Reflux Management Tips

28 Aug 2016 | General Information

Reflux Parents’ Tips

Different techniques work for different refluxers so trial and error are needed to identify any that may help you. They may work for refluxers and silent refluxers alike. If you have any concerns, please discuss these with your child’s doctor or Child Health Nurse.

These tips are written by reflux parents for the benefit of reflux parents, based on their own experiences. They are of a general nature only and are not meant to replace medical advice.

  • Feed your baby while they are upright. Keep their body straight with their head higher than their stomach.
  • Try to keep your baby upright for at least 30 minutes after a feed. Try to avoid the upright seated position during this time as this position can increase pressure in the abdomen and trigger reflux.
  • Avoid placing your baby flat on their back immediately following a feed.
  • Avoid exposure to tobacco smoke.
  • Avoid overfeeding – if your baby vomits, wait until the next feeding rather than feeding them again. Check with the doctor or Child Health Nurse that their intake is appropriate.
  • Consider offering your baby a dummy (or your clean finger) if you are comfortable with this idea. The swallowing action may help your baby to settle. Talk to your child’s health nurse if you have any concerns.
  • Avoid rough handling or bouncing your baby (you may need to remind family and friends of this).
  • Leave a TV, radio or white noise music on for background noise so that the baby is not easily startled by loud noises.
  • Use products to help keep your baby upright or help calm them, such as an automatic baby swing, bouncer and/or baby hammock as suitable. IMPORTANT: Never leave them unattended or let them fall asleep unsupervised in these devices as they are not designed as sleeping products.
  • The best time to lay your baby on the floor is when their tummy is empty – for example, before a feed.
  • If possible, change your baby’s nappy before a feed rather than after, as reflux is more likely to occur with a full tummy. Take care to avoid lifting the baby’s legs too high to change a nappy; try rolling your baby to the side instead. If it’s necessary to change the baby after a feed, consider changing on an inclined surface.
  • Avoid any tight clothing around the waist such as tight nappies, and elastic waistbands.
  • Thickened feeds (AR formulas or infant formulas thickened with commercial thickening agents) may be effective for some reflux babies, especially those who vomit. Discuss this option with your child’s doctor first.
  • If a food allergy or intolerance is suspected, a two-week trial of hypoallergenic formula can be helpful if your baby is formula-fed. If you are breastfeeding, you may choose to eliminate specific foods – for example, cow’s milk and soy from your diet (with medical supervision). Consider the possibility of food allergy or intolerance in older children as well. Seek medical advice regarding this. Do not change your or your child’s diet before seeking medical advice. Talk to a dietitian.
  • Contact a reflux support organisation for further information and support. The effect on the baby AND the family can be devastating and support groups can provide more detailed information, and offer the emotional support you may need.
  • Burp baby frequently during the feeds (as tolerated) – for example, after finishing each side in a breastfed baby, and after every 30-60ml in a bottle-fed baby.
  • Try feeding smaller amounts slightly more frequently (unless this upsets the baby). Frequent large feeds can trigger reflux.
  • Massage can be soothing to babies and children, and it can also aid digestion. Learn how to massage your baby/child so they get the most out of it.
  • Minimise foods and drinks if they cause irritation or increase the risk of reflux. Examples of these may be spicy foods, citrus fruits, tomatoes and other acidic food, fatty foods and caffeine.
  • If your baby is under 12 months of age, elevating the head of the bed is not supported by evidence from research studies (Craig, Hanlon-Dearman, Sinclair, Taback, & Moffatt, 2004). It may be helpful in reducing episodes of reflux in a child who is over the age of 12 months.
  • For children over the age of 2 years, adapt the management strategies to suit – for example, avoid lying down for several hours after meals, eat smaller meals more often etc. You may also like to encourage them to avoid large meals before exercise or stressful events such as exams, and avoid or minimise caffeine.
  • Encourage older children to find a comfortable sleeping position. Sleeping on the tummy or side may be helpful.
  • Older children/teenagers may consider using sugar-free chewing gum after meals, as it may reduce acid reflux and help clear acid from the oesophagus.

 

Additional Suggestions from RISA Members

“Go for a walk outside if you can – the screaming never seems quite so loud in the great outdoors.”

“Put your answering machine on/take the phone off the hook when you get a chance to rest.”

“Invest in a portable phone if possible. This allows you to keep in touch with friends and family whilst still attending to your baby’s needs. It is also perfect to keep beside you during baby feeding times, as the phone almost always rings after you get settled.”

Download the printable version of Reflux Management Tips (PDF).

This article is written for the benefit of reflux parents, based on the experiences of reflux parents. It is not meant to replace medical advice and is of a general nature only. If you have any questions or concerns, please seek advice from your medical professional.

Article by:

Written by Glenda Blanch, RISA Inc member and author of Reflux Reality: A Guide for Families in association with RISA Inc © 2010.

Additional information on gastro-oesophageal reflux is provided in our book Reflux Reality: A Guide for Families.

References:

  1. BabyCentre UK Medical Advisory Board. (2008, January). Caffeine and pregnancy: what’s safe? Retrieved April 19, 2008, from Baby Centre UK: babycenter.com.au/pregnancy/nutrition/foodsafety/caffeine
  2. CDHNF. (2007, September 24). Pediatric Gastroesophageal Reflux Evaluation and Management. Retrieved April 28, 2008, from Children’s Digestive Health and Nutrition Foundation: gerd.cdhnf.org/User/Docs/PDF/Slides/GERD_Core_Set_1_Hour.pdf
  3. CDHNF. (2007). Pediatric GERD. What’s Up With My Kid’s Stomach? Retrieved April 2, 2008, from Children’s Digestive Health and Nutrition Foundation: /gerd.cdhnf.org/cms/en/PatientsAndFamilies/Kids/Patients_Kids_Landing.aspx?menu=patientskids
  4. CDHNF. (2006, March 9). Teen’s Checklist for GER or GERD. Retrieved April 30, 2008, from Children’s Digestive Health & Nutrition Foundation: gerd.cdhnf.org/User/Docs/pdf/GERDTeenChecklist.pdf
  5. Craig, W. R., Hanlon-Dearman, A., Sinclair, C., Taback, S., & Moffatt, M. (2004). Metoclopramide, thickened feedings, and positioning for gastro-oesophageal reflux in children under two years (Review). Cochrane Database of Systematic Reviews (3), Issue 3. Art. No.: CD003502. DOI:10.1002/14651858.CD003502.pub2
  6. Harnsberger, J. K. (2008). Management Algorithm #2: Management of a Child or Adolescent With Chronic Heartburn. Retrieved April 2, 2008, from Medscape Pediatrics: http://www.medscape.com/viewarticle/494079_12
  7. Henry, S. M. (2004). Discerning Differences: Gastroesophageal Reflux and Gastroesophageal Reflux Disease in Infants. Advances in Neonatal Care, 4 (4), 235-247
  8. McLoughlin, H. (2008). How To Use Infant Massage to Relieve Reflux. Retrieved June 20, 2009, from How to Do Things: howtodothings.com/family-relationships/how-to-use-infant-massage-to-relieve-reflux
  9. Nielsen, R. G., Bindslev-Jensen, C., Kruse-Andersen, S., & Husby, S. (2004). Severe Gastroesophageal Reflux Disease and Cow Milk Hypersensitivity in Infants and Children: Disease Association and Evaluation of a New Challenge Procedure. Journal of Pediatric Gastroenterology and Nutrition , 39, 383 – 391
  10. Schwarz, S. M., & Hebra, A. (2009, May 13). Gastroesophageal Reflux. Retrieved August 26, 2009, from eMedicine: emedicine.medscape.com/article/930029-print
  11. Van Niel, C. W. (2008, March 12). Treat Babies with Reflux Conservatively. Retrieved March 31, 2008, from Journal Watch Pediatrics and Adolescent Medicine: pediatrics.jwatch.org/cgi/content/full/2008/312/4
  12. Vandenplas, Y., & Sacré, L. (1987). Milk-Thickening Agents as a Treatment for Gastroesophageal Reflux. Clinical Pediatrics, 26 (2), 66-4
  13. Vandenplas, Y., Rudolph, C. D., Di Lorenzo, C., Hassall, E., Liptak, G., Mazur, L., et al. (2009). Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of NASPGHAN and ESPGHAN. Journal of Pediatric Gastroenterology and Nutrition, 49 (4), 498-547
  14. von Schönfeld, JV et al 1997, ‘Oesophageal acid and salivary secretion: Is chewing gum a treatment option for gastro-oesophageal reflux?’, Digestion, vol. 58:2, pp. 111-114, viewed 21 July 2008
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