Answer: Hi Bel,
Congratulations on the birth of your little boy. I am sorry to hear how tough things are, and I’m not surprised you are exhausted! People often don’t understand if a baby is sleeping through the night, that the mother can be exhausted, but as you say, he requires your attention all day long.

My first suggestion is to talk to your doctor- you don’t mention if you have done that, although that is a very important first step. It is essential to get a formal diagnosis of reflux, as there are other conditions that can present similarly (for example urinary tract infection).

With regards to sleeping him on his side, have you been advised to do this by your doctor? Just so that you are aware, side sleeping is not recommended as an alternative to sleeping baby on their back because of safety aspects. It is not a stable position and they can easily roll onto their tummy from that position, and according to SIDS and Kids, no positional devices are recommended. Unless your doctor has advised otherwise (in writing), a baby with reflux should be placed on their back to sleep on a firm, flat mattress that is not elevated; in keeping with recommendations from SIDS and Kids. You can find further information about safe sleeping on their website (www.sidsandkids.org).

If you have been to see your doctor and you do have a diagnosis of gastro-oesophageal reflux, then there are some other things you can try. Have you discussed with your doctor the use of medication? Sometimes lifestyle changes can help, but there are times that medications are necessary too, so don’t automatically discount that. It is often a matter of trial and error and trusting your instincts, until you find something that works. Remember that it is important that any strategy you try is safe for your baby.

Some of the strategies you may like to try are:

• Feed him in an upright position, and keep him upright for half an hour afterwards. Avoid car seat positioning in that time as that can cause more reflux by increasing pressure on his tummy. Also avoid slumping, for the same reason
• Avoid exposure to tobacco smoke
• Avoid placing him flat on his back immediately following a feed
• Try feeding him smaller amounts more often however if this distresses him, try the opposite and see if that helps
• Burp him frequently throughout a feed
• Avoid overfeeding- if he vomits straight away, don’t feed him again, but wait until his next feed. If you are unsure, talk to your child health nurse to ensure he is feeding enough
• Thickened feeds are sometimes effective. You don’t mention how you are feeding, but it can be achieved with both breast and bottle feeding. you can use commercially pre-thickened formulas for bottle feeding, or add a commercial thickening agent to the bottle. Alternatively, you can offer a spoonful of thickened milk before, during or after a feed
• Avoid tight nappies and elastic waistbands and ensure clothes are loose fitting
• Consider offering a dummy if you are comfortable with the idea
• Consider the possibility of food sensitivities. Over 40% of babies with reflux suffer from cow;s milk allergy, and half of these suffer from sensitivity to soy. Other foods can also be implicated, so it is a difficult area. If you are bottle feeding, it may be a matter of using a specialised formula (on prescription from your doctor); and if you are breast feeding, it may entail you avoiding all traces of cows milk and maybe soy products as well. This is a complicated area, and if you find this helps, it is important to get advice from your doctor or a dietitian (who specialises in food sensitivities).

If you are already trying these things, then medication may be your next step. You may also like to try altering his routine- so instead of feed/play/sleep, perhaps it would be worth trying feed/sleep/play (but remembering to keep him upright for half an hour following a feed). Babies and children are all different, and sometimes it’s worth trying other ideas or routines, just to see if it helps.

Hopefully some of those ideas will help. Remember to trust your instincts, and to also stay in contact with your doctor.

Glenda