How to manage your baby's reflux and sleep

I read once that reflux and sleep should actually be referred to as reflux and lack of sleep. As both a paediatric nurse and a certified sleep consultant, I couldn’t agree with this statement any more. Not only is reflux painful for babies and upsetting for parents as they try and soothe them, reflux can also wreak havoc on sleep—both day and night.

When I was pregnant I had shocking reflux even when heavily medicated. I would be asleep and suddenly jolt awake with burning acid in my nose and mouth making me feel like I was choking or drowning. It was also a huge contributor to my nausea and vomiting, which as someone who suffered from HG with both pregnancies I needed to additional causes of feeling sick.

Needless to say, my empathy for babies with reflux and parents of those babies is now sky high.

Red Nose definitions of reflux in babies:

Gastro-Oesophageal Reflux (GOR) is the effortless regurgitation or spitting up of gastric (stomach) contents into the oesophagus (food pipe) with or without effortless regurgitation and vomiting.

Gastro-Oesophageal Reflux Disease (GORD) occurs when the reflux of gastric (stomach) contents causes troublesome signs and/or complications, that is, when GOR has an adverse effect on the well-being of the baby. For example, when the GOR causes poor weight gain or complications such as oesophagitis or respiratory signs. This requires medical assessment before a diagnosis of GORD is made.

What are the symptoms of reflux in babies?

Like most things, reflux symptoms in babies can vary greatly in terms of severity. For some, they have a bit of a vomit and move right along. Symptoms are generally more painful and severe with those diagnosed with GORD. These symptoms may include:

• Forceful, frequent vomiting/spitting up
• Refusing to feed and development of an oral aversion
• Blood in their vomit
• Vomit with a greenish tinge

Now I’ll be the first to say that I’ve never had a baby suffer from GORD. I’ve had a happy little vomiter, but the only painful thing about that was how often I had to change my clothes.

Babies with reflux will often struggle with sleep because the acid can be painful. It can run back up the oesophagus and wake your baby with pain. As you know the evidence shows that we must always put our babies down to sleep on their backs. This position, unfortunately isn’t very helpful for reflux babies. Lying flat often isn’t their friend. Hence why sleep and reflux really is an oxymoron.

So, what can you do to help your baby’s sleep with reflux?

1. Firstly, if you are ever worried about your baby, their pain, the ability to feed or their weight gain please always see your medical practitioner. This might be your Maternal Child Health Nurse (MCHN) or perhaps a GP who may or may not recommend medication.
2. It is also often recommended to hold your baby upright after feeds for about 30 minutes. This helps their little body have time to properly digest their milk feed before the acid tries to make them spit it back up again.
3. Try and seperate feeds from sleep. If you move more towards a feed-play-sleep schedule then your baby’s tum won’t be as full as if you were feeding right before sleep. A full tum tum can put pressure on their oesophagus and trigger reflux.
4. Many reflux babies love to suck to help keep the acid down. A dummy/pacifier may provide a source of comfort for them.
5. If you are using The Snoo, the leg lifters available raise the SNOO at a slight, safe incline. They are used for babies whose doctors recommend elevating the head for mild colds, stuffy noses, or reflux.
6. Offer smaller, more frequent feedings.

What should you NOT do?

1. Sleep positioners are not recommended. These can become a suffocation risk in the cot, and are not considered safe for sleep.

2. Please never confuse your baby’s unsettledness for your worth as a parent. Reflux babies can be really hard to settle and I know parents can often feel helpless and exhausted. You are a wonderful parent. Please, PLEASE reach out for a medical review to see if there is anything that could be prescribed to help your baby.

3. Unless you are using an SNOO where your baby is strapped in, please do not elevate the head of your cot or bassinet as there is a risk of your baby slipping down under their bedding and their head becoming covered.

Before you consider sleep training or making changes to sleep, please seek help to manage the symptoms. Good sleep is absolutely possible, but the priority is to help you little one feel more comfortable.