A childbirth educator and doula's scrapbook of birth wisdom, information, media links, research, birth stories - and some of the truly daft things people say and write about birth and babies.
Sarah Johnson is a doula and HypnoBirthing practitioner in London, UK. She is also a journalist and author
Tuesday, May 17, 2011
Is it reflux? Is it colic?
I've been finding out some fascinating stuff about reflux and colic and I'd like to share it with you.
Every other baby I meet these days seems to have something called reflux but an awful lot of these babies seem to have what in my day we just called colic. It's really confusing - are they the same thing?
So here's what I've found so far.
Gastric Oesophageal Reflux (GOR) is the normal phenomenon of stomach contents washing back past the oesophageal sphincter into the oesophagus. 70% of all healthy, happy, thriving babies do it several times a day. The peak period is 3-7 months and normally babies have stopped by 12-15 months old.
Gastric Oesophageal Reflux DISEASE (GORD) is when the reflux causes the baby pain and/or not to thrive because it is affecting digestion, feeding and causing damage to the oesophagus
My take on this: GOR is when the spitting up is mainly a problem for your laundry basket. GORD is when it is distressing the baby persistently and causing poor health.
“Silent reflux” – no outward signs (i.e. no regurgitation) but baby is unhappy because stomach contents are washing up a short way into the oesophagus àoesophagitis.
NB: JUST BECAUSE IT LOOKS LIKE REFLUX DOESN’T MEAN REFLUX IS CAUSING THE PROBLEM – THERE MAY BE UNDERLYING REASONS! Such as excessive gassiness, constipation, a food intolerance (especially to cow’s milk/soy milk), INFECTION, sensitivity to tobacco smoke, “colic” (baby is too little “switch off” crying) – MUM SHOULD ALWAYS CONSULT DOCTOR IF IN DOUBT (see “red flag” list)
An easy way of remembering the various solutions for GOR and GORD is:
·Gravity – anything that helps the food go down and the air go up
·O (= a boob!) – improve the breastfeeding technique or pattern
·Reassurance/relaxing – anything to soothe baby (and mum)
·Diet, Doctors and other health professionals – medical and alternative therapy solutions
Baby as upright as possible during feed – eg in a wrap sling
Keep upright after feed 30 to 40 mins – a sling/carrier can help a lot
Baby upright as when over your shoulder rather than slumped in a chair (American Journal of Paediatrics, Orenstein and Whitington, October 1983)
Frequent burping BEFORE, during and after feed
Avoid car seat immediately after feed
Avoid nappies or clothing tight round tummy
Baby at 30 degrees – not flat – in cot or on babygym
When changing nappy, put a cushion under baby’s head
Sleepcurve and special wedges
O= a boob (Better breastfeeding)
Check the latch – getting air in?
One breast at a time, allow baby to continue until stops.Sucking à continuous muscle movement through digestive tract àkeeps it all going down; baby emptying breast ensures baby ends with calorie-rich hind milk which stays in stomach longer; at end of feed flow is slow àless coming in at top while muscle movement still keeping things moving down.
In some cases with overactive letdown even two feeds in a row on one breast. Consider whether using a breast pump in between feeds is really helping.
Feed baby when not over-hungry so not gulping in air.
Feed baby more often to encourage smaller, more manageable feeds and more downward action.
Reassuring, relaxing and soothing
A pacifier helps baby carry on the helpful sucking action
Atmosphere calm and cosy –You are not a failure if you can’t “stop the baby crying”, you are a hero for giving baby the kind of environment that helps baby to calm self eventually
Mum relaxed with a glass of wine? (recommended byDr Jack Newman!)
Massaging Baby tummy and back, upright
Movement that is rhythmical and swaying - rocking, buggy, swing-seat, your lap, your arms
Support from others: Take turns, Find another mum with a colicky/reflux baby
Diet, Doctors (and other health professionals)
Write down everything mum eats for 3 days and log fussy episodes – is there a pattern?
Try cutting out one suspect eg dairy products for 3 days
All these foods and substances have been implicated in GOR and GORD: