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.”

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