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 an alternative to standard cow’s milk based formula for one week**.|
|Check latching/feeding, flow of milk and position|
|Not working?||Not working?|
|Karicare Aptamil Food Thickener or Baby Rice***.||Try these thickeners/formulas: AR Formula, Karicare Aptamil Food Thickener, Baby Rice***, Cornflour (cooked).|
General Management Techniques
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 except for during “tummy time”. (Tummy time is important and newborns should have this at least once a day: http://www.plunket.org.nz/your-child/newborn-to-6-weeks/play-and-learning/)
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? (This is only an option if LMC and Parents are comfortable with it. Consider latch and milk supply issues.) Sucking gives comfort but feeding continuously may exacerbate or encourage more GOR episodes. See Dummy or no dummy? by Pinky McKay on Essential Mums for pros and cons.
|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 “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 may 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. However, with the move away from prescribing for GORD by many Health Professionals unless there appears to be significant pain, severe complications, growth issues or difficulties feeding it may be appropriate to discuss thickeners with your Health Professional (doctor, Well Child Provider or dietician).
*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.
**For advice on 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 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.
NB: Raising the head of the bed is no longer recommended and studies have shown that “head elevation may not always be of clinical value“. http://pediatrics.aappublications.org/content/early/2011/10/12/peds.2011-2284.full.pdf and http://www.changeforourchildren.co.nz/files/docs/infant%20positioning%20and%20reflux.pdf Some health professionals still recommend raising the head of the bed and we would advise that you should only do this after discussion with your own health professional.
© 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 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.”