Infant Feeding and Reflux

Frequently Asked Questions (FAQs)

When “spit up” becomes “reflux” things can get complicated. Reflux can interefere with typical feeding development, growth and ability to gain weight. Not only that, having a “refluxer” myself, it can be messy and frustrating. This FAQ will help you understand more about reflux and ways that it can interfere with feeding and feeding develpment.

What is reflux or GERD (gastroesophageal reflux disease)?

Gastroesophageal Reflux (GER) or Gastroesophageal Reflux Disease (GERD) is a condition commonly known to many adults as heartburn. GER is the backward movement of stomach contents into the esophagus, throat, or mouth and is not uncommon in infants. GER often resolves without further difficulty, however, it can lead to feeding problems, or even refusal to eat. Complications of GER may include recurrent vomiting, failure to thrive, poor or slow weight gain, reactive airway disease, aspiration, pneumonia, esophagitis (inflammation of the esophagus) and feeding refusals.

How do I know if my baby has GER?

There are six behaviors that are commonly associated with GER: discomfort (crying or frowning), emission of liquid or gas, yawning, stridor, stretching, vomiting and mouthing. In isolation, these behaviors may not be bothersome. But, if they occur frequently or in combination, it can be disrupting. Other signs and symptoms of GER may include: irritability, poor sleep, frequent short feedings, arching during or after feeding, seeming desire to feed and then refusing, acidic breath and frequent unlatching during feeding.

My baby spits up a lot of milk after almost every feeding.

While it is not uncommon for a baby to spit up a small amount after some or all feedings, it is not typical for a baby to cry, fuss, choke, gag or be uncomfortable after feeding. Frequent large volume spit up or vomit should be monitored for complications. Discuss concerns with your doctor. One of the treatment recommendations may be a referral for Feeding Therapy.

If my baby is refluxing, should I stop breast feeding and start formula?

Studies have shown that babies who are breastfed or breast milk fed, have fewer and less severe episodes of reflux because human milk is more easily digested. Because human milk is emptied from the stomach more quickly, it has less opportunity to reflux. Human milk is also less irritating to the esophagus. All good reasons why formula companies spend a lot of money trying to replicate human milk. With that being said, there are, however, some babies that cannot tolerate even human milk and require a very specialized formula or the mother may need to modify her diet to increase the baby’s tolerance to her milk.

Can an allergy/intolerance to cow’s milk cause feeding difficulties?

Studies have shown that in up to 50% of infants under one year of age, cow’s milk protein intolerance is often the “cause” of reflux. If cow’s milk protein intolerance is suspected, under the guidance of your doctor, we will help you initiate a trial elimination diet.

What else can cause reflux?

Some babies have poor tone in the Upper Esophageal Sphincter (UES) or Lower Esophageal Sphincter (LES) making it easier to reflux. Unless there are severe complications of the reflux, this is often treated with clinical or pharmalogical intervention (medication). Pyloric stenosis, an other condition that affects the gastrointestional tract, can cause forceful vomiting and may result in dehydration. This condition is often diagnosed before an infant is 6 months of age and is treated with surgery.

What is Aerophagia?

Aerophagia is air swallowing. Some infants with poor suck patterns, restricted tongue patterns, tongue tie and poor coordination of suck swallow breathe may swalow air during feeding. Air swallowing can increase reflux or reflux symptoms. Gulping during swallowing or sounds audible during swallowing can be a clinical sign that the baby is swallowing air. Evaluation for Tongue Tie and Feeding Therapy are indicated for a baby with aerophagia. A tongue tie release can provide increased tongue (and lip) range of motion and Feeding Therapy will train and teach your baby the way they can most effectively use their tongue, lips, jaw and cheeks to ensure effective feeding and swallowing safely without swallowing air.

Can reflux affect feeding patterns?

Because reflux can make you feel nauseous, infants with reflux tend to hold their tongues in a retracted position and are very sensitive to touch on their tongue and inside of their mouths. Both tongue retraction and a sensitive gag reflex can interfere with appropriate latch, prevent efficient tongue patterns and can contribute to breastfeeding and swallowing difficulties. In addition, aerophagia (swallowing of air) due to the above tongue patterns can cause or aggravate the baby’s reflux placing the baby in a bad cycle. With Feeding therapy and management of the GER, oral sensory and oral motor difficulties can be addressed. When addressed, tongue patterns will become more typical and dysfunctional patterns can be resolved.

What are the Red Flags and what can I do?

If you are concerned about GER and feeding difficuties, aerophagia, coughing/choking during feeding, poor feeding patterns, weight gain issues, sleep feeding/dream feeding, tongue tie, and uncoordinated suck, swallow, breathe patterns, ask for a referral for a Feeding Evaluation.

What can I do until I can get an appointment?

Position and feeding schedule changes along with feeding therapy can help your baby feed more effeciently and may reduce reflux complications. Please see the Infant Reflux Red Flags paper for more details.

If you think that your baby is experiencing reflux a Feeding Evaluation is indicated. Your Feeding Therapist can identify specific techniques that support your baby’s feeding and swallow skills.