Weaning and Reflux
What are Reflux and Silent Reflux?
Most babies suffering from reflux are diagnosed within the first few weeks of life. The symptoms of reflux vary but the most common one is discomfort when feeding. Your baby may arch their back, scream, refuse the breast or bottle and physically turn away.
How does reflux happen? When your baby drinks milk it travels down their oesophagus and in to their stomach where the acid gets released to start breaking it down. The diaphragm in your baby should contract and close the gateway between the stomach and oesophagus, preventing regurgitation of the contents. If the gate doesn’t close then the milk, which is now mixed with acid, bubbles up and burns the oesophagus causing pain and possibly vomiting. If your baby experiences the pain but doesn’t vomit they may be diagnosed with “silent reflux”.
The taste of the acid isn’t nice, so your baby probably wants to feed again to wash it away – a comfort feed. However, their stomach is probably already full, so this has a negative effect and causes more vomiting because they will have overeaten. Now you can probably see why weight gain/loss is never a good indicator of reflux, because some babies avoid eating to avoid pain, while others overeat to get rid of the acidic taste.
Jen’s Story: Jen came to see us with her 9 month old son, Charlie, who was showing signs of fussy eating. She was at her wits' end and had been following the “controlled crying” method, allowing Charlie to “self-soothe”. From the case history it was clear that Charlie was likely to be suffering from reflux. Osteopathic examination showed that his diaphragm was restricted and unable to contract to fully close the stomach. Following referral to a paediatrician, an endoscopy was performed and Charlie's oesophagus was found to be ulcerated from the repeated acid burns. Charlie's apparent fussy eating issues were therefore actually a sign that he was in pain from the reflux.
Weaning a reflux baby early
Many parents choose to introduce their baby with reflux to solids a little earlier than other children, the reason being that gravity holds heavier food down more easily. If you picture the stomach as a drawstring bag and you drop a heavy tin inside then the bottom of the bag gets pulled down and the top comes together, closing the gateway. Many people will tell you that this goes against the ethos of baby-led-weaning as you should wait for your baby to show the signs they are ready before introducing solids.
However, if you are introducing solid food early to help your baby cope physiologically with eating, then we would say that this is certainly in line with the ethos of baby-led weaning, as you are following your individual baby’s needs. If your baby has reflux and you feel they will benefit and your GP or health visitor sees no issue with weaning early, then you go should ahead and follow your parental instinct.
Never introduce solid food before 17 weeks, unless instructed to by a health professional
Serving food to a reflux baby
We have always said that purees have their place and this is also goes for a reflux baby. Serving up a variety of textures can be helpful - so, serving a combination of purees and chunky solid foods but still allowing your baby to self-feed. You may either find yourself having to pre-load a spoon of puree and allow them to guide it into their own mouth or they may be happy to slap their fingers in the puree and pop it in their mouth. Don't let the reflux put you off - allowing your little one to play with the food, dip their fingers in mush, pick up a stick of something and pop it in their mouth is definitely still possible with a reflux baby.
Here are some general guidelines:
- Relax. Remember that you and your child are attuned to each other, so any stress you feel will automatically be picked up by your child. When your child cries it also resonates with you in a unique way, which it would not with another adult. Stress from either of you is sensed by the other.
- We always suggest sitting and eating with your baby for safety reasons as well as to ensure that your baby grows up seeing mealtimes as a pleasurable time where he gets to engage with mummy rather than being left whilst mummy washes up! However, with a reflux baby you need to be even more alert to spotting a particular food that might be causing pain, so make sure you sit with your baby and enjoy mealtimes together
- Forget about offering a “balanced diet” because nutrition until the age of 9 months comes from milk feeds. In the period between 9-12 months of age, your baby will have got the hang of feeding and nutrition will begin to play a bigger role. The milk feeds will naturally reduce as more solids go down.
- Reflux babies will gag in the same way as any other baby – read more on gagging here.
- Babies with reflux tend to vomit more easily when they gag, so try to avoid serving a milk feed too close to solid foods.
Solids before milk
When weaning, many people suggest serving a milk feed before a solid food so that your baby doesn’t get fractious and hungry while trying to eat the solid food. With a reflux baby it can be best to reverse this and serve solid food before the milk feed. The reason is that if we think again of the diaphragm as a bag, having the solid food in it to weigh the bag down before offering a milk feed can actually help to reduce the reflux. On average, leaving an hour between a solid feed and a milk feed can be helpful.
Which foods should I serve to a reflux baby?
A combination of purees and finger foods are ideal so that they get the opportunity to choose, self-feed and try a combination of textures. Some examples include our Broccoli Bonananza and Cucumber Platter, which all have sloppy foods and firm foods to keep things interesting and cater for different degrees of reflux.
Which foods should I avoid with a reflux baby?
There are some “risky reflux foods” that are renowned for aggravating reflux. However, just because these foods are common reflux triggers doesn’t mean they are going to be a trigger for your baby. Try introducing one “risky reflux food” at a time and see how they get on before deciding whether or not it is risky for your baby.
Risky reflux foods include:
- Acidic Foods: such as apple, tomato, peppers, onions, berries, oranges, kiwi, grapefruit
- Tomatoes: some babies can tolerate cooked and some can tolerate raw and some can tolerate none at all so you might need to experiment
- Fruit Juices: Such as prune, pear and apple which are high in sorbitol