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.
|Try a dairy-free diet for Mum for up to 2 weeks*.||Try a non-dairy formula for one week**.|
|Check latching/feeding, flow of milk and position|
|Not working?||Not working?|
|Karicare Food Thickener or Baby Rice 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).|
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.
|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 “Silent Reflux” 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.
- 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.
- 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.)
- 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 feeding” for more information. If the baby has started solids then these also need to be free of dairy.
© 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 2013.
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, just wanted to say that this page and your website has been a huge help! It has provided ideas, helping me and my 8 week old son cope with his reflux. He was diagnosed @ 4 weeks old, and has been on gaviscon since. I have also gone dairy free, not sure if it's helping but he's definitely settled over the weeks. Hopefully he 'grows out of it' as the Dr says, grateful for all tips and advice from other parents experiencing the same...'I'm not alone'....this is a photo of our son in his Happy Place, where he goes from crying to smiling straight away!
Hi, Just wondering if you could help me with a question please. I got given Losec Suspension today. Since it's in suspension form and not the granules how long before a feeding should I give it to my baby or can it be given at the same time?
My baby has been diagnosed with reflux, her dr prescribed her ranitidine 150 mg/10 ml. It says 1 ml 3x a day, shes 5.7 kgs, does this sound right? That seems alot to me...
Hi there. I've been reading your website and Facebook page with interest over the past few months and it's been really helpful. My daughter is coming up 4 months old and her reflux seems to be improving. We tried gaviscon but it didn't make much difference. Main thing for us has been that I cut dairy out of my diet. I now have food with dairy in it but just don't do the core basics like cheese, yoghurt, milk etc and although she still spills often, the associated pain seems to be almost gone. Am hoping she's growing out of it but the dairy still seems to have a bit of an effect. Anyway, in two months time I have to go back to part-time work and will need to start using a formula on those days. I usually used karicare gold with my kids but have no idea what options would be best for my reflux baby. Can you make some suggestions? I'd like to try some out to see how she reacts etc before I go back to work but don't know what brands to try. Thanks.
Hi, I have a wee girl Matilda, 3.5 months, who has been diagnosed with gerd and is currently on Ranitidine and Domperidone. We have tried Losec and gaviscon infant too, and after trying pepti jnr and neocate we are now on elecare formula. Also have done the usual, raise cot, chiro, upright after feeds etc. We don't seem to be making much progress and its really heart-breaking to try all these medications on such a wee person! We do seem to have 3-4 great days when she is happy and contented but then have 3-4 terrible days with constant crying, not much drinking, so much vomit and terribly unsettled, not much sleeping etc; my question is, is this 'normal' ?! Is gerd cyclonic? Thanks, Amanda :)
My four month old son has recently been diagnosed with reflux after his feeding has become worse and worse over the last month. He will cry before and during a feed and constantly turns his head from side to side. It takes alot of coaxing to get him to drink. He has also started waking almost hourly through the night. We have tried gaviscon which gave him terrible constipation and now ranitidine. After reading the dosages on the spilt milk site we realized the dose we were given was far too low so have now been on a high ish dose for a week with little change. How long should it take to see a change? We also have a script for omeprazole so can try that next. Anyone else with a reflux baby also had these sleeping issues? Any tips welcome, we have raised the bed and keep him upright after feeds. Thanks in advance
Anyone recommend a good paediatrician in Auckland, son has reflux and looking to get some help!
How can I give my omeprazole granules to a 5 month old? I have been putting in pear puree but now want to introduce food and think this is putting her off wanting to eat!
Our membership form is now working again. Sorry for the delay. We are looking forward to meeting some new members. http://www.reflux.cryingoverspiltmilk.co.nz/grsnnz.../ Joining Gastric Reflux Support Network NZ for Parents of Infants and Children Charitable Trust gives access to our Newsletters and Private Local and National Support Networks. Membership is free, and this gives you opportunities to discuss gastric reflux related issues with others in a safe and confidential setting.
hi i have a nearly 8 month old girl, she is on ''Kari-care anti reflux AR'' now they say by six months the reflux or spewing up heaps of milk should be fine now. but im scared to put her on normal kari care cause she use to vomit like crazy, what formula should i be going on? thanks :)
Advice sought please. My bf 11mo has reflux which is basically under control with restricted diet (no dairy, no soy and query gluten intolerance too, so no gluten) for us both and 10mg omeprazole daily. Gaviscon as required. Acid symptoms generally improved. However still no sleep due to wind/tummy pain etc. and we are exhausted (waking hourly to 2-hourly in discomfort/wanting to feed). Found this remarkable thread re windy toddlers (err see first comment for link) which totally resonated. Wondered if any GERD families on here had wind issues and perhaps tried low FODMAP diet? Or had other tips to share re calming the entire GI tract, top to bottom? Thanks.