby motion and help with reflux. The babywearer group in Tampa hates the Bjorn, but my pediatrician said it was ok for times when my baby really wants to face out. She is big enough for the Ergobaby now, but I also have a mei tai and several wraps…sigh.

      Reply

    • Try checking with your pediatrician about insurance coverage for special formulas. We were able to get our insurance to pay for 70% of the cost of Nutramigen . The pediatrician did all the paperwork and set us up with a specialty pharmacy that shipped us a months worth at a time.

      Reply

  2. This is a great post. My baby has reflux too. Holding her upright after feedings helps a lot. It’s a pain, especially at night, but worth it for her comfort.
    I do agree with Matt about the Baby Bjorn. A baby carrier should support a baby from knee to knee, and the baby’s bottom should always be lower than their knees. Yep, spread eagle! Looks awful, but babies are falling asleep like this every day! Baby Bjorn is what is called, (in the baby-wearing community anyway) a “crotch dangler”. Doesn’t sound so comfy, huh?

    Reply

    • I forgot to mention this but if your kid as reflux then you’ll want to gently wean off night feedings as soon as you possibly can (with my second child we were done by 6 months). Because yes dealing with an upright baby who has tummy issues at 3:00 am is a bummer 🙂

      Reply

      • Can a reflux baby’s tummy handle long periods between feeds? Do they get gastric, which can worsen reflux? We noticed that our 9 week old presented with silent reflux symptoms/ heartburn after going through 2 nights from 1am to 7am without a feed. Now we are back to feeding her through the night to prevent gastric.

        Reply

  3. I agree with the Bumbo not working, which really disappoints me. We used it with our first two (one being a really bad spitter, but didn’t seem to be affected by sitting in it, he just spit up all the time no matter where he was). The newest kid seems to always spit up when seated in the Bumbo. He’s 4.5 months old now and just today I sat him in it for the first time without him spitting up. I think it’s because his back is stronger and he could sit up better in it.

    Also, he has been sleeping in his swing until last night. 95% of the time it wasn’t on, but it helped him with his startle reflex and it kept him upright. He also became a tummy sleeper last night too 🙁 I don’t like it one bit, but every time I rolled him over to his back, not only did I wake him up and piss him off, but he’d find a way to roll back over to his tummy.

    And one more thing – we just switched pediatricians and the new pediatrician wanted us to get him off of Prevacid based on not liking the adult research. He said we had to wean him off. So, FYI – when you stop Prevacid, you might need to wean your baby so to not cause them more upset.

    Reply

    • Jennifer,
      Are you going fro prevacid to something else? Or is the new pediatrician just suggesting that your son doesn’t need to be medicated anymore? Also I don’t quite understand what you are saying in the last sentence?

      If he rolls over on his own, why not let him sleep on his tummy? It’s the PERFECT position for reflux (gravity closes the valve at the top of the stomach). As long as he isn’t swaddled, once they’re flipping over, more power to them!

      Good luck with the prevacid weaning. We tried multiple times and are still on it at 2.5 years 😛

      Reply

  4. The pediatrician said that he needed to get onto Zantac while weaning off of Prevacid. If we just quit the Prevacid it would be too painful for him. He said that after we were on just Zantac for a few weeks we could stop giving it to him if we want. We just stopped the Zantac a couple of days ago. I’m not sure if I’ve noticed a difference or not though. His eating has become more annoying, but I think most of that is because he wants to stop and smile at me instead of eat. The actual spitting up hasn’t changed – it’s still as disgusting as ever!

    I’m all for tummy sleeping as I know they sleep better on their tummies, I’m just a bit hyper-paranoid about it now… our second kid passed away in 2009 and I don’t want to go through that again. It wasn’t SIDS (even though we really don’t know what it was so technically I guess that means it was SIDS), but I’m just paranoid.

    Reply

    • I’m so sorry for your loss! And of COURSE that makes you hyper-vigilant. While generally these motion sensor monitors are a waste of money and result in too many false alarms, given your history, would it help YOU feel more comfortable?

      http://www.amazon.com/Angelcare-Baby-Movement-Monitor-White/dp/B0014KUGNQ/

      Sometimes it can be worth a few $$$ if it helps you relax (and not let her sleep on her tummy without flipping her over all night long:-).

      Hope your Zantac weaning has gone well. Sometimes it takes weeks to know because it takes a while for the irritation to build up. So time will tell 🙁

      Reply

  5. We have a baby with reflux. It got really bad he was about 5 weeks old. He was screaming for hours and hours on end and nothing, and I mean nothing I did helped him or calmed him down. After researching it online we took him to the doctor and our doctor diagnosed him with reflux. the doctor prescribed Prevacid but we didn’t have great results. I was breastfeeding and occasionally formula feeding, but switched to solely breastfeeding when I found out about the reflux. My husband regularly visits the chiropractor and mentioned to him that our son was diagnosed and the chiropractor recommended bringing him in. We started to take him once a week (the Dr also recommended a pro-biotic) and by week 3 the screaming stopped – completely. For the next few months he still spit-up but the screaming and discomfort was gone. He is now 9.5 months old and we have been scream free since. He only goes to the chiropractor about once a month now and the doctor recently said he can probably stop coming all together.

    Reply

    • I’m a bit leery of chiropractors too (especially with infants) but hey, it worked out yes? My guess (and who will ever know!) is that the baby had colic vs. reflux and responded to the probiotics. But that’s the challenge with babies, sometimes you NEVER know.

      Reply

      • Actually, chiropractic care can help a refluxing baby. My first son had reflux and would spit up large amounts…as in soaking his entire outfit and the car seat, and leaving large pools of spit up in the shell of the car seat. We did everything you are supposed to, kept him upright during and after feeding, elevated his bed, elevated his changing table, Zantac, Dr. Brown’s bottles, the list goes on and on! My husband and I both go to the chiropractor and after telling him about how things were going he asked if I would be comfortable with him giving my baby an adjustment. My husband and I decided it was worth a shot, we were at a point where it really couldn’t get any worse. The chiropractor was very gentle, in fact my son didn’t even know he had been adjusted, he slept right through it! And…it worked! I kid you not, the spitting up STOPPED that day. Now remember, for some children depending on the severity of the reflux it could take more than one adjustment to see results, but we saw results immediately! I have never been so thrilled in my entire life! Now, if he could do an adjustment to make my now 2 1/2 year behave…. 🙂

        Reply

  7. By time we got our son to the Dr, diagnosed, and then gave prescription medication a chance he was about 8 weeks old when my husband took him to his first appointment with the chiropractor. The chiropractor basically did massage therapy – No neck or bone cracking or anything crazy like that! There is a lot of speculation that babies with “traumatic” birth experiences are more prone to infant reflux/colic. Delivery can increase pressure on the neck of a baby and cause stress to their nerves. When the vagus nerve is affected, colic or infant reflux can occur. The massage therapy given by chiropractor corrects subluxations in infants by doing gentle and subtle manipulations. In our case, my labor and delivery seemed short and sweet, but then when my son was delivered the cord was wrapped around his neck 3 times. Not to mention being yanked out! I was nervous about him going to the chiropractor as well, but I have the proof that in our case for our son it was extremely beneficial. I give more credit to the chiropractor for his initial recovery than the probiotics only because we had to order it in a special powder form and it didn’t get delivered to the Dr’s office until after his 3rd visit which is the one where we saw the significant reduction in crying. The excessive spitting up still occurred until he was about 7 months and was sitting up more and more and he was strengthening his core then it stopped completely. I know that a chiropractor might not work for every family or baby, but we had tried Prevacid and then Zantac with minimal results. Our son was crying 8-10 hours a day and was inconsolable. He would arch his back and kick and scream and was miserable. I was a wreck and I would never want another parent to go through that. If I can suggest an alternative that helps even one other person then I will. The chiropractor we took him to was one that my husband has been seeing for a long time. It was important that he saw someone we trusted.

    Reply

    • Hi there! I just read your post about a traumatic delivery. While to me, my delivery was what every mother would want (no drugs, 20 min of pushing, out baby Jacob comes 1/21/12)however, my son did not get a good “squeeze” as the Drs called it when he came out, therefore, he swallowed a lot of fluid. He was just recently diagnosed with acid reflux by showing his Dr a video of him feeding and arching his back and crying after burping and rentering bottle. His Dr did not want to push meds right away but rather had us put him on Enfamil Gentlease for fussiness and gas. She did write us a rx for Zantac but only to use if the formula did not help. It has helped in a way that he has not cried during his feedings ( knock on wood) but I am wondering if his ingestion of fluid during delivery is to blame for his “acid reflux”? I don’t see how it could be but I’m curious

      Reply

      • The “squeeze” you are talking about generally pushes fluid out of the baby’s lungs. But even if this doesn’t happen at birth babies get it out just fine on their own (C-section babies don’t get the squeeze either but it works out just fine). So no – I don’t believe this had anything to do with his reflux whatsoever.

        Basically your Dr. is hoping you have a milk protein issue instead of reflux. Hopefully doc is right. You should know within days if that is the case. If things haven’t improved dramatically it’s probably time to work with drugs + lifestyle management. Reflux is no fun but it DOES get better. Good luck!

        Reply

        • My grandaughter was premature due to a car accident. Right after car accident my daughter complained of cramping and pressure she also had a concussion. Doctors kept saying all is normal pain. She delta with this pressure for 4 more months and baby came a month early 5 pounds 11 oz. At first baby ate well burp well was all formuka she could not produce Brest milk.. Baby stated out not being able to poop went from 2 times a day to none for 4 days. Dr. Said babies don’t poop every day. Then came the major spit up total discomfort. Now Dr says might have reflux. Would not recomend a different formula cause said wic wouldn’t cover it. She went on gentalEze anyway. Spot up became unbearable. Have done all the recommendations holding up etc. I asked my daughter to try hypoallergenic nutrgruin seem well at first. But baby just started spitting up pretty bad again. She has an appointment with an ent. I wish not to have her formuka changed again. Very upsetting all the discomfort my grandaughter is in and my daughter feeling so bad like it’s her fault

          Reply

          • Chana,

            I’m so sorry your grandaughter is suffering 🙁 Preemies are more likely to have reflux and it sounds like there is possibly some food allergies in the mix as well. Hopefully the ENT will be able to help you come up with a good strategy to help her.

            If it helps at all, 2% of babies have reflux JUST BECAUSE thus it’s highly unlikely that it has ANYTHING to do with the car accident, and it’s simply because she has reflux. Both of mine did!

            Reply

  8. Oh wow, where to begin? I have so much to say on this topic. We have a 6 month old, Ember, that is our first child. She was diagnosed with GERD at 1 month old after confirmation from an Upper GI Scan. At the time slight burning was found on her esophagus and she was put on Zantac. Prevacid did not help Ember. We did not sleep for the first 3 months of Ember’s life. It was awful. We knew we were treating the GERD with medicine, measured feedings that she could hold down, etc. But still her spit up was awful and the fussiness and gas were out of this World! I nursed Ember for 1st month, and was told to pump and feed only 2.5oz every 3 hours. She could only hold down that amount of milk until she was about 3 months old. We made all the changes, she sleeps in a Nap Nanny (God Sent- sleeps in it til this day). But still something was wrong. After 8 straight nights of being up with a screaming child every 10 minutes we had had enough. No one was sleeping and I knew something was wrong. We were told it could be a formula intolerance. We jumped through 4 different formulas including Soy. They told us to stay on the new formula for 1 week for it to have enough time to work. All was a nightmare. We finally were at wits end and went to Enfamil Nutramagin. Come to find out Ember not only has GERD, but a Soy/Milk Protein allergy that she can not digest. Within 48 hrs on Nutramagin she slept through the night. Her naps still max out at 30 minutes each, but we sleep at night! Seems like we were fighting with both arms tied for many months and now Ember is finally feeling well! I wish we would have known of her allergy before now. She – and us – might has slept the first 4 months of her life.

    Just stumbled upon your page today as I was searching for answers to her short naps. Love it! Thank you for posting these great articles!

    Reply

    • I find your story so true for my first and since her name is Ember also, I thought it was an old post I did! Only exception is my Ember was born in 2010. On antother note, my second child Keylin (6weeks old) has severe GERD. Hers is silent and spit ups hours later. We are doing Zantac and she has a Daydreamer that she pretty much lives in. It’s just like the nap nanny. Btw I loved the nap nanny but it’s been recalled and didn’t keep it from my first daughter who used it. Zantac and Prevacid doesn’t stop spit-ups, it is only to keep the acid from burning/damaging the esphogus. We spent two night in hospital because Keylin stopped breathing several times for few seconds from choking on the reflux. We then went to Leboneur, and they suggested Reglan. With the side effects of even more fussiness and shakes/jitters we chose to not give it to her. It’s because her stomach will get stronger in time but will not completely trash the idea if it gets worse. I breastfeed and was told to pump and mix with rice cereal. Which the rice caused her to be colic and those screams for hours have you questioning this isn’t worth it. Plus with my first when I was told to solely pump and not offer breast I dried up. This time I breastfeed except for the 2 night feeds. Oatmeal cereal is another option too. Only thing with rice or oatmeal cereal their bodies do not digest it. It’s only to help make feelings heavier to hold down. Either way any parent who deals with a reflux infant is a mighty strong person. I find my self amazed at how I’m able to keep going, but then her smile is all the fuel I need. It’s still a constant battle but it will get better!

      Reply

  9. There should be a special medal that parents of refluxing babies get to signify their incredible accomplishments in functioning without sleep and parenting a stressful cranky baby for so long.

    Bravo to you for listening to your gut and getting the food allergies sorted out!

    If it helps at all, subsequent babies get much easier. We did the same miserable 5-month thing with our first kid before we figured out what we were really dealing with. Baby #2 was medicated and in a swing at 10 days old.

    So now you know, next time will be a breeze 😉

    Reply

    • 🙁 If it makes you feel any better about things Reflux diagnosis is REALLY tricky. Even the invasive tests don’t provide that much information so the Drs. are all left guessing. And babies are HUGELY overmedicated. About 2% actually HAVE reflux while close to 25% are TREATED for reflux. So doctors are in a tough spot.

      Hopefully you’ve found your way to keep baby happier. It’s a bit of a slog but it does get better!

      Reply

      • Thanks! Things did get better…
        After a few weeks of mayhem I looked around for more options and found that lactation consultants recommend a change in diet when reflux is suspected.
        I stopped dairy and the “reflux” was fixed in a few days time… Now I substitute with buffalo products which seem to have no effect on her allergy.

        What really baffles me is why so many doctors seem so clueless on breastfeeding, milk protein allergies and so many other issues it took me a few hours of online research to learn about…

        Reply

      • Any tips on Grunting Baby Syndrome? Our son is 4.5 month old and he grunts, kicks, pumps his legs, frantically whips his head from side to side sometimes hourly or every 2 hours if we’re lucky. I do believe he is in a light sleep during this as his eyes are closed. But he inevitably will eventually get frustrated and waking himself up, crying. At which point my husband or I will go in and either feed him Alimentum until he settles again, or pick him up and place him sitting facing outward on our tummies and frogleg him while feeding him the bottle. This position and sucking angle will sometimes allow him to fart. Then he’ll go back to sleep for another hour or two if we’re lucky. Then the whole process starts over again.

        He self-settles initially when we put him to bed at night so I do believe he would be a good sleeper IF he did not have these tummy troubles to deal with.

        We’ve tried ovol, Bio-gia, angling his crib at 30 degrees, Prevacid, baby wearing during the day, Alimentum… Nothing is helping.

        Reply

  11. Just stumbled upon this article when I was reading your articles about sleeping thru the night. I have a 5 month old that was diagnosed with reflux when he was 4 weeks old. We used zantac then switched to prevacid solutabs and they are working great. No issues with the reflux other than spit up occasionally, not half as bad as before. But my biggest question is getting him to sleep better at night. I keep being told that it’s because of his reflux, but it’s under control, so how can it be keeping him up at night! I allow cat naps in his swing but he sleeps in his crib for afternoon long nap and night time. I’ve propped him and it didn’t help. He relies on his pacifier, so how do I get rid of it? Doctor told me reflux babies love to suck, so I let him have it, now I feel it’s the cause of my zombie-ness! Please help! 🙂

    Reply

    • After reading this, I feel like I need to add more into or some real help. My little guy is 23 weeks and DEPENDS on his pacifier at all times of the day. We have no problem getting him to go to sleep but it’s KEEPING him asleep that is our problem, and yes I KNOW it is the pacifier! We feed once in the motn, usually between 3-4am and I’m okay with that. How do I wean him off his pacifier during day and at night? Do i completely get rid of it all at once? Do I deal with CIO at night? And try soothing during day? I am ready to do CIO but I want as much info as possible before starting. My biggest concern is that his reflux may act up due to all the crying, so how do I balance everything?! I really appreciate your help and can’t wait to hear back from you so we can start sleeping better at night! 🙂 🙂

      Reply

    • Stacey,
      Well it’s been months since you wrote and I, sadly, never saw your comment. But the answer is the post I linked to below.

      Here’s the thing with reflux. You NEVER know if you have it under control. Even the really invasive tests are sort of sketchy because Ph levels vacillate during the day so all you do is “manage” things with drugs and/or lifestyle adjustments and hope for the best.

      Is he waking up frequently due to reflux? Is it habit or normal newborn baby stuff?

      NOBODY KNOWS!!!

      That’s what makes reflux so crappy. Or one of the things anyway.

      Lots of babies are glued to pacifiers. However reflux babies tend to be even more so because it’s uber-soothing AND stimulates saliva production, which is a natural ant-acid. So he could be, effective, self-medicating with the paci.

      Or he could be just fine and just really really loves the paci.

      I know this advice is far to late to help you out any. But I’ll answer it anyway in case somebody else is reading this and is struggling with the same stuff….

      Reply

  12. My son had signs of acid reflux relatively quickly in his little life. He would lie in his bassinet a few hours after feedings and arch his back and gag. I had no clue what that meant and why he would only do it in the early morning as opposed to during the day or earlier in the night. It makes sense now because later in the night, as soon as he was asleep after eating, I would immediately put him down so I could sleep whereas during the day, I would have him upright more post feeding. After a visit to his doctor, we decided to try zantac and also adding the rice starch formula (made by similac) to his night bottles. I made a 50% mix with regular formula. I also always kept him upright post feedings for at least 20 minutes,even when I just wanted to go back to sleep. Now, he is four months old and just this week we are trying a week without the zantac and then if that works, we will be weaning him off of the rice starch as well. We also just last week introduced solids once a day in the form of oat cereal.

    Reply

    • Hey Michelle,
      Just a tip – the thickened formula has been shown in studies to have no impact. Doesn’t hurt, but doesn’t help either. Good luck with your Zantac trial. You may not know for weeks if he’s really OK without it. So if things start to go south on you ~2-3 weeks from now, it’s probably the reflux.

      Solid food probably won’t help much either. At this age hardly any gets into their tummies and solid baby food isn’t really solid (from a gravitational perspective). Sadly food doesn’t really fix things. Sitting up, crawling, etc. do because it puts baby in a physical position to minimize reflux.

      Still it sounds like his case is REALLY mild so hopefully he’s already outgrown it, you’ll go off the Zantac, he’ll be just fine!

      Reply

  13. My 18 week old was diagnosed with reflux shortly before his one month appointment. He unfortunately had the classic symptoms of reflux discomfort, arching his back/neck, pained cries while sleeping, coughing, chocking, inconsolable sobbing, and lots and lots of spit up, both right after feedings and even hours later. After trying Zantac (worked for a few weeks but then stopped), Prevacid (never worked for us), a combination of the two, and finally Omeprazole, our pediatrician (who has been very supportive) referred us to a Pediatric Gastroenterologist. We’ve completed the Upper GI Series with barium swallow and luckily had no physical abnormalities in his upper track. I’m now on a dairy free diet and the Omeprazole dose was increased. You name the tip & we’ve likely tried it–holding him upright for 30 minutes, propping his bed up, sleeping in a swing/chair/etc, smaller meals, lots of burping….on and on…Unfortunately we’re STILL having reflux issues.

    The point of my comment (outside just general venting 🙂 is to ask for your advice on other soothing techniques for a reflux baby & your thoughts on CIO with reflux. My husband and I have to bounce/walk the baby to get him to fall asleep–this can be a 5 minute to 50 minute exercise! If we put him down before he is asleep, he will fuss and fuss and I’m afraid of him either aggravating the reflux or aspirating (as he do cough/gag when he cries too much). We subscribe to your theory on the importance of lots of sleep for babies and so it can sometimes feel like that’s what the bulk of our day(s) is. I’m exhausted not just from lack of sleep but from the exertion of bouncing a refluxing/upset 14lb baby throughout the day. Do you have any other suggestions?

    Reply

    • Meghan,
      Sorry it’s been such a slog 🙁

      Soothing a refluxing baby IS exhausting. I know, I’ve been there. When my first was 5 months old French grandma came for a few weeks and largely shouldered the fussy baby soothing, bouncing, holding. For this she has a HUGE GOLD star in my book and can do no wrong.

      Because I was frankly at the end of my rope. It’s an exhausting eternal grind. So really, I do get it.

      At his age I would work with a swing, loud white noise and possibly a swaddle. 14 lbs is way under the 25/30 lb weight limit. It’ll take some work but this is your best bet to get out of the 50 minute bouncing. Plus you already KNOW he likes motion. I would have him sleep there ALL the time. And I would (due to his age) start to work on it ASAP. Once you’ve got that consistently working for you, then you could start trying to put him down awake in there.

      The problem with CIO is that yes refluxing kids tend to have a rougher go. I’m not worried that he’ll aspirate (babies are really good at not getting stomach contents into the lungs, but they can cough/sputter in an alarming way). But at his age and with his reflux severity, the crib (even propped) is likely to be a bad position for him to sleep. It’s just TOO reclined.

      So my fear is that crib+CIO=bad time for you guys. Which is why I would REALLY work the swing angle as much as possible.

      Good luck 🙁

      Reply

      • The woman above described my life exactly however my baby is 6 weeks old. I have tried the swing several times but she just hates it and screams and screams. I fear I will be bouncing her as it is the only way for many more months to come! Please help!

        Reply

      • The described above is exactly like my daughter!!! She is almost 5 months and has always loved to move. She has hated car rides since the day she was born and still does unless she doses off. I have come to the realization that she has a reflux problem and we are still battling, since she was 2 months old, with figuring out what works best. We believe she has a milk allergy and switched her to soy with she could keep down ok but then have had a battle ever since. She has been on Similac Advance, Similac Soy and Gerber Soy, to Similac Sensitive, back to Similac Soy. on Similac Total Comfort and not is on Similac Alimentum and is still spitting and showing reflux symptomes….my other problem is she always has bowel movements and is not now since we went to the alimentum!!!! I am suppose to call the pediatricians office tomorrow and we may be trying meds since nothing else has seemed to work. Her daytime is exactly like evryone described (she takes short naps but startles easy but sleeps at night almost all night except waking for one feeding), her binky is her best friend otherwise she constantly has her fists all the way in her mouth drooling everywhere!!! Our life saver so far has been constantly having her binky available and in her mouth when she is fussy and we swaddle her constantly when sleeping! She also is always at an upright angle. We are still looking for the right formula and cure for her to not be spitting all the time at every feeding tho 🙁

        Reply

    • Just my 2 cents, my Pedi had my daughter on Axid Oral… was like a miracle! She also was not a back sleeper.
      We did a lot of bouncing, too. It will get better!!! Keep these words of wisdom in mind (given to me) “The days are long but the years are short”
      Blessings!!

      Reply

  14. Check out babywispering methods before letting him/her CIO as it is a much calmer respectable method. It is easier than listening to your child cry for longs periods. I hope I’m not too late in replying. Just Google baby whispering There are loads of information about putting baby to sleep.

    Reply

  15. Hi Alexis, I have recently found your blog and am happy to read your sound advice, which is a welcome voice. Most of your advice reflects my own beliefs, in a nice concise format. We have a 20 mo. boy who still doesn’t sleep through, which is why I still read Internet “mommy blogs” when I should have quit this a while back. I have a million excuses why this all happened, starting with my traumatic birth experience, then some PPD + SIDS paranoia, my son’s insane GERD that started at <1 month, his "reverse cycling" nursing and lack of interest in cow milk (or other breast milk substitutes) and the true fact that he is an intrinsically bad sleeper. He just is. But he is sooo awesome otherwise, so we must be doing something right. He does sleep in his own crib, has a solid bedtime routine, and naps predictably. He gets the light sleep from me… same with the GERD. You are 100% right with the GERD interventions, no dairy at all was a huge help, and we did Prevacid till 5.5 months when he could sit unassisted. It's totally gone now. But it was one of the hardest things I have ever been through. The "still not sleeping through the night" is embarrassing. The truth is I still nurse him. We've tried Ferber, 4 times, with no success. Well, it works briefly, but when he relapsed, almost immediately, we gave in. I think the Weissbluth complete extinction is the only way to go at this point, but my soul is still working up the confidence to take the plunge again. Several failures make us reluctant to do any CiO. We did just take away pacifiers, with success! and the night nursing is next. I have no specific questions, just gratitude to read someone's advice that is not AP and causing me guilt. PS: I work FT, as a pediatrician, which is why my non-sleeping baby is embarrassing… And why I let this go on so long (my middle of the night cuddles have been part of my "being a mom" experience, helps with my missing him during the day). But it's realllly time to stop.

    Reply

    • Hey Kathleen,
      In a weird way I think it’s sort of AWESOME that you’ve had this experience.

      Everybody lies to their pediatrician.

      Dr: “How is your kid sleeping?”
      Mom: “Oh just great!”

      We don’t want to be judged. We don’t want you to look disapprovingly at us. Because obviously, as a pediatrician, you must be a perfect parent whose children are as beautiful as they are smart and kind. And nobody wants to fess up to not being able to handle something as simple as getting their kid to sleep.

      So now when people come in freaking out that they can’t get their baby to stop crying, or their 3 YO only sleeps while attached to their boob, or how guilty they feel about the whole thing, YOU’LL know exactly where they are coming from.

      And maybe that’s a pretty awesome thing?

      You know what ELSE is awesome? Sleep. I know you miss him during the day but honest, you’ll feel so much better when you’re sleeping. I know you think you’ll miss the night cuddles. But I can guarantee that a month from now you’ll be wondering why you didn’t make a change sooner 😉

      Reply

  16. I have 2 sets of twins(my oldest are 3,my youngest are 10 months) and 1 of my older boys had severe gerd when he was a baby combined with laryngomalacia.he had it so bad,he developed an aversion to the bottle & refused to eat while awake at all-he was a “sleep feeder”,meaning every 2 to 3 hours for his 1st 15 months(that’s how long it took me to toally transition him to a cup & spoon with the help of an awesome feeding therapist) to feed him so he would not starve.the nonstop screaming and feeding refusal started at 2 weeks old & we endured so many med/formula changes I thought truly i would be living with one hour of sleep per 24 hours forever.plus I had another baby(who thank god was reflux free) to take care of.the best advice I got was from his feeding therapist who told me right off the bat that he would never take a bottle “normally”,so forget about that,keep feeding him overnight,and get him on a cup &spoon.the nap nanny saved my life along with the ar wedge..hes now 3 and perfectly healthy! Eats like a horse & you’d never know he had any issues! Fast forward to my 2nd set of twins–my daughter ended up being diagnosed with gerd to the point where she had blisters in her throat,got her on prevacid,bought a new nap nanny for her,and I can say she’s doing a lot better now.her twin also has reflux though not as bad..also on a nap nanny & prevacid…gerd sucks big time.

    Reply

    • FOUR TWINS? Sorry I’m still getting sympathy anxiety about the whole concept of double twins. WOO HOO!

      Oh yeah, and they have severe GERD? Man oh man. We all send you our sympathy for that.

      I’ve never used a nap nanny but they get rave reviews. Do you think it is better/different than using a recumbent swing? I ask only because I generally lean towards the swing due to the angle PLUS motion. But given that my own kids had reflux (not near to the degree you’re talking about) and we stuck with the swing.

      Nap nanny thoughts?

      Reply

  17. Can reflux be a cause of nasal congestion? My 8 wk old daughter has been congested for over a month, which affects her sleep when she snorts, snores or wheezes. Nothing is coming out of her nose, but we hear it rattling. We’ve been to the doc 3 times. She has no fever. He thinks that when she spits up she aspirated.

    Reply

    • Sure can. In fact it may not even be schniffles – it may be vomit that is going up into her nasal passages. Not that it makes a difference (it’s all just fluid that makes her snort and wheeze). But it could be the case where instead of projectile vomiting it’s shooting up her throat into her nose.

      OR she could be a really crappy long cold. Tons of babies have constant colds too.

      Reply

  18. Thanks so much for this website! It’s been extremely helpful to me. I’m wondering if you have any survival tips for me. I have two children, a 3-yr old and a 7-week old. Long story short, the 3-yr old had reflux and has food sensitivities so I knew what reflux was when my newborn started to show signs. She is currently on Prevacid, I have removed dairy from my diet (I’m breast feeding) and we will see a naturopath next week who may want me to eliminate more food. She continues to be a typical reflux baby…fussy, needs lots of bouncing, etc. My question for you is how to handle the 5:00-7:00 fussy time with both kids. My husband often works late so I am on my own several times a week. The baby cries a lot and I feel like I’m not able to give the 3yr old any attention. He does ok with this but is starting to get upset about her crying. I do swaddle her, try the swing, pacifier, and carry her in the Ergo. Most of these things work but only for brief periods of time. She typically gets so upset that she ends up over eating and then projectile vomits all over both of us. She doesnt seem to want to nap during this time at all unless i can bring her to a dark, quiet room- which is impossible with my son. Any advice? Thanks in advance!

    Reply

    • Maris,
      This is my honest to god advice for getting through the next few months.

      TV and presents.

      There it is. Embrace for now, that the TV is your friend. Get small special toys (check craigslist!) and whip one out every few days. Explain that baby needs extra help right now, just like he did when he was little. Be matter of fact about it – no guilt. Then explain that for now, because you are so busy with the baby, he can watch extra TV time. Or make one of the presents FROM the baby, “Baby appreciates all your help with her sore tummy. I think she would want you to have this.”

      I know bribes is not the answer you were looking for. But it is what it is. Seriously. For now. This is the answer.

      Reply

      • Thank you!! TV has become our best friend and I was feeling so guilty about it. Thanks for making me feel less guilty. 🙂

        Reply

  19. Alexis,
    I’ve written you in the past about my never-sleeping baby and I thought I’d post on this page because, well, the diagnosis came back and he has terrible reflux. Went to a GI doc and they confirmed that he is one very uncomfortable little guy. While he’s thriving and gaining weight relatively well, he still has terrible reflux. Since birth we figured we had a “high-needs” baby and have accommodated accordingly. Using all the reflux techniques to limit his discomfort. He’s now six months old, on medicine (prevacid: not happy about it but as in most cases, we just don’t want him to be in pain anymore). He’s never slept well due to the reflux but with that I think we’ve gotten into some not so ideal sleep associations (for me, not him, he loves them). We tried the swing for a while, had one great week of sleep (slept a full three hours in a row!) but have had no luck since. The only thing that he finds relief in are my sweater puppies. We co-sleep, which we started at 4.5 months because I thought at least then I would get longer than a 45 minute stretch. It worked for a week once we introduced the paci. Now, he won’t take the paci at night, the boob is literally in his mouth from 11 pm (when I come to bed) till 7 am. If it pops out for once second, BAM! awake and screaming bloody murder. My questions:
    A) obviously I have the sucking/feeding=sleep association. The doctor told me refluxing babies find nursing to be the most soothing to their poor little throats/stomachs. Will he die if I break that habit by slowly pulling away over time? Or cold turkey?
    B) The co-sleeping isn’t working anymore. I am going to put him in a sidecar sleeper to start and make a rule to only feed him every 3 hours. My major MAJOR dilemma is: dad should soothe right? when dad does attempt soothing, he screams and screams and then wakes up fully. He’s at least calm but then he’s awake? Is that the end of the world? Most of the time I give in once he’s fully awake because I get panicked thinking he’ll revert back to days and nights mixed up. Ultimately do I have to surrender to the idea that baby and daddy may have a few sleepless nights?
    C) Not really into CIO, especially since any prolonged crying has led to a serious vomit attack. Plus I read AskMoxies page on babies that release tension while crying versus babies that get even more worked up once they start crying. This baby gets more upset. Like the world is ending upset.

    Reflux babies are hard. It’s hard when you know there’s a possibility he could be in pain but you’re thinking “no baby, I’m not a buffet.”

    Reply

    • Eliza,
      For what it’s worth you can TOTALLY go back on gluten. Gluten isn’t passed into breastmilk so your gluten won’t go into his tummy. Probably best to stay off soy and dairy though. At least you can now enjoy some vegan diary-free cookies?!?! Yum?

      Here’s the deal – soothing is enormously soothing. BUT it’s also a vicious cycle because he’s nursing to self-soothe, but that means he’s also constantly eating and food=tummy upset. So my best advice which you’re going to find INCREDIBLY FRUSTRATING is not only that you need to separate the boob=sleep thing but that you’re ULTIMATE goal is to gently night wean as soon as you feasibly can.

      Basically you want to separate food from sleep as much as is possible because the less time he spends on his back with a fully tummy the better.

      With my second refluxer we really pushed night weaning at 6 months for this reason. No crying involved but we were WAY more focused than I would have been at 6 months.

      For reflux babies food=tummy discomfort. Only nursing=soothing. So you get into this more nursing = more discomfort = more need for soothing = more demands to nursing. Make sense?

      Also crying aggravates reflux kids so CIO is not ideal if you can avoid it.

      I would start with:
      1) Is he on the right dose of prevacid. Also are you giving it to him on an empty stomach about 30 minutes prior to eating? Both of these are tough to suss out but if he’s still really uncomfortable everything else is going to be a slog.
      2) I would go back to the swing over a co-sleeper because generally reflux kids do better sleeping upright. But go with your gut. The swing may not solve all the problems but if the elevation helps his tummy (may take as long as 7-10 days to notice improvement) it may be a better option than the co-sleeper.
      3) Give him whatever soothing you can. Swaddle and white noise are both highly recommended! Reflux kids are often swaddled FAR longer than their happy tummy peers.
      4) If you can sleep somewhere else for a while it may help Daddy be more effective. If baby can see you he may accept no substitutes.
      5) TRY TRY TRY to put him to bed without nursing. Your night efforts all START at bedtime so you’ll have WAY more luck getting your boob out of his mouth if he STARTS by not having your boob in his mouth. You may find some helpful tips here? (see link below)

      Reply

  20. My little man, now 7 months old, still has issues spitting up, no matter what I do. He was diagnosed with reflux and a milk/soy allergy when he was about 1 month old. He has been on Prevacid and Zantac, of which the Prevacid has worked the best. He is also on Alimentum and does pretty well on that. He is always in a swing or bouncer after eating for a minimum of 30 minutes (sometimes longer). What is really frustrating to me is that even after a nap in the swing or bouncer for 2 hours, he still spits up when I lay him on the floor for play time. I just don’t know what I can do to help him with the spit up any more. Any suggestions would be appreciated. Thanks for this website. It helps to know I’m not alone.

    Reply

    • You can’t fix the spitup. You can only help him feel comfortable. That’s it. The spitup will stop when he grows enough so that the valve at the top of his tummy closes. That’s pretty much it.

      So he spits up! If he spits up and SCREAMS about it, you have work to do. If he spits up and continues playing then you’re work is done.

      Hope that helps.

      Reply

  21. At 1.5 months old my son started having reflux. He would eat and would spit up for hours after. He would relax for a minute or 2 when he was feed again or given gripe water. I told tell it was cooling his throat, but it would only last for a few minutes.
    We were mix feeding him, mostly formula (Gentlease), breast feeding when my wife could (medical issues prevented full breastfeeding.)
    We tried the most expensive formula, Alimentum, and, thankfully for my wallet, it didn’t help at all. So we moved to a soy-based formula, no change.
    Finally the doctor told use to start adding rice to the bottles and it worked the first time. We tried weening him off the rice, because it makes his poops very solid and hard for him to pass. Once we did the reflux returned.
    Now we are now using the AR formula and he has never been happier. He still spits up, but now it is just after eating and he doesn’t wail for hours afterwards.
    Talk to your doctor, ask about the rice, and don’t let people make you feel bad about it (not talking about this site, but there are others that will call you the devil for thinking about rice.) If your child starts having hard poops, trying using less rice, you will find a balance that will stop the reflux, but will give him easier poos.
    I will note that results are not typical, each child is different. I didn’t want to use meds if I could avoid it.
    Good Luck.

    Reply

  22. Hi there, I’m desperate for some help.
    My 7 month old daughter is an appalling sleeper (2 x 20min naps during the day & up every 20-60 mins all night).
    I am absolutely ready to start CIO
    BUT
    she has severe reflux & crying exacerbates the reflux symptoms. If I let her cry, she tries to settle but then she refluxes, swallows & starts screaming all over again.
    She is on protein pump inhibitor medication for reflux (a dose more than twice the usual dose for a child of her weight).
    What I am hoping for is advice about what to do – I’m wondering whether I need to give up on sleep & just get up all night to feed her back to sleep? Or whether there are some techniques I could try that wont make reflux worse but will contribute to better sleep.
    My family has coped well till now but I think we’re on the verge of unravelling a bit.
    Please help.
    Thanks in advance
    Liz

    Reply

  24. Judy curious..everyone’s md appears to put their LO on Prevacid or Zantac..my md put my 7 wk old on axid… 1 ml 2 x a day. We do ebf and I overproduce and have strong let down..I have been working on these and have resolved the explosive green poops 75 percent of time. DD sleeps on me in bed or in boppy in our bed…we are very sleep deprived..she sleeps with me because she can’t lay flat without gagging and choking..even in boppy she will have episodes and I wake up and lean her fwd and clear her mouth.. She spits up some but not bad. My main complaint is the wrenching gagging and gurgling raspy breathing she has all the time.. She is gaining weight well and does not seem distressed during nursing. My md does not seem concerned and tells me to let her cry it out in crib..I totally disagree! Any suggestions?

    Reply

    • I definately would not do cry it out until at least 5 months old. They have NO tools to self soothe. And I didn’t let my GERD baby cry it out until I was 100% sure she was not hurting.

      People will give you their opinions, as am I, so catch the ones that trigger what your mama intuition is saying, and disregard the others.

      At the end of the day, the people giving opinions aren’t the ones listening to a screaming kid all day. YOU are. So do what keeps you sane, and going. And ditch the rest!

      I feel for you, and understand. My baby is now 18 months old. Was on Zantac until 9 months old. She slept in a nap nanny until she was 10 months old. I think it was the only thing that kept her feeling well enough to sleep. They are a God Sent for reflux babies. I know they’ve been taken off the market now, but there’s another mattress that I wish I had known about prior because it is a great idea.

      Here’s the link : http://comfyliftbed.com/

      Reply

  25. Cut out anything at all acidic, soy, dairy, chocolate, caffeine.
    When my daughter had terrible reflux, even the axid did little to relieve the constant crying. I could not put her down, or even give her to others to hold. She cried in the swing, the car, and any baby seat or stroller.
    We lived in our baby bjorn.
    She was up every hour in the night, and couldn’t nap more than a few minutes at a time.
    We lived in a pool of spit up, which we began to view as normal, though friends and visitors would react with surprise at the volume.
    She would wake to nurse at night and could not return to sleep until she had finished spitting up, maybe two hours later.

    Finally, at my wit’s end (around 5months), I begged my pediatrician to change her medication completely or send us to a specialist. The GI doctor increased her dosage and told me to avoid the foods listed at the top of this comment.

    This basically restricted all fruits and salad vegetables except lettuce, apples, and bananas. Occasionally I’d get brave and eat a piece of melon or a strawberry, and regret it the next day when she could not be put down. No lemon juice or vinegar ingredients, tomatoes, pickles, fruits . . . We called it the “bland diet”!

    But it also went a long way in relieving her discomfort. She didn’t turn into an angel baby, and I still had to manage all the cooking, cleaning, and laundry for her five siblings in three half hour naps a day, but at least she calmed down a bit!

    We eventually reintroduced milk successfully, though reintroduction of soy was a reintroduction of spit up, which had stopped by then.

    Now she is 3 1/2 and can eat everything (except for eggs, which she is allergic to), and is the sweetest little thing!

    Reply

  26. Hi,
    What a great resource! Thank you!
    My son has reflux, we think, he is 14 weeks and we saw a huge improvement once I cut dairy, soy and eggs out of my diet. He is on liquid zantac to help as well but since starting it his naps have gone from 1.5hr to 30 min. and now wakes 4-5 times a night only going 2-3 hrs max. between feeds, usually its only an hour. Previously it had been 2 wake ups and 6 hr stretch until the first wake up. I am wondering if the zantac is the cause of the shorter naps and more night time wake ups? I changed my diet a few days before we started the medication so I am not sure if the medication is doing anything. I’ve tried adding dairy/soy/eggs back into my diet and he was a mess, so I know that is helping. I’m wondering how to tell if he needs the zantac? Should i just give it a try without it and see how he does?

    Reply

  27. While I agree for the most part with this I’m not a fan of giving my son prescriptions when there are alternatives that worked. Hyland’s coil tablets saved my life. My son started to have reflux very badly at about 2 months. He was a month early. I nursed untill 7 months. I was on a very strict diet. No soy, dairy gassy greens( brocoli, cabbage, spinach) unless cooked. So basically chicken, rice potatoes, squash and water. With the help of my doctor and naturopath I was taking supplements to make sure my health did not waver as well. I don’t agree with the car seat note. My son practically lied in his car seat. I had a britax b-safe model seat. I was very impressed by the shape and size of it. The oy way I get him to sleep at some points was to put him in his car seat and rock him. Unfortunately I wasn’t able to keep my milk supply up and he was switched to allimentum. Since then he has not had one issue with reflux. I would highly recommend allimentum. He tried nutramogen at first and reacted horribly to it. He is almost 1 year old and still not eating puréed solids but it is a work in progress. The other saving grace was the carrier. I have a standard wrap and an ergobaby. He loves the ergo and still does. Every child is so different. It’s great to hear other mamas stories what works for one isn’t assured to work for another.

    Reply

    • Ashley, I was just wondering what what of reaction your son had to Nutramigen? We started off on Similac products from the hospital, but after I got her home ***TMI Alert*** she had explosive bowels, like and fountain. My mother can up from FL, and as we looked at each other in horror she said that after having 3 children she had never seen anything remotely that bad. That’s when we switched to Enfamil products. We would have a short period of relief from her silent gerd (unknown, undx’ed at the time). Her ped told us we had to start Nutramigen. After 3 months she could not swallow and was given zantac which I’m not sure whether it helped… Dr after dr, even a gi blew me off bc she was gaining fine so I got the ever famous she’ll grow out it(since she’s a silent refluxer and I was told to put a ridiculous amount of rice cereal in her bottles so of course she was gaining weight). I could see the desperation in her eyes as I watched her struggle to fight pain every day. She lived in a rock’n’play until she grew out of it. After being blown off dr after dr, one morning she was extremely hard to wake up. She deliberately avoided eye contact, stared off into the distance as if she was looking through you, and made bizarre animatronic jerking like motions that were worse when someone approached her. I had enough and went to the er. I had a great peds dr that admitted and transferred her to a childrens hospital. They thought she had infantile spasms. After eeg’s, they told me that her reflux caused her so much pain that she had no way to deal with her pain, but try to block out all stimuli. She had Sandifers Syndrom and was placed on previcid. Now she doing remarkably better at 10 months, but not 100%. Our biggest problem now is terrible gas, bloating, distention, constipation, and really runny stools. My poor daughter has never had a pain free day in her life. So, I’m wondering if maybe the Nutramigen may be contributing. So, I was wondering what happened that made you realize that he was reacting horribly to the Nutramigen? She’s been through so much and am afraid to switch 🙁 I’m glad he’s doing much better, and I’m look at ergo’s now!!!

      Reply

  28. Silas is 5.5 months and he was diagnosed with reflux about two days ago. His symptoms came out of the blue. He does have a mild case of Torticollis (http://www.torticolliskids.org/faq's.htm) as well. We have switched his formula to Enfamil AR from a milk based (no breast milk). We give him gripe water, sleep him on his stomach 100% of the time, keep the mattress on a 30 degree incline (head high, feet low), give him prune juice to offset constipation issues with Enfamil AR and started him on Zantac.

    My questions for others are…
    1) Has anyone found Zantac to be the solution or a big help? It seems as if I’m not finding a lot of instances where Zantac helps.

    2) Has anyone tried a Hazelwood necklaces? I don’t believe in hokey voodoo, but word on the street is Hazelwood absorbs extra acid from the body.

    3) Silas arches his back about every 20 minutes and we are spending so much time carrying him upright where he’s most comfortable. Does anyone have any solutions for a way to keep the baby comfortable with reflux? We’ve tried a swing and a jumper and those were a bust.

    4) Alexis, do you have any suggestions based on your experience? Have you had any dealing with a chiropractor?

    Great blog Alexis, thanks for your hard work!

    Reply

    • Hey Byan,
      Sorry to hear about the reflux. Good thing to try the AR formula. Here’s my thoughts in no particular order.
      – Gripe water doesn’t help. It doesn’t hurt but multiple blind studies have shown that it doesn’t do anything. None of the “gas drops” or what have you do anything.

      – I’m not down with tummy sleeping but if you and your doctor have agreed on that plan then cool.

      – Zantac is the “weaker” drug. It’s essentially an antacid. It’s also the ONLY prescription approved for pediatric use. It’s been around for ages and hasn’t been linked to any negative side effect so it’s the first thing that your doctor is going to reach for if you suspect reflux.

      The “stronger” drugs are PPIs which essentially tell the body to stop making acid. Prevacid is the most commonly used. These are not officially approved for pediatric use although lots of babies take them.

      I think starting with Zantac makes the most sense. Yes it’s weakwe and ALL of these medications take a few days to build up in the system. So you need to wait 5-7 days. Also if he’s got a bunch of inflammation built up he’ll still have discomfort for a while even after the acid is cut down (does that make sense?).

      Because none of these drugs keep his tummy contents from getting pushed up into his esophagus. They just make it less acidic.

      Also you’re doing 2 things at once – cutting out milk protein AND putting him on meds, yes? So if he starts to get better, how will you know which one is having the impact? Just a thought. Moving on…

      – Yes you need to keep him upright all the time. Also try to space feedings out if you can so that there is at least 30 minutes between him eating and him doing anything else (car ride, bath, floor time, bouncer time, etc.) because yes – you will need to hold him upright after feedings all day long.

      Some babies dig the Ergo. It holds them upright but your hands are free. Personally I DON’T recommend the bumbo – puts too much pressure on the tummy.

      PS. The “hold upright for 30 minutes” thing is why I night weaned both of my kids pretty aggressively. Night feedings are easily a 1 hour mess so best to try to get out of them as soon as possible 😛

      – Hazelwood necklaces are stupid. Please don’t buy these. Acid doesn’t come from “the body” – it comes from various glands near the stomach.

      – Also I would steer clear from chiropractors. Look I know that in every crowd there is somebody who had some lifelong illness cured by a chiropractor. And I have no issues with adults going. But please don’t take your newborn to one. Babies are not adults. There are too many chiropractors pitching “birth trauma” and “spinal damage” about babies with no scientific basis to back it up. I see many risks to going down this path and no reward.

      I don’t meant to sound anti-alternative medicine. I’ll admit I’m not TOTALLY into alternative stuff, but when it comes to babies yes I’m extra conservative. 2% of babies have reflux. That makes it HUGELY common. While concrete diagnosis can be impossible, we know how to manage it. I’m sure you’re eager to make things get a lot better a lot faster.

      But don’t let that enthusiasm for improvement lead you to snake oil salesmen,yes?

      My youngest was also diagnosed at 5 months so I totally get where you’re coming from and how hard things have been for you. Try the milk protein free + Zantac for 2 weeks. If you feel it’s not getting you anywhere throw in a Prevacid trial.

      You’re in the home stretch.
      *Fist of Sleepless Solidarity*

      Reply

      • We have a son that will be a year this week and have had multiple tests done and been given the Dx of atypical reflux by a pediatric GI, in that he doesn’t get fussy or upset unless his stomach is empty not after he has eaten. He doesn’t have milk allergies as we have trialed all of that to no avail. His biggest problem is he will awake screaming in obvious pain and arch for hours and not really be awake. It has become clearer in the last month when he is awake or not. He takes previcid and zantac with helpful effects however still can no sleep for more then 3 hours at a time. He is exhausted visibly but happy. He doesn’t fuss or cry except when he awakes in these states of pain. Dr’s seem to be at a loss on how to help him and my husband and I are at a loss with over a year of no sleep. Any thoughts?

        Reply

  29. Wow, thanks for the quick reply. So you’re a big fan of Hazlewood huh 🙂

    Thanks for the explanation on the Zantec. I was unaware of some of the specifics. I agree on the Chiropractor, but do keep hearing how it worked for a few others. But these are Chiropractors who specialize in infants only. Think that’s more of a last resort.

    Yes we are all over keeping him upright. We’ve probably got him upright about 90% of the time he is awake!!! Plus we do 30 minutes after every feeding (day or night). It is driving us mad, but he seems happy. Uggh the trade off!

    We decided to try two things at once (milk protein AND putting him on meds) to get to the root of the problem faster. Based on our research neither Zantac or Enfamil AR were even close to a silver bullet. No one really seems to have a solution, so why not try the combo. It feels like if we tried each potential solution one by one he would be 7 by the time we got to the root of the problem.

    Unfortunately we are totally down with tummy sleeping. Our specialist explained that it can help keep the LES closed. Maybe that is hearsay like the Hazlewood 😉 To cover his ass, he technically recommended back sleeping because legally I don’t think they can recommend tummy sleeping anymore. That’s ludicrous! Also, Silas has a slight case of Plagiocephaly due to back sleeping (SIDS protection). Tummy sleeping has corrected that quite nicely. All children are different and to rule out tummy, back or side sleeping seems like a mistake. Personally I think SIDS is a bit overrated.

    Thanks again for ideas and fabulous input. You’re awesome!

    Reply

  30. Wow, thanks for the quick reply. So you’re a big fan of Hazlewood huh 🙂

    Thanks for the explanation on the Zantec. I was unaware of some of the specifics. I agree on the Chiropractor, but do keep hearing how it worked for a few others. But these are Chiropractors who specialize in infants only. Think that’s more of a last resort.

    Yes we are all over keeping him upright. We’ve probably got him upright about 90% of the time he is awake!!! Plus we do 30 minutes after every feeding (day or night). It is driving us mad, but he seems happy. Uggh the trade off!

    We decided to try two things at once (milk protein AND putting him on meds) to get to the root of the problem faster. Based on our research neither Zantac or Enfamil AR were even close to a silver bullet. No one really seems to have a solution, so why not try the combo. It feels like if we tried each potential solution one by one he would be 7 by the time we got to the root of the problem.

    Unfortunately we are totally down with tummy sleeping. Our specialist explained that it can help keep the LES closed. Maybe that is hearsay like the Hazlewood 😉 To cover his ass, he technically recommended back sleeping because legally I don’t think they can recommend tummy sleeping anymore. That’s ludicrous! Also, Silas has a slight case of Plagiocephaly due to back sleeping (SIDS protection). Tummy sleeping has corrected that quite nicely. All children are different and to rule out tummy, back or side sleeping seems like a mistake. Personally I think SIDS is a bit overrated.

    Thanks again for ideas and fabulous input. You’re awesome!

    Reply

  31. I was just wondering if anyone out there could recommend the best way to keep their little one upright for 30 minutes after feeds? I know this may seem like a silly question but our little guy (4 weeks, not diagnosised with reflux at this point but his older brother had it) gets fussy when I keep him upright on my chest/shoulder so then I try just sitting him upright in my lap, to which he gets fussy again. I just keep alternating between both positions for 30 minutes and then finally set him down in his swing for a whooping 45 minute sleep (sorry for the sarcasm… Just a little sleep deprived like you all 😉

    Reply

  32. Hi there,

    I am sorry to take up more space an this board but after all my researching it is this web page that I have found both easiest to read and most informative therefore if there is any chance someone here may be able to help me out, I would be so grateful.

    Our second son (Keaton) is now 9 weeks old. At 4 weeks he was diagnosised with reflux based on him ‘choking’ at night, his voice had suddenly gone hoarse (though he had also been doing a lot of crying at the time) and family history of reflux (both parents have hiatal hernias – are those tied to reflux? and my brother has acid reflux). My oldest son was also treated for reflux. I guess I sometimes feel a bit skeptical about the ‘reflux’ as I more worry that I just have high expectations for what an infant should be like or even worse… That I somehow cause this due to an inability as a mom, which sucks as I do love being a mom 🙁

    Anyways, our ped put him right on Prilosec at 4 weeks and we noticed a night and day difference. The crying stopped, he seemed to be happy to be awake and he slept not too bad. However we seem to have gone downhill again and even worse – Keaton doesn’t ever seem happy or comfortable. We now have to bounce him to sleep (after swaddling and giving a soother) and then put him in either the swing or Rock n Play, which he will then only sleep for 25 minutes at best. And now at night he can’t even stay asleep. In the wee hours he wakes up grunting and shooting his legs out and sometimes even lets out a pained cry.

    We had his dosage upped to 1.5mL twice a day as he was up to 11 pounds last week but things are just continuing to get worse. We are now sleeping at nights with him, as that is the only way we are all getting sleep.

    My question (after that therapeutic rant) is should I ask about switching to Prevacid? Should I ask about seeing a GI Specialist? And finally, does anyone have some additional advice or things I could do differently for him?

    Thanks to anyone who may be able to help me. We are seeing his ped on Monday for his 2 month well-baby so I would like to go in informed and prepared for any suggestions she might make.

    Once again – thanks for your time.

    Reply

  33. Hi Alexis-
    My daughter 12 weeks was diagnosed with silent reflux today but I’m not convinced that is what is going on. Would love your input. The dr mentioned that reflux can peak around 3 months and although my daughter has been fussy in the past at times and hated her car seat and laying flat on her back during playtime it want too bad. We found ways to work around it. Her spitting up was causing her trouble and she seemed in pain so I stopped feeding her with a nursing pillow and started feeding her more upright which really helped and cut down on the spitting drastically. In the last week she has stopped napping during the day and wakes after completing her first sleep cycle and is unable to soothe herself back to sleep. This has never been a problem for her in the past and she was a good sleeper prior to 8 days ago. Now she wakes up after 30 min like clockwork whether on her back, in the swing, or in her bouncer chair. She will only sleep for longer when being held. She has also started waking more frequently at night. Was waking once now 2-3 times.
    The dr prescribed Zantac because of her symptoms of fussiness and screaming while eating and arching her back during feeds (not every time.)
    Does this seem like enough symptoms to fit the silent reflux diagnosis?
    She has been fussy and inconsolable for the last week and it seems like she’s regressing in her sleeping habits?
    She does seem to do better in her side, is this safe for naps? Do you think the waking after one sleep cycle could be related to pain from reflux?

    Reply

  34. Dear Alexis,

    My Baby had colic till 4.5 months and has never slept without violently protesting sleep till now. She is now 11months old and teething and has suddenly developed reflux. She started spitting up a month ago and now although there is no spit up, she has silent reflux (only at night). We spend hours putting her down for naps during the day as she fights sleep and then naps for 30 minutes ONLY every single time. At night bedtime takes 1 hour plus and she is awake almost 3-4 times screaming sometimes with reflux sometimes fighting sleep. She is on alternative medication for reflux now. My concern is most babies outgrow reflux by 10 months. Can babies develop reflux at 10 months? She is already on a dairy free gluten free diet to eliminate possible causes.

    Reply

  35. Hello there,

    I’m a breast feeding mother of a 7 weekold.

    Not sure if anyone mentioned this before ? What fixed this for us was emptying ONE breast first.

    How to know that the breast is empty ? Have the baby drop off the breast before switching to the next.
    The result was miraculous.

    We had all the symptoms of reflux but found out that the cause was really oversupply because of frequent switching.

    HTH,
    Cheers,
    Tania

    Reply

  36. My 1 yr 3 month old has silent reflux and has only slept through the night 9-10 times. Otherwise she is up every 2-3 hours crying. It’s been a really difficult sleep deprived year for us!
    Zantac and an Anti-Regurgitation formula have helped which is when she has slept through. It still doesn’t deliver consistent results though.
    After reading this, I’m going to try the chiropractic alignment, and stopping her night feed at 5am.
    Just a big pat on the back for all the reflux parents, I know how stressful and exhausting it can be!

    Reply

  37. Dear Alexis,

    Thanks so much for your website! Based on your advice, we let our baby sleep in the swing for the first time 2 nights ago and it was amazing! Before, he had been sleeping flat on his back in the pack and play. He went from tossing/turning/making distressed noises and waking up crying every .5-1.5 hours (if he slept at all) to sleeping for 3-4 hours straight. Somewhere, I had heard that you weren’t supposed to let babies sleep in swings – in this case, it seems like the benefit of a good night of sleep (for all of us) must outweigh any drawbacks! We have also ordered a Rock n Play.

    I have a question about the dairy elimination diet. How important is it to cut out ALL sources of milk protein? i.e., is it necessary to also cut out things like bread and crackers that just have a small amount? And, if so, do you know of any breads, cereals, etc. that are milk protein free?

    Thanks so much!!

    Reply

  39. Just a note. Found your site searching for babys who are on zantac and sleep all day. My 6week old is sleeping a lot during han I thought possible anyway.
    Anyway, I just wanted to note that in searching your site was listed and it said something abt baby NOT sleeping on zantac. Myself and my husband both experience in INSOMNIA when taking zantac. I took it when I was pregnant with my first child and all of a sudden I wasn’t able to sleep. Literally, I could not sleep even though I wanted to. I read up on side effects of zantac, b/c it made no sense why I wasn’t sleeping and I needed to! So, found out it is a possible side effect and I was lucky enough to experience it! So, it was back to tums for me. Just thought I’d share, incase your wondering is something wrong w/my baby? And now more than ever you need sleep! Talk to their doctor. If the doctor doesn’t acknowledge this as a possible sideeffect tell them you want them off of it and to try a new medicine to see. If, WHEN, They start sleeping again you can call their doctor and tell them you were right and doctors need to listen to their patieents more often! I know my OB didn’t think it was the zantac, but it WAS! Then, come to find out my husband has same problem. Can’t take it due to t causing insomnia.
    Hope this helps someone. Best of luck. Oh, and be careful leaving baby in reclined sleepers and carseats too much. It can cause flattening of the skull and weak development of the neck muscles.

    Reply

  40. Any idea how long this lasts? Does it gradually decrease or all of a sudden it’s gone. My baby is 5 months and seems worse than ever. I also use dr browns and he’s on nutremigen.

    Reply

  41. Great post! I love your site, it’s so helpful. I have a question though: how do you know that reflux babies in particular do better in swings? Are there studies to support that or are you just going from personal experience?

    Reply

    • There’s no specific scientific evidence about swings per se but the medical community is on board with “upright is better” and currently there are no great ways to keep sleeping kiddos upright. Mattress wedges don’t work, babies slide down. During the day holding them upright or babywearing works but not so great at night.

      So science is with me on “upright”, and I’ve come up with “baby swings” as the only viable night time alternative.

      Reply

      • Ah I see. Well that seems to make sense. The only thing that worries me is that the stomach would be a little more compressed in a swing than if they’re lying flat. And perhaps the rocking might be dodging the stomach acid around? I know that sounds exaggerated, but I just mean that perhaps there would be more “activity” going on in the belly due to the constant rocking, especially at higher speeds.

        Reply

        • As always you’re free to make your own choices 🙂 But my overwhelming experience with refluxing kiddos (both my own as well as thousands via this site) is that they do much better in the swing (generally while it’s moving) then they do on their back. So if you’re dealing with your own little refluxer you’re welcome to experiment and come to your own conclusion but upright + motion almost always trumps flat + no motion. Good luck!

          Reply

  42. My 4.5 month old has reflux that is mostly (finally) under control. I exclusively pump so he has breast milk, but is fed out a bottle so he is semi-upright…and we do add rice cereal…which I know doesn’t really help, but I find it thickens his spit up (if that makes sense) so it isn’t completely spewing all over. Plus he was not gaining weight well. He is on Prevacid and sees a Chiropractor (WORKS WONDERS). He still spits up, some days more than others, but the screaming and refusal to eat has gone away completely. My question is this: we are in the middle of the 4 month regression and are getting NO SLEEP. He has never been a good sleeper, but RIGHT before the regression it was OK. We do co-sleep, but not exclusively. It usually happens after many wake-ups and we are all exhausted. We want to start some kind of sleep training. We just introduced the crib (he was previously in a pack n play…we have wedges in both) and it is not going well. I know that number one thing we need to do is put him down awake. This is difficult when we feed him before bed and he falls asleep while burping/waiting the 30 minutes before putting him down. How do I start putting him down awake? Waking him up after the 30 minutes? DO I wait until we are out of the regression? I’m sorry this is lengthy! I LOVE your website and would just love some insight! I am so scared of CIO, but will do it if I have to…but I would like to avoid it!

    Reply

  43. I’m so glad that I’m not the only one whose little refluxer wasn’t diagnosed until 5 months old… I read about babies being diagnosed at 2 weeks, 1 month, etc. and wonder what took me so darn long to figure out that all the screaming, lack of sleep, feeding issues, et al) is GERD? So thank you, Alexis, for making me feel better. 🙂

    Alexis, were you ever able to wean your peanuts off meds? Are they still struggling with tummy issues? I know you mentioned a while ago that all weaning trials with one of your kids had failed. Just wondering if there is light at the end of the tunnel for us…

    THANK YOU FOR ALL THAT YOU DO! You and your blog are godsends. x

    Reply

  44. Very informative article. i only knew about a baby swing. Never knew anything to do with baby bouncers, baby carriers or even that milk protein would be the cause of acid reflux. The article is very detailed and help you. You’re a life saver!.

    Reply

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