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Reflux and Weaning

Posted by felicity Thursday, February 21, 2013

Weaning a Baby With Reflux

 
Not much is written about reflux and weaning but that’s probably because a paediatric osteopath and child psychological therapist have never gotten together to sift through the research.

 

What is 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 turn away.
 
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, now mixed with acid, bubbles up and burns the oesophagus causing pain and possibly vomiting. If your baby has 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. But since the stomach is probably full already this has a negative effect and causes more vomiting as they have overeaten. You can probably see now  why weight gain / loss is never a good indicator of reflux since some babies avoid eating to avoid pain and others overeat to get rid of the acidic taste.
 
 reflux.gif
 
 
Jen’s Story: Jen came to see us with her 9 month old, Charlie, who was showing signs of fussy eating. She was at her wits-end and has been following the “controlled crying” method, allowing Charlie to “self-soothe”. From the case history it was clear Charlie was likely to be suffering from reflux. Osteopathic examination showed his diaphragm was restricted and unable to contract to fully close the stomach and following referral to a paediatrician an endoscopy was performed and the oesophagus was found to be ulcerated from the repeated acid burns.

 

 



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 is 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 this goes against the ethos of baby-led-weaning since you should wait for your baby to show the signs they are ready before introducing solids. 
 
But, introducing solid food early is baby-led weaning since 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 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 purees have their place and this is the same with a reflux baby. Serving up a variety of textures can be helpful so a combination of purees and chunky solid foods but still allowing your baby to self-feed. You may find yourself having to pre-load a spoon of puree and allow them to guide it in to their own mouth or they may be happy to slap their fingers in the puree and pop it in their mouth. Allowing your little one to play with the food, dip their fingers in mush and pick up a stick of something and pop it in their mouth is still possible with a reflux baby.
 
Here’s some general guidelines:
 
  • Relax. Remember that you and your child are attuned so any stress from you will automatically be picked up by your child. When your own child cries it resonates with you in a way different to any other person, that is the attunement, so any stress from you will be picked up by your little one
  • We always suggest sitting and eating with your baby for safety reasons as well as for ensuring your baby grows to see 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 t spotting a particular food which might be causing pain so sit with your baby and enjoy mealtimes together
  • Forget about offering a “balanced diet” since nutrition to 9 months comes from milk feeds. From 9-12 months they will have got the hang of feeding and nutrition will begin to play a bigger role as the milk feeds 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 and so try to avoid serving a milk feed too close to the solid foods.
 

Solids before milk

When weaning, many people suggest serving a milk feed before a solid food so your baby doesn’t get fractious and hungry whilst tying to eat the solid food. With a reflux baby it can be best to reverse this and serve solid food before milk feed. The reason being is if we think again of the diaphragm as a bag, having the solid food in it to weigh the bag down before offering  milk feed can actually help reduce the reflux. On average, leaving an hour between a solid feed and a milk feed can be helpful
 

What foods should I serve a reflux baby?

A combination of purees and finger foods are ideal so 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 it interesting and cater for different degrees of reflux.
 

What foods should I avoid with a reflux baby?

There are some “risky reflux foods” which are renowned for aggravating reflux. However, just because these foods are common reflux triggers doesn’t mean they are going to be a trigger in your baby.  Try introducing one “risky reflux food” at a time and see how they get on before deciding whether or not it is in 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
Some ideas for first foods for a baby with reflux are BroccoliBonanza and Cucumber Platter
 
 
We like to set our little ones a good example and encourage sharing. We don't mind you using any of the information, recipes and tips from our website, all we ask is that you credit us hard-working mummies here at Yummy Discoveries. 
Thank you x