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.

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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:
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• 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.

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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.

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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.)

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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}