We are proud to announce that Laura Barmby’s booklet, Breastfeeding Your Baby with Reflux, is now available for free. I have a month old daughter who is suffering terribly. I have been breastfeeding since she was born in November 2011. I decided to pump vs. actual breastfeeding (BF) because I’m always thinking she’s not getting enough food. Since I started BF, she has had all the foremilk-hindmilk imbalance symptoms, except not gaining weight. She has been gaining weight appropriately. Because of diarrhea, we took her to the doctor, and they found microscopic blood. Also, they said she had acid reflux and wanted us to start her on Zantax. We said No to Zantax because she wasn’t spitting up much.

Babies with reflux need to be positioned so gravity can help keep the food from coming back up out of the stomach. Many babies with acid reflux are held upright almost every waking minute. In the past it was recommended that babies with reflux should never be left on their backs because refluxed food may be aspirated into the airway or lungs more easily in this position. Babies with reflux were always kept in a prone (face down) position when sleeping. These positioning instructions are now being questioned in light of the Back to Sleep Campaign. Only you and your doctor can determine whether the risk of SIDS or the risk of reflux aspiration is greater for your child. If your child experiences apnea or misses breaths, consult your doctor immediately. An apnea monitor may be used to determine whether your baby is safer on his or her back or stomach.

Many mothers find the traditional cradle hold to be the easiest. The mother sits up, perhaps with a pillow behind her back for support, and holds the baby’s head in the crook of her elbow, with her hand holding the baby’s buttocks or thigh. The baby should be lying on his side, facing in toward the mother. He should not have to turn his head to take the breast, and his mouth should be right at nipple level. It might take two or three pillows to get him to the proper height. For a baby with reflux who has problems with choking during feedings, the mother might modify this position by leaning back slightly, supported by pillows, so that her breast is angled up and the baby’s neck and throat are a little higher than the nipple. A baby with reflux may have fewer problems with keeping the milk down if he is held somewhat upright during feedings, well supported on mother’s arm or with firm pillows.

Another common recommendation is that parents thicken the liquids that their baby receives by adding cereal to the bottle. The theory is that thick food has a harder time bouncing back up the esophagus, but research has not proven this to be effective. You should be aware more bonuses that giving bottles of thickened milk, even thickened breast milk, can interfere with breastfeeding. If you and your doctor decide this is worth a try, you may want to do it only on a trial basis to see if there is any improvement in your baby’s health or demeanor.

Some babies with reflux do not have a problem with food refusal; they eat and eat and eat. These babies find nursing to be soothing because each sip of milk washes down some acid from reflux. The problem may be that they continue to nurse long past the time they need to fill their tummies. They nurse to the point that they seem to vomit every time they eat. If this description fits your baby, pacifier use may be a help. If the pacifier is given when the baby is not nursing for food (sucking slowly and less frequently, not a lot of swallowing), it may be soothing to him and a relief to you. The careful use of a pacifier may help your baby keep from overfilling his tummy and subsequently vomiting.

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