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lessons in infant reflux and what’s working for us
Jai’s reflux was not always an issue. The first 2-3 weeks after he came home were pretty easy – feed, burp, hold for 10-15 minutes, Jai passes out, Mommy and Daddy settle Jai into his co-sleeper. Piece of cake. Well the party ended quickly and the reflux smacked us right in the face.
And what a rude awakening it was.
The routine almost instantly changed to: feed – burp – feed some more – try to get Jai to burp and not projectile vomit out what he just took in – hold Jai up right with constant fear that he may projectile vomit right into our face or worse, our mouth. Yikes. This was followed by trying to get him to finish the bottle while he’s arching, squirming, grimacing with discomfort – then another attempt to burp – hold for 45 minutes to an hour or more – try to put him down – crossing fingers that we doesn’t have a major spit up while he sleeps or that he doesn’t wake up from the pain of the acid burning his sweet little throat. Oh my poor baby – and oh poor mommy and daddy too! Anyone out there relate or know what you can do to stop these problems, do you feel our pain?
We looked desperately for solutions – anything to help Jai through it and us too. At the recommendation of our pediatrician, I went on an elimination diet, which meant no dairy, no soy, and no gassy food likes broccoli. Simultaneously, we tried Similiac Alimentum – a super expensive formula that also smelled nasty designed for babies with sensitivities to milk or soy protein. Come to find out, Jai did not have a milk protein allergy, so I was back to my normal diet and we chucked the Alimentum. We continued to read a lot online and talked to friends/family – (special shoutout to my girl Bhagi for being the first one to send me all her tips!). And we ended up with a lot of helpful advice and solutions.
Jai’s reflux has definitely improved, as we knew it would with time; however, I know that many of the things we tried along the way really helped us through this crazy ride. In addition, I know it helped me to hear what other parents tried and what worked or didn’t for them so I wanted to share what we tried and worked for us. I tried to organize all of the advice into an order, which I think makes some sense. Hopefully, it will help parents out there who are going crazy with their refluxing little one.
Breast is best, if possible:
If possible, give your baby breast milk. I’m still providing it for Jai and really had a lot of incentive to for so many reasons but especially because of his reflux. Breast milk digests much quicker than formula. And the less time milk spends in your baby’s stomach equals fewer chances of spit-ups and discomfort. Although Jai is currently being supplemented with some formula too, giving him breast milk has helped tremendously.
So fresh and so clean (before feeds):
Before each feed, Jai’s diaper was changed. This is so important to do before the feed and not after since baby’s belly is full afterwards and there will be increased chances for big spit ups and discomfort. Another tip we learned is to roll baby to the side when placing a diaper under him rather than bringing his legs up toward his head or bending them. This can squish their little tummies which again can result in major spit ups.
The right bottle:
Dr. Brown’s bottles actually work. They are designed to reduce the amount of air your baby takes in because of the unique internal tubing system which removes the vacuum that builds up inside the bottle. I recommend trying Dr. Brown’s bottles if your baby is refluxing and/or gassy. There are a billion parts to this bottle so it makes it annoying to clean but I know it’s made a difference for Jai so we’re big time fans!
Wrap ’em up like a burrito:
Swaddling was essential to keep Jai organized while feeding and helped to maintain his level of comfort and security since he arched his back and squirmed around a lot in the beginning. We thought about getting him a feeding bib but he might be a little young for that at the moment. We made sure not to have the swaddle too tight around his belly area but also were certain to keep his arms and hands contained. The only swaddling blanket that really ended up working for us is the Aden and Anais swaddling blanket. We tried the Miracle Blanket when Jai was much younger, and although it worked great to keep him swaddled he got way too hot in it. I have one hot baby! The Aden and Anais blankets are made of a muslin gauze like material and really help to keep him comfortable although I have to admit, throughout each feed we have to reswaddle him several times since he manages to squirm himself out of it when being burped.
Mastering feeding positions:
The more upright we held Jai while bottle feeding (I pumped and started exclusively bottle feeding less than month into Jai being home) meant that he swallowed less air which meant that less milk came back up. A baby lying flat on his back or with even a slightly turned neck will swallow more air and is more likely to reflux. Holding Jai in these special positions while feeding was hard but ended up proving to be worth it. After we mastered holding him, feeds went much more smoothly. Initially, I was holding him completely sidelined on my lap with my knees bent and legs propped on the side of the bed. Basically, he was on his right side (I’m left handed) with his feet down near my stomach. Again, this was not the most comfortable for me but very helpful for him.
Keep it short and sweet:
Since a too-full tummy can put pressure specifically on the lower esophageal sphincter (thanks to Hitesh for helping with the correct medical terminology) or just on the belly area in general, it can cause babies to spit up. Smaller feeds worked for us for a short period of time but it was hard to do this for very long because Jai was not satisfied with small feeds…which leads to me my next piece of essential advice.
This is extremely important. Burping helps to get rid of some of the air that babies tend to swallow during feeds. With most reflux babies, not being burped enough will lead to even more spit ups, which leads to more crankiness and more gassiness. Since Jai was bottle fed, we usually burped him at least after every 1.5 – 2 ounces or sometimes less if he was squirmy or showed major signs of discomfort. I read that breastfed babies with reflux should be burped when they also start squirming around and definitely when momma switches from one side to the other.
I burped Jai over my shoulder and held him close enough to me so that he did not bend, slouch or slump. I was told by a nurse to rub his back starting from his left shoulder and moving my hand clockwise. Supposedly, that is the most effective way. It worked for us. Also, gentle but firm pats worked. Sometimes and for some reason, just standing up from a seated position, worked magically to cause a burp or two.
Even burping before beginning a feed helped Jai. I know, you’re thinking what baby needs to be burped before a feed? Parents of a refluxing baby…you know exactly what I’m talking about. Sometimes your baby will let out a big burp, wet burp or a spit up even hours after a feed. This will help, try it out.
Use protection…burp cloths & bibs:
Most burp cloths I found were too thin so quickly, I switched to all cloth diapers. Anyone who has a refluxer in the house knows the value of good burp cloths. Cloth diapers have great absorbency and are definitely the way to go. We use the Babies R Us store brand cloth diapers and they work great.
As far as bibs go, I love this brand called Green Sprouts. They proved to be incredibly absorbent plus they are eco-friendly, which is a an added bonus.
The Aden and Anais burpy bib combo is awesome too. So useful and multi-functional…totally plan on getting some more of these soon.
Hold that baby:
It’s not rocket science, if you want gravity to help keep stomach contents in the stomach and out of the esophagus and onto your baby, yourself and your floor… then you want to keep your baby perpendicular to the floor pretty much all of the time. Carried babies are less stimulated and so experience fewer incidences of major spit ups and vomiting.
Since it’s super exhausting and next to impossible to do this all of the time, I have to especially stress how important it is to hold for at least 30 minutes after every feeding. With Jai, we were initially holding him for almost an hour, sometimes more to ensure that the milk stayed down. Gradually, we decreased it down to 30 minutes, which we are still doing now. The main thing we had to keep in mind as we carried Jai was to avoid putting pressure on his tummy. It’s important to make sure that your baby is not slumped in any way and that the spine is straight while you’re holding. This made holding him for long periods of time hard, but it was necessary. We also learned to never hold him on our hips as this definitely puts pressure on his tummy. The best position that I found to carry Jai was with his bottom on one forearm and my other hand behind his back to support it and keep him close to me.
There are many baby carriers and slings in the market that can help carrying baby much easier. We have a Baby Bjorn carrier which we feel will put too much pressure on Jai’s bottom so we haven’t really used it much. I’m still interested in the Moby wrap/sling but not sure if we’ll really get one at this point. Plus, my arms are getting so toned that it’s hard to justify making a change right now. 🙂
Keep calm and carry on:
Stimulation, including laughing and crying, can trigger infant reflux episodes. We limited Jai’s interactions after each feed and usually he took a good nap afterwards anyways. We also kept our movements as we held him, down to a minimum. Very gentle swaying or rocking in the rocker were ok. Anything more, and it could get messy.
No pressure please:
We still primarily dress Jai in onesies. Pressure against his belly is a big time no no, so onesies are his attire of choice, (I mean our choice) for now. They work better than any other clothing options. I can’t wait to dress him in cute shorts and pants but for now, those will have to hang patiently in his closet. The elastic around the waists will undoubtedly add unwanted pressure to his little tummy. We even keep his diaper looser than what’s considered normal just to keep added pressure off.
Pacifier use is encouraged for all newborn babies but it’s an especially powerful tool for refluxing babies. Pacifiers encourage saliva production and saliva is a natural antacid. This Wubba Nub pacifier was a nice find since Jai could hold onto the little giraffe which helped to keep it from constantly falling out of his mouth.
According to WebMD:
• A new study shows that infants who suck on pacifiers have fewer and shorter episodes of reflux, although researchers don’t go so far as to encourage the use of pacifiers.
• Pacifiers stimulate the flow of saliva and downward contractions of the esophagus, reducing the time it takes to move the irritating stomach fluid back where it belongs.
Initially, Jai loved his pacifier and we encouraged him to use it for the reasons listed above. But now he wants nothing to do with it, so we stopped offering it.
Initially, we elevated the co-sleeper he slept in by propping up the side by his head with pillows. We also bought cinder blocks from the hardware store and propped up one side of the pack-n-play that he slept in once he got too big for the co-sleeper. Since we wanted him to sleep in our room in the beginning, so we decided to just move the pack-n-play in instead of moving the crib from the nursery.
Once we felt he was ready to be full time in his crib in the nursery (around month 6 for us), we purchased a crib wedge to provide some elevation. We still have this Safe Lift Universal Crib Wedge under the mattress in Jai’s crib. I am not sure if it’s because of the wedge or not or if it’s because Jai’s reflux has just gotten better, but he does sleep comfortably in the crib for the most part. I had my doubts with this wedge since I didn’t think it provided the 30-degree angle that is needed to really help with reflux. But we still are using it even now.
An awesome tip I got from a gal at Buy Buy Baby was to purchase a crib sheet protector. Boy, am I glad I got this thing. It totally protects you from having to clean dirty sheets all the time and if you have a baby that spit ups a lot, this a necessity. You just unsnap and snap around the rails of the crib…it’s that simple. SO much easier than removing all the bedding and then putting it back on each time there’s major spit up.
Chillin’ in the Nap Nanny:
This infant recliner helped Jai get comfortable and fall asleep. The incline seemed to be perfect for him and he had minimal spit ups while chillin’ in it. Of course, the Nap Nanny Chill should be used with caution and only on the floor. I have to admit, we used to keep it in between us in our king sized bed sometimes…but only when we were awake and watching close by.
Baby Bjorn Babysitter Balance:
The Baby Bjorn Babysitter Balance is really awesome. This thing is a baby bouncer and an upright chair that you can adjust the angle on, which provides you with a much needed break from carrying your little one and your little one some freedom. It definitely does give us all much needed relief. The incline your baby can get in the babysitter balance is terrific for preventing acid and spit up from coming up plus it really doesn’t add any pressure to his tummy. Usually, if Jai doesn’t fall asleep after his feed and it doesn’t look like he’s tired plus he’s already been held for at least 30 minutes, we use slide him into this. It works wonderfully. He also loves being in it for story time.
Get baby’s sleep on:
Getting your little one to sleep fast after feeds is important because this helps keep more of the feed in the stomach. I totally suggest getting a sound machine to help with this. We purchased the Cloud B Sleep Sheep. It’s a cuddly, soft stuffed sheep that has four different sounds to help your little one fall asleep. There’s the heartbeat (Jai’s favorite), rain, ocean and whale song. It has a 23 and 45 minute setting, giving you enough time to get your baby to sleep, plus it has volume control. You can attach it to the outside of the crib or anywhere else using the Velcro straps. Jai fell asleep so easily to the heartbeat sounds after feeds.
Ok parents of refluxers, hope this long list helped a little. And if you have your own tried and tested methods of combatting the nightmare known as reflux, we’d love to hear from you! Words of encouragement from mommas & poppas is welcome too!