The information provided on Crying Over Spilt Milk is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician.
Please seek assistance from your Doctor, Midwife, Well Child Provider, Health Professional or Dietician about feeding your baby.
The foods that can make reflux pain worse for a baby/child are:
- Fruit and fruit juice, especially oranges, apples and bananas. Pears are the least acidic and an ideal first fruit for reflux babies.
- Tomatoes and tomato sauce
- Tea and coffee
- Spicy Foods
- Fizzy drinks (especially coke)
- Fatty foods (i.e. fish and chips!!)
It is important to note however, that these foods will not worsen vomiting, and so it is not necessary to avoid them in a ‘happy chucker’.
Well tolerated first solids include baby rice (please check the ingredients as some brands of rice cereals, contain milk products), kumara and pumpkin. Here are a couple of Feeding Guidelines that provide sensible plans for introducing solids to a baby with reflux if the foods listed on this page that are likely to cause problems are introduced later and with caution: Starting Solids from heathed.govt.nz and Solid Foods – Advice and Support from Kariclub.
Breastfeeding and the mother’s diet
Citrus fruit, tomatoes, caffeine containing drinks (tea, coffee, coke) and chocolate may also need to be avoided by the breast-feeding mother of a reflux baby. Of course alcohol should also be avoided by the breast-feeding mother.[i] Some asthma medication (e.g. Theophylline) taken by the breast-feeding mother may also make the baby worse. Remember that all babies are different and different babies react to different foods – the list above is a guideline only.
Food allergy or intolerance
Another food that can affect babies with reflux is dairy products. If you suspect that this is a problem for your baby and you are bottle-feeding, you may need to try an alternative to standard cow’s milk based formula. (Please discuss which formula to choose with your Health Professional (doctor, Well Child Provider or dietician) or phone Nutricia on 0800 258 268 to speak to a Dietician).) If you are breast-feeding, you can go on a “dairy-free” diet. This means avoiding all milk and foods that have dairy products in them (e.g. cheese, yoghurt, bread, biscuits, cakes etc.) for up to two or three weeks to see if there is any improvement in your baby. Any solids that your baby is eating will need to be dairy free also.
It is our experience that a number of infants with GOR do not cope well with the introduction of gluten (wheat, barley, rye and oat products) and may develop an intolerance to this. Some Specialists recommend delaying the introduction of wheat to babies with a strong family history of allergy until the age of 9 months (or 12 months to be cautious) to minimise the development of allergy.[ii] Symptoms of gluten intolerance may not appear immediately on introduction, so if GOR/GORD worsens with no obvious reason, consider if this could be a cause. If gluten has been in the diet for 6 weeks, testing for Coeliac Disease may be appropriate before trialling a gluten free diet so please discuss this with your doctor.[iii]
There is some evidence that breastfeeding reduces the risk of allergy development.
Volume and variety
In 2008, MOH guidelines changed the recommended introduction of solids at age four to six months, to no earlier than six months due to developmental readiness.
Solids are known to either help reflux or make it worse when introduced. In our experience, it is best to start with a small amount and increase this very slowly. Reflux symptoms may be made worse if the total volume of food given in a day is increased too quickly. For example, the baby may be able to tolerate one tablespoon once a day or one teaspoon three times a day but not one tablespoon three times a day. Don’t be too concerned about variety or amount of solids in your baby’s diet – they will eventually grow up and be able to tolerate larger volumes and variety. If you are concerned about their diet, consult a dietician.
Some babies progress well onto solids, but are reluctant to take mixed (lumpy) textures. Aim to start your baby on mixed (lumpy) textured solids by seven to nine months of age. Delaying introduction of mixed textures until beyond nine months is associated with fussier feeding during pre-school years. Make eating a fun experience and allow your child opportunities to feed themselves and experience new textures in their own way. Be prepared for lots of mess! Research shows it is the frequency of tasting solids rather than the amount your child eats that helps them progress onto new tastes and textures. Therefore, try offering your seven to nine month baby very small amounts of mixed texture food at least twice daily until your child indicates he/she is keen to eat more.
Diet and reflux
Some infants presenting with signs of gastric reflux may have their symptoms relieved entirely by changing their diet.
If there is a history of any allergy (including hay fever) in either parent there is an increased risk that their children will have allergies and if both parents have allergies this is further increased to 50-60%. Even in a non-allergic family there is a 5-15% risk of allergies.
Studies have shown that about one third of infants with gastric reflux disease will have a cow’s milk protein allergy or intolerance.[vi] Skin prick or blood RAST testing will often not pick up this “gastrointestinal” food intolerance as it may be a delayed reaction, and is best diagnosed by an elimination diet and challenge. This involves removing dairy from the mother’s diet if breastfed or a trial of a non-cow’s milk based formula.
Some parents have found that unproven forms of testing such as Kinesiology have helped them to remove offending foods. GRSNNZ doesn’t endorse these and would recommend that limited diets also be supervised by a dietician, that a medically qualified health professional (paediatrician, allergist, immunologist etc.) be involved and if appropriate the foods be challenged after a suitable time lapse.
Cow’s milk protein allergy should not be confused with lactose intolerance. Breast milk always contains lactose even if the mother is on a strict dairy free, lactose free diet so a baby who responds to a change in their mother’s diet, does not have a lactose intolerance.
If you want to read more about Gluten and how it might affect GORD, please contact us for an article.
Allergy Today Spring 2006 ( page 48 )
Crying Over Spilt Milk Survey December 2006
Allergy Today Summer 2006/07 ( page 8 )
[ii] Prevention of Allergies in Children – http://www.allergyclinic.co.nz/allergy_prevention.htm
[iii] Coeliac disease tests and diagnosis for children – http://www.healthinfo.org.nz/index.htm?toc.htm?37286.htm
[iv] Northstone, Emmett, Nethersole & The ALSPAC Study Team (2001). The effect of age of introduction to lumpy solids on foods eaten and reported feeding difficulties at 6 and 15 months. Journal of Human Nutrition & Dietetics, 14, 43-54.
[v] http://www.moh.govt.nz/moh.nsf/indexmh/0-2-food-and-nutrition-guidelines-may2008-questions#9 … content no longer available.
[vi] Gastroesophageal reflux and cow’s milk allergy in infants: A prospective study.
© Gastric Reflux Association for the Support of Parents/babies (GRASP) and Crying Over Spilt Milk Gastric Reflux Support Network New Zealand for Parents of Infants and Children Charitable Trust (GRSNNZ) 2004. Used, edited and added to by Roslyn Ballantyne (RN), National Coordinator GRSNNZ and Fiona Kenworthy, Speech-Language Therapist with permission. Last updated March 2015.
Page may be printed or reproduced for personal use of families, as long as copyright and Crying Over Spilt Milk‘s URL are included. It may not be copied to other websites or publications without permission and acknowledgement. This information (unedited) was also provided (by GRASP) to health professionals in New Zealand to use ” to continue to support and inform families with babies/children with Gastro-oesophageal Reflux.”