Managing Uncomplicated Reflux

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 do not change your child’s medical treatment without first consulting their health professionals.

Babies with uncomplicated reflux are often described as “happy chuckers”. These babies vomit or spill frequently, but are otherwise completely happy, sleep well, gain weight and have no other obvious reflux complications.

Happy Chucker

fed from a spoon before a breastfeed.These thickeners are all safe from birth. Try them one at a time. You will need to give them at each feed for about three days before you should try to decide if they are helping.Try these thickeners/formulas: Karicare Aptamil AR, S-26 AR, Karicare Food Thickener, Baby Rice, Cornflour (cooked).

Breastfed Bottle-fed
Try a dairy-free diet for Mum for up to 2 weeks*. Try a non-dairy formula for one week**.
AND
Check latching/feeding, flow of milk and position
Not working? Not working?
Karicare Food Thickener or Baby Rice***.
AND AND

General Management Techniques

Raise the head of baby’s bassinet/cot and changing surface to 30 degrees. Raise the whole cot/bassinet rather than putting something under the mattress. Put feet at the end of the bed or use safe-t-sleep to keep face clear of covers.

Use a front pack, sling etc to keep baby upright when awake. A Hammock may be useful.

Winding/burping regularly (preferably high on the shoulder with a nice straight body to allow the wind to escape more easily).

Avoid pressure on tummy at all times.

Wrapping for sleep.

Sleep pattern in place.

Avoid “crying it out” as crying worsens gastric reflux and is distressing to family. Bad sleep behaviours do not develop and sleep patterns are easily established once gastric reflux is adequately controlled.

Pacifier/dummy like NUK brown rubber teat (this is only an option if LMC and Parents are comfortable with it). Sucking gives comfort but feeding continuously may exacerbate or encourage more GR episodes so this is where a dummy can be a helpful tool.

Not working?

As a last resort, the medication Gaviscon Infant and/or a motility medication may be prescribed. However, neither of these will consistently reduce/stop the vomiting in every baby tried on them. They may also have unwelcome side effects. Infant Gaviscon may cause constipation; with motility medications stomach cramps, diarrhoea and headache are common. All happy chuckers will outgrow the vomiting/spilling with time. Many parents make a decision just to “ride it out”. There may be long term benefits to these babies for doing this.

 

  • If you have a child who gets both pain from reflux and vomits/spills, you will need to refer to the charts showing treatment options for both “Managing GORD” and the “Happy Chucker”.
  • However, an important point to note is that with babies who get pain from reflux as well as vomit, it is important to control the pain and acid first before considering the use of thickeners or thickened formulas. When the pain/acid is under control with appropriate acid reducing medications, then try the options on the ‘Happy Chucker’ chart. Babies who get pain due to reflux all have some degree of oesophagitis (inflammation/ulceration of the oesophagus). Studies have shown that although thickeners and thickened formula may reduce the number of episodes they prolong the length of time of the remaining episodes as thickened fluid does not drain as well from the oesophagus. It is these prolonged reflux episodes, when they contain acid that can do the most damage.

*The time frames mentioned for this diet is the length of time that the diet should be trialled for by the breastfeeding mother before deciding that it is not helping and before returning to a normal diet. The dairy free diet needs to be a complete removal of these foods as cheating does matter. A positive response may be seen earlier than the time frame indicated. If the baby has started solids then these also need to be free of dairy. If the diet is successful in resolving symptoms then it needs to be continued or another form of feeding considered. Breastfeeding is nearly always best for the baby with gastric reflux but the mother’s health is also important, so consider this decision carefully with the help of a paediatrician for future feeding options.

**There are three options for non cow’s milk based formulas.

  1. Soy based formulas are not recommended when soy is the only source of nutrition. Therefore, a child who is bottle fed only (with no solids) would be best not to be on a soy formula.
  2. Goat milk formula is often effective in children with reflux problems due to cow’s milk protein intolerance. (Opinions vary about the suitability of goat’s milk due to the proteins being similar to cow’s milk so this may need to be discussed with your health professional.)
  3. Hypoallergenic formulas are best recommended by a paediatrician as a special authority number is required to receive these subsidised (otherwise they are around $100 per tin).

See our fact sheet on “Infant feedingfor more information or phone Nutricia on 0800 258 268 to speak to a Dietician. If the baby has started solids then these also need to be free of dairy.

***Please check the ingredients as some brands of rice cereals, contains milk products.

© 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 and edited by GRSNNZ 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.”

  • Hi there are there any formulas that you can get on prescription or financial assistance? Pretty sure my 8 week old isn't coping with his formula that he's on. He has reflux and on ranitidine but now he has green mucousy poo so im thinking he might need some different formula? But I see specialist formulas are expensive!!

  • Hi, my 5 month old has started solids and we have been ok'd to feed these before milk as otherwise he spills most of it. He takes losec granules, which was have been giving with pear 30mins before a milk feed. Can we now just give these with his solids with milk following half an hour+ later? Or not due to the higher volume of food in his stomach so it wouldn't be digested by the time he has his milk. Thanks

  • Hi. We've used the karicare thickener in our boys bottles on top of losec and neocate to control his reflux. Now he's 4 months old I was looking at using watties rice cereal to thicken his bottles before moving to solids at 6 months. Looking to find anyone who thickens with rice cereal. Advice? Thank you

  • Argh! I don't know if I'm doing the right thing for my wee girl. We discovered her reflux early 8 days old and has been on goats milk formula for 3 months. Did it help? Hard to say but she was happy enough. We were reffered to the hosp dietician by our plunket nurse and on Thursday started neocate. Its made things worse and she seems in pain.. her poops are slimy green. We gave her a few gaviscon feeds with it to help her tum cos she seems to have a sore tummy a lot. So its Sunday, we've been on it three days but I am continually second guessing myself. Should we have seen a change in her by now. Is it normal to take a few days for the tummy to get used to it? I hate putting her through all this esp if it doesn't end up working... sometimes I just want to throw it in and put her back on goats milk... would love some advice from others on neocate or just any advice/encouragement please and thank you :)

  • Hi mums I have recently taken my daughter off losec on advise from a paed to see how she went. We didn't notice the symptoms coming back and also started solids around same time with it going great. She's had a cough and cold but is over it except this nagging cough which is day and night until she eventually throws up. My question is could the cough actually be the reflux and should I start losec again.

  • A Good News Story ... http://www.cryingoverspiltmilk.co.nz/his-gastric-reflux-stopped/

    Hi Roslyn, Thanks for the updates over the past several months. I am leaving the group as my little boy no longer suffers from gastric reflux and is also no longer dairy intolerant! FYI he was on Neocate from 3 months old and had a combination of formula and my milk until he was 7.5 months. ...

  • Hi. My boy is 6.5 wks. He started screaming at 3 wks. Became unsettled for periods of up to nearly 12hrs without sleep. He's been on formula as my milk never came in. He gets about 100-200 ml breastmilk /dy I pump. He started spilling/vomiting a lot at 4.5wks old.started losec 9 dys ago-frm GP. Saw paediatriciAn 4 dys ago and started amino acid formula to check for CMA. I feel things improved a bit about 4 dys after losec started. Also he seemed great once on th amino acid formula but thn yesterday was his old really bad self - fussed all day 10am-4pm thn really distressed n frantic 4-9pm. He's been ok today.i also started adding karicare thickener 2 dys ago. His first poo day after starting amino acid formula was soft n ok but I thnk he might b constipated with th thickener. He really had to push to get yesterday's out n was very sticky. Anyone else experience this? What do you do? I've heard lactulose and prune juice etc can make reflux/ wind worse. I thought about halving th amt thickener I'm using.also his vomiting better on th new formula I think but still occasional. He vomited Sunday night n mayb brought th losec up- could 1 missed dose like thts make him bad th next day like he was? Any opinions greatly appreciated

  • Please consider joining Gastric Reflux Support Network NZ for Parents of Infants and Children Charitable Trust for access to our Newsletters and Private Local and National Support Networks: http://www.reflux.cryingoverspiltmilk.co.nz/grsnnz-membership-confidentiality-agreement-form/ Membership is free, and this gives you opportunities to discuss gastric reflux related issues with others in a safe and confidential setting. If you have completed a membership form previously, but never received anything further, please message me (Roslyn Ballantyne at https://www.facebook.com/roslyn.ballantyne.rn ) or comment below. The membership sign-up had been a double opt-in with a confirmation email, but as some people have had trouble with this, I've now changed it to a single opt-in. (I do still need to process applications and add you manually to your Local Support Networks though.)

    Gastric Reflux Support Network NZ for Parents of Infants & Children Charitable Trust Membership & Confidentiality Agreement Form / Newsletter Admin PageFirst NameLast nameEmailStreet AddressCity/TownAreaPostcodeDo you live in NZ?Country and Area if not NZHome Phone (include area code)Partner's NameE…

  • Hi I'm a bit confused. I filled out th membership form on th cryingspiltmilk main page. Do I need to do anything else? I see there's a forum somewhere else - kiwi health or something? Or do I just post n use this Facebook page? I'm thnking you hav th older site but most people jst use this Facebook page now yeah? Ta :) I hav a 6 wks old beautiful boy who has been in so much pain been breaking my heart but I'm jst getting things in motion now to help I thnk. Saw paediatriciAn few dys ago n hav started losec gaviscon mylanta and amino acid formula with karicare thickener

  • Hiya, I'm starting to introduce solids to my almost 6 month old and just wondering if there are any foods that any of you have found to be better than others and which ones to avoid? TIA. :-)

  • Other information here: http://www.lalecheleague.org.nz/news-a-events/lllnz-conference-2014/312-lllnz-50th-anniversary-conference-2014