Reflux and Sleep: How to help your baby
All babies spit up a bit of milk from time to time, but if you suspect your baby has reflux you need to seek professional help to get a diagnosis.
It can be terribly upsetting to watch your baby in pain. Naturally you want to do everything possible to alleviate their discomfort and soothe them.
Reflux (GERD) can cause night waking, discomfort when lying down and shortened naps.
Doesn’t sound like much fun for bub or mum, right?
Before we look at how we can sleep train a baby who has reflux, let’s first take a look at some of the signs your baby might have reflux.
Signs and symptoms of reflux
If your baby has reflux, they may start to vomit milk, especially after feeds. Especially during or right after feeds they can appear like they are in pain. Crying a lot and arching their backs. Most babies with reflux are otherwise well, and show no signs of discomfort or distress. They are growing well, and their breathing is normal.
In some instances, reflux can lead to complications. This is called gastro-oesophageal reflux disease (GORD). If your baby has GORD, they may:
• have pain and discomfort in their chest or upper abdomen (stomach), which will make them irritable, cry a lot or arch their back
• have disrupted sleep or be hard to settle
• show poor weight gain
• have breathing and swallowing problems (e.g. gagging, choking, wheezing or coughing a lot).
If your baby shows any of the signs above, discuss it with your paediatrician before embarking on any sleep training.
To read more about GORD and other common questions about reflux see this section of RCH website.
How Sleep May Be Affected
Let’s now take a look at how reflux/GORD may be affecting your baby’s sleep, and what you can do about it.
As parents our natural instinct is to comfort a baby who is in pain. And that’s precisely what we should do.
But it’s important to pay attention to how we soothe a baby who has reflux.
As we comfort our baby, we don’t want to inadvertently reinforce poor sleeping habits.
Walking, rocking, feeding, and swinging to sleep can create a habit that’s hard to break. And life is challenging enough with a baby, let alone a baby with reflux, so let’s not add to the challenges.
Here are 5 tips to help a reflux baby sleep:
1. Keep a record
As with a colicky baby, reading reflux babies’ sleep cues can be difficult. Is it hunger? Pain? Tiredness? Or perhaps it’s a combination all burred together.
When you can’t differentiate their cries, it is naturally more difficult to understand what they’re crying about, and you may not respond as consistently.
So, you have to be more diligent about watching the clock, not just your baby.
Keep track of when your baby fed. As they get older, you’ll want to stretch out the time between feeds as long as you can without provoking more vomiting, particularly overnight.
Pay attention to the duration spent awake. Make sure your baby naps on time. The last thing they need is an overlay of exhaustion on top of a burning oesophagus.
One thing that is REALLY important is to go into a quiet, dim room for a while before nap or bed. Your baby may show sleepy signals more clearly in such a setting. Also, the quiet environment may act as a cue that it’s time for bed.
2. Try different feeding positions
When feeding your baby, placing them in a few different positions might help alleviate discomfort and prevent reflux.
A helpful position for young breastfed babies is under the arm (often known as a football hold), while older babies can be held sitting upright. Bottle fed babies might benefit from a more upright hold too.
Continue to hold them upright after feeding for 20-30 minutes. Once the reflux has settled down, and your child is no longer in pain, try not to hold him until they completely fall asleep. You don’t want them to develop an association between sleeping and being in your arms, or you’ll have to hold them to sleep all the time for months to come.
Don’t worry if they fall asleep in your arms occasionally — just be mindful not to teach your baby that your arms are their only bed. If they fall asleep in your arms every time then you are teaching them that this is they only way that they should go to sleep.
Remember: babies get good at what you practice with them the most!
It’s really important to allow enough time between feeding and bedtime for an activity in between. After you have fed baby, held them upright for a while, try reading a book, or giving them a bath and a massage.
When it’s time for him to sleep, put bubba down drowsy but awake. Stay with them and soothe intermittently until they are asleep. Gradually reduce your soothing as they learn to do it on their own.
If crying ramps up quickly then pick them up and hold them to sleep and try again another day. It is better to wait until you are confident that your baby is not in pain before you start sleep coaching- no matter how gentle the method.
3. Vary the frequency of feeding
Try experimenting with different ways of with feeding to see what works best for your baby. Feeding your baby smaller amounts more often can help, as this can help reduce reflux. But as babies get older, beyond 4 months say, it may be better to give them a larger feed less often, and then be kept awake and upright for about an hour after their feed to help prevent reflux.
Talk to your doctor or maternal and child health nurse about varying the feeds. At some point the night feed ceases to be a physical requirement and may start to disrupt sleep. When that happens you need to stop the night-time feeds gradually and gently.
4. Try a dummy
Every new parent hears about the pros and cons of a dummy, and I have written about that myself here. But when you see your little one squirming in pain anything is worth a try.
The sucking motion that a dummy induces can help digestion and may offer your baby some relief from reflux between feeds. I find dummies work especially well in the newborn stage (up to 12 weeks).
5. Follow a consistent bedtime routine
Sleep is important, both for infants and for their parents. Make sure to establish a consistent bedtime routine, and then follow it nightly. Rocking your infant in an upright position until they’re drowsy but not asleep can help soothe them and may lessen symptoms of GERD or acid reflux.
To help cope with lack of sleep try to rest, if possible, when your baby sleeps, even if it is just for 20 minutes. Organise family or friends to babysit for an hour or two so you can have a break.
Finally, be kind to yourself and know that this won’t be forever.
As always, if I can help you in any way, reach out to me via email, DM or below
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