Food and Reflux

Food and reflux pain

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
  • Chocolate
  • 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, contains 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 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, tea, coffee, Coke, alcohol and chocolate may also need to be avoided by the breast-feeding mother of a reflux baby. 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

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 formula – see our “Managing GORD” document. 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. Here is a list of names that dairy ingredients can hide under.

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. Many of the children with ongoing gastric reflux (beyond 18 months of age) have an intolerance to gluten. Dr Rodney Ford recommends delaying the introduction of gluten to our babies with gastric reflux until about the age of 12 months to minimise this. However, the risk is also reduced if breastfeeding is continued beyond the introduction of gluten possibly due to the antibodies to gliadin in breast milk. Various studies have shown that breastfeeding reduces the risk of allergy development.

Volume and variety

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.

References:
Prevention of Allergies in Children – http://www.allergyclinic.co.nz/allergy_prevention.htm
GRSNNZ article – Gluten can cause gastro-oesophageal reflux disease!
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.
http://www.moh.govt.nz/moh.nsf/indexmh/0-2-food-and-nutrition-guidelines-may2008-questions#9 … content no longer available.

© 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 August 2014.

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.”