Baby Led Weaning

Growing healthy babies with healthy appetites

Reflux advice from Someone Who’s Been There…

Eleanor, one of our forum members, very kindly wrote a piece about what it’s like to have a BLW head on while weaning her reflux-y little darling. Thanks, El!

 

Reflux and BLW

The following is what I’ve gathered from my experience with a baby who suffers from gastric reflux. Not all babies have the same issues and this isn’t meant to be a substitute for advice from your GP or health visitor.
What is reflux?
Gastric reflux means an inefficient valve at the top of the stomach lets food and acid flow back into the baby’s throat, causing pain and usually vomiting (in “silent reflux” babies aren’t actually sick). Reflux babies typically arch and writhe around during milk feeds. They can be very windy and are sometimes misdiagnosed as just ‘colicky’. They’re happiest being held upright and tend to sleep badly, especially on their backs. Many are comfort eaters, constantly wanting to feed to soothe themselves and wash down the acid, which creates a vicious circle because the extra milk has to come back up again. (The comfort-eating refluxy baby often gains weight fast despite frequent vomiting, and again this can mean misdiagnosis if it’s assumed that a good weight gain means no “real” problem.)
Why is it sometimes advised to wean refluxy babies early?
A baby who is uncomfortable with a tummy full of milk – liable to vomit which then causes pain, wind, more vomiting and disturbed sleep – may be happier having some of that milk replaced by mush. This was the case with my son, who was miserable and sleepless by 5 months. Introducing purees wasn’t a magic bullet but it made him more relaxed and the laundry mountain decreased slightly.
If I have to wean my refluxy baby early, does this mean BLW is off the menu?
BLW works by relying on milk to keep babies nourished until they’ve learned to feed themselves larger amounts, whether that happens at 9 months, a year or beyond. If you have to get some food into your baby because they’re uncomfortable on milk alone, it’s hard to be truly ‘baby-led’ – especially if your baby is sometimes confused about ‘hungry’ and ‘full’ signals because of the discomfort of reflux symptoms and the comfort-eating habit. But having weaned one baby the BLW way and now another the traditional way, I believe you can definitely do traditional weaning with a BLW hat on.
These are the BLW principles that you can still follow even when you’re spooning:
- Relax and enjoy it. Have fun helping them explore new foods and sharing sociable family meals.
- Like other babies, they’ll have times when they’re not keen to eat or even go on strike (teething, colds, just not in the mood…) Hang in there. It will pass.
- It’s easy for spoonfeeding to become all about ‘accepting’ or ‘rejecting’ the spoon, but try not to give in to that mindset. At least with a pukey baby there is little temptation to play “here comes the aeroplane” to try to get them to take more than they want!
- Offer chunky finger foods at 6 months or thereabouts, alongside the spoonfeeding – when the baby can reach for them and pick them up. Ricecakes, toast, melon, banana, broccoli and butternut squash were all early favourites here.
- Follow the baby’s signals: if a particular food seems to cause pain in swallowing, or make reflux symptoms worse, forget about it for a while. Plenty of time to try again later.
- Don’t worry about a ‘balanced diet’ yet. Food is still for fun and milk for nutrition until they’re one – even if you have to try to “get some into them” for tummy-comfort.
- Don’t worry about gagging. Most babies gag as they’re learning to eat, but if it doesn’t upset them it isn’t a problem. If it does upset them, just move on, offer water, something else to eat, or playtime instead. (It’s a very good idea to do an infant resuscitation course so you would know what to do in the event of choking.) Reflux babies may gag more and for longer, on mush as well as finger foods, and in our experience this ruled out ‘bookending’ meals with the offer of milk before and after: the slightest gag, and the whole bellyful came back up.
So what doesn’t work?
The big difference I’ve found between BLW and puree-weaning a reflux baby is there’s not much scope to feed on demand. Unrestricted milk feeds are central to BLW, so that they’re nourished even when they eat little. However, my son needs to wait at least an hour between milk and solids, preferably two hours. Extra feeds within that window end up making him feel worse, as the extra milk comes back plus whatever solids he’s eaten.
What can’t reflux babies eat?
Acidic foods seem to cause problems for many: this may rule out apple, tomato, onions, citrus and berries. (None of these are great early BLWing foods anyway but you’ll find them in most prepared baby foods.) And as with any weaning method, if you have a family history of allergies you may want to introduce dairy, wheat, etc. at intervals and keep a food diary. But don’t assume that you have to stick to ‘safe’, bland foods. Babies often love strong flavours and trial and error is the key.
I’m very happy to be PMed via the forum if anyone wants to compare notes. There’s some good advice here http://www.babyreflux.co.uk/knowledge/questions/41/Weaning+%26+Reflux – they also reiterate that health-care professionals should be your first call for personalised advice for your baby.
Good luck and have fun!

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34 Responses to “Reflux advice from Someone Who’s Been There…”

  1. Nicole Crowley says:

    This is such good advice. My son (now 11.5 months) suffers from reflux, and although it’s better it’s not solved totally. I tried a fully BLW approach with him, but it wasn’t right for him, so we went for a mixture (although he would never accept purees) of traditional and BLW, which has worked well. He gags alot, but copes well mostly, and lately raspberries have become his favourite food.

    Thanks so much for debunking a lot of myths that I believed about BLW a refluxer.

    Nicole

  2. Eleanor says:

    Thanks :) DS is 11 months now and his reflux is very much better lately – cow’s milk turned out to be his major problem (including what was coming through in my milk). It’s so nice not to be running the washing machine three times a day …

  3. Naomi says:

    Thanks for the great article. Your description of your baby is a perfect match for our precious but uncomfortable son. After many difficult months he was finally diagnosed with silent reflux (despite being told many times that he was putting on weight and so was fine) and cow’s milk protein allergy. I started rice cereal and mashed pear at 4mths and it has really helped him. He is now 5.5 mths and I am starting to get ready to introduce more foods. Your advice on how to do a mixture of BLW and the traditional mashed food has been really helpful. Sounds like fun :) Thanks again!

  4. Derya says:

    My son was diagnosed with reflux. I hated giving him prescription medicine at less than two months old. It just didn’t seem right. Then, I did a lot of reading about it online, and realized that he might be allergic to cow’s milk. For the next pediatrician appointment, I took a poopy diaper with me (hehe gross) and showed it to the doctor, and she agreed that it was milk allergy. 10 days after I eliminated all dairy from my diet, he stopped spitting up all the time and was able to sleep at night. It was amazing. So, some times reflux is a symptom.

    Thank you very much for this post. He is about to start solid foods, and I feel much better about it now.

  5. Abi says:

    Really informative. Thanks for posting Eleanor.

  6. Linda says:

    I like all the advice posted here about BLW and reflux. Eating does help with the reflux, but I am keen to make BLW work for us. I am using a combined approach too, and it works fine for us.

    Another advice I have on gastric-reflux is to carry your baby in a sling upright as much as you can and especially after meals. It means that your baby my fall asleep on you a lot and then you are literally stuck with carrying him/her for a bit but I find it more than worthwhile to keep the reflux at bay. I had a baby who wouldn´t sleep on his back, ever, as the acid immediately started running up his oesophagus.

    Good luck lads and ladies

  7. kate says:

    really good advice.. best description of my 5 month old sons symptoms I’ve ever read and good tips for weaning him. Thanks

  8. [...] oooh, on the same website too, there is a good post about weaning with reflux which has helped me and shows BLW isnt so cut and dry the way some mums make it out and you can TW with a BLW hat on…yay!…. http://www.babyledweaning.com/features/999-2/ [...]

    • Aitch says:

      BLW can’t be cut and dried, can it? It requires co-operation from a six-month-old (approx) baby, who will very much put their stamp on things… but then on this site we are pretty anti-dogma. there is the way things ‘should’ work… and then there is the way things ‘do’ work, in your house, with your baby.

  9. LauraP says:

    Ok I officially love this website. Im TW my LO since she was 20 weeks on advice from our doctor due to her severe reflux and its going great but I wanted to BLW so its good to know I can combine the two so to speak. Id been told unequivocaly by some of the mums out there on the internet that I couldnt.

    • Aitch says:

      ah you see, as a fello mum on the internet i recommend listening to yourself and your baby first and foremost, and to ignore the peanut gallery who want to tell you how things must be.

  10. RachelL says:

    My son has severe silent reflux and milk allergy. He is breastfed and feeds frequently but only takes a little at a time and has struggled with weight gain… 8lb 13.5oz born and still only 15lb at 7 months. We even tried offering bottles but the problems remained- milk does not sit well with him.

    Now fully weaned, LO is fully BLW- we don’t do purees/ mashed at all. I intended to use purees as this is what I had done with my daughter but he just grabbed the spoon from me every time so I reverted to BLW and have to say I’m loving it! He was obviously hungry so started cramming the food down from day one and has is capable of picking up pretty much anything to get into his mouth. His weight gain has been much better since weaning and he is SO much happier after solid food. In fact, my dietitician has advised offering him a snack after his mid-morning and mid-afternoon breastfeeds as well.

    Just wanted to let you know that sometimes solid food will sit better with a reflux baby and you will not necessarily have to offer purees as well.

    • Josefifi says:

      I just wanted to add my own experiences in case anyone can make use of them.

      My LO was sick many times a day from birth, but she didn’t appear to be in any discomfort and was happily putting on weight (she was a comfort eater as described in the article). When she hit 4 months it all went downhill and she displayed the all the usual reflux symptoms – she was very unsettled, crying and arching her back during feeds, poor sleeper at night and refused day time naps… At this point she was being sick between 15 and 30 times a day and I was getting so worried about her nutrition. I was trying to increase her feeds as she was asking for less and less breastfeeds, it was a battle situation and it was horrible. I truly believe we were very close to a nursing strike.

      We were advised to start weaning her, but my little Sausage turned her head and clamped her mouth shut if she even saw me eating from a spoon, UN peace keepers would have to be called in if we attempted to put a spoon anywhere near her person!

      So we made the decision to medicate her, after an unsuccessful week with infant Gaviscon (made her constipated and didn’t improve her symptoms) we saw a consultant at the hospital who diagnosed severe reflux and put her on Ranatidine and Domperidone. She improved almost over night. She still vomited once or twice a day, but she was happy again.

      So a few weeks later we began our BLW journey, She’s done so well and now at nearly one, we’ve begun to reduce her medication.

      We learnt a lot on the way that I hope you’ll find useful in addition to the advice from Eleanor and others above:

      -Understanding the physiology of the problem helped me worry less. There is no valve (sphincter muscle) at the top of the stomach. The two things which prevent regurgitation are:
      1/ peristalsis (= the normal contractions of the muscles along the gut which move food downwards)
      2/ the esophagus connecting with the stomach at an angle of about 20 degrees to the perpendicular, so that the food can’t go straight back up.
      The problem with refluxy babies is that their stomachs haven’t yet developed this angle/tilt. It’s purely developmental and that’s why the problem more often than not resolves itself within the first year (sometimes 2)

      -Even just a tiny bit of solid food can help keep the milk down, I could tell the days she’d eaten a bit of steamed carrot she was happily whacking on her highchair tray and the days she hadn’t by the reduction in sick cloths! So don’t feel that you must completely wean them onto solid food and off milk as soon as possible

      -Raising the head of the cot with a few books under its legs really does help them to sleep better

      -Foods which we found made reflux symptoms worse were: acidic fruit (oranges, grapefruit,kiwi etc); tomatoes (only cooked, raw ones were fine); and cucumber. Some foods I thought may pose a problem such as berries (blackberries, strawberries) and grapes were absolutely fine. So my advice would be to introduce one new “risky reflux food” at a time and see if it affects your baby before you restrict their diet unnecessarily.

      -I read an academic study which found that almost 50% of babies with reflux have an intolerance to milk which causes their symptoms. The gold standard test so see if this is the case with your baby is to remove ALL sources of milk and soy (check any processed food labels) from your baby’s diet (and yours if you breastfeed) for 2 weeks. If symptoms resolve during this time, it is still important to challenge the intolerance by gradually adding milk back into baby’s diet to be certain that milk was the cause before eliminating it long term (please only do this with medical professionals go ahead).

      Thanks for reading, hope it helps someone xx

  11. Sammy Ward says:

    I can really relate to this write up & comments having a breast fed 12 week old baby with severe reflux, Im close to tears most of the time as our GPs will only give very basic medications at the moment so she is currently on a combination of Gaviscon, Ranitidine & now Lactulose (to combat the constipation caused by the Gaviscon), she wont lie flat on her back so she is practically propped upright in her moses basket at night which must also be a bit uncomfortable for her as the poor little poppet ends up in a crumpled heap at the bottom & I have to sit with her upright for a long periods before I can put her down after each feed but it ususally still pumps back out of her, even when she is on my shoulder. During the day I put her in a reclining bouncer chair to sleep when I have finished mopping her & myself up over and over, so I can get yet another load of washing on, I get little chance to do much or get out which is really hard having a 3 year old child aswell and all our wash pile is bibs, muslin cloths, baby clothes, sleeping bags and my clothes, twice, sometimes 3 times a day! Ive tried everything I possibly can at this stage, I could go on and on, I’m so exhausted physically & mentally, so I am going to try to start weaning her on this advice & comments by other parents with similar problems with their bambinos at around 4+ mths and see how it goes. Thanks and fingers crossed!

    • Amy says:

      Really feel for you Sammy, my daughter is now 6 months old and with initially being misdiagnosed with colic, understand how you feel about having no time to do the cleaning and to rest yourself.
      I had help from my mother and friends that enabled me to get enough rest to be able to cope with an uncomfortable and upset baby. She has only recently been diagnosed with acid reflux, as she is not sick and she is putting on weight. When I first introduced the medication, she was like a different baby overnight but I had to persist with nhs doctors to get them to help, Ive seen them countless times and they have gone straight to my daughters weight chart and said she looks fine so to just continue as I was in looking after her. Now, her quality of life is so much better. Shes still not 100% but she will actually sit on me now and have a cuddle like other babies and I can relax!! Before I would have to be constantly moving around with her, rocking her and comforting her. Things that seem to sooth her are her chair which vibrates.
      Also when she was about 3 weeks old I discovered a feeding position that helped her take more milk, I held her sitting on me facing to the side, quite upright and I had the top of her back resting on the palm of my hand so she ended up sitting upright with her back arched and her head was supported on the top of my hand. She responded to this feeding position extremely well, Id recommend trying it.
      Good luck and keep trying! Would love to hear how you get on.
      Amy

      • Georgie says:

        Hi Sammy,

        My daughter is 6 mo, and was diagnosed with reflux at 6 weeks, we medicated with Gaviscon, and then moved to Losec (Omaprazole). we started solids at 20 weeks (purees), and have now started with finger foods. I have noticed a significant improvement, and we are now beginning the process of weaning off the losec.

        Good luck :)

    • Sarah isaacs says:

      dear Sammy – you poor thing we had exactly the same its been so stressful and upsetting. I went to the doctor and demanded that it was silent reflux and that i couldn’t carry on sleeping upright it was making me ill – they finally gave me the correct meds – so so so much better ever since. I also found that fennal tea really helped my bub. It does get better I promise I’ve been where you are and it really does get better. Just forget everything else – cleaning etc get some help – get family to cook you up some meals and just get through the next few months/weeks concentrating on you and your baby.

  12. sara says:

    hi my son is now 3 and still suffers from reflux just lately hes been wanting more milk before he goes to sleep hes on neocate milk not dairy but last nite he was being sick alot it was bile any advice please thankyou

  13. Eleanor says:

    Hi Sara, that sounds very stressful and I wouldn’t like to try to give any advice on it other than to talk to your GP or another medical person! Hope he’s feeling better soon.

  14. Nadine says:

    So glad to discover this article and comments as I can totally relate. My son is 6.5 months old and has been a very vomity baby since birth. He is breastfed and is heavier than other babies his age (although the weight gain has slowed down now as he’s more mobile). Reading this article finally helps me understand a bit more what he is going through. The first 3 months or so were very hard for me as he was constantly vomiting, crying and comfort feeding. I’ve seen a couple of doctors who weren’t at all concerned and said it’s probably reflux which he will grow out of eventually. The only medications I tried were Infacol and Panadol which really didn’t make a difference as he hated the taste. I just tried keeping him upright which helped a bit as he burped and spewed sooner. Now that he’s a bit older he sleeps pretty well and is on his back or side with rarely any issues. I’ve started solids slowly from 5 months and now we’re getting technicoloured smelly vomit! Some days are worse than others and I can’t leave the house until at least 2 or 3 hours after feeding. Like everyone else, I have to wash just about every day, sometimes several loads. And I’m washing more bibs and spew rags than clothes usually. I’m really interested in combining BLW with the traditional method. I’ve tried both separately but that didn’t seem to make a difference in the vomiting. If anything, he was vomiting more from eating purees. Perhaps I was giving him too much as he just opens his mouth and down it goes (before coming back up) I might have to try eliminating dairy from my diet and his to see if it helps. It’s all trial and error I guess.

    • Aitch says:

      Oh the absolute BEST of luck with it, i hope it all calms down soon.

      • Nadine says:

        I’m pleased to report that my son’s reflux seems to have resolved itself (knock on wood) For the past 3 weeks he has not vomited at all, save for the occasional burp that brings up a tiny bit of spew. He’s 8.5 months old now and crawling and generally quite active so I’m relieved I don’t have to race around wiping up spew trails. My wash load has dramatically reduced and I don’t know what to do with myself now that I have a bit of spare time on my hands, lol. We’ve been BLWing for the past couple of months (while still BF) so I don’t know whether this has helped calm the reflux or not. To all other reflux mums, hang in there, it will get better. I was prepared to wait until the age of 1 and beyond and am so pleased it seems to be over.

      • Aitch says:

        gosh, what a relief for you (and your water bill).

  15. nic says:

    I have found comfort in reading the other stories – I am not alone! We have had a horrible year with reflux and allergies with our second child (now 10 months). I am hoping that we are through the worst of it now. I just wanted to mention a couple of things that helped our situation. (1) We tried Chinese medicine and accupunture on our little boy. He was already on Losec, but kept vomiting and was losing weight. The Chinese therapy reduced the vomiting overnight! It worked for us. (2) Extra support at home. With no family, we elisted the help of babysitters from my 1st child’s childcare and a local teenager. This help was for 4:30pm to 7:30pm a couple of times a week. And I also had a house cleaner once a fortnight for 6 months. Expensive, but a lifesaver! (3)Introducing solids early, puree and finger food (starting with more solid mush that he could lick of hands). And always eating with others…as much as possible having family meals with mum, dad and sister all sitting together or to be out with mother’s group for meals. I found that he would eat better (and drink better) if we were out in the park or in a cafe! I think the social enjoyment of food helped my little boy bounce back from his oral aversion caused by the reflux.

    • jigisha says:

      hi,
      my son is suffering from severe reflux and he is 8 months old and i feel like his symptoms are getting worse. i heard about acupuncture and called couple places but no one treats infant reflux. I was wondering if you can help me with some questions… which Chinese medicine you used on our child? where can i order it?? and does reflux go away? I am first time mom and my son is suffering since he was 7 weeks old. It breaks my heart everytime he cries in pain and then throw up and now he vomits the whole food. he is on solids but doesnt seem to make any difference. he spits solids too. please help me if you have some ideas i can try with my son.

      • Aitch says:

        Huge sympathy. I hope someone who can help sees this, but in the meantime have you been to the forum? You’ll be able to access more ‘old hands’ there, the people who are reading here tend to be newer to BLW, if you know what i mean?

  16. Carrots says:

    Thank you so much for writing this, it has made me feel so much better about what we are doing with my son. He is 5 months and I am just starting to wean him because his silent reflux has got much worse. Goodness knows whether he has any dairy allergies – the GP won’t offer any more help than low-dose Gaviscon because DS piles weight on due to comfort eating. Unfortunately, I think apathy from HCPs is common with silent reflux and I do sort of understand why, but watching your baby writhing in pain every time they feed is so upsetting.

    What was really nice to see was that you mentioned the difficulty in them not being able to regulate their appetites. I always say that I feed on demand… ‘sort of’… because DS always wants feeding. He will eat until he is screaming in pain and continue to try to eat.

    The hints and tips that you have given are really helpful to me, but you’ve made me feel better for mixing TW with BLW. The first day that I tried to spoon feed him carrot-mush, he snatched the spoon off me and shoved it in his mouth! I wouldn’t say that he is always eating it, but he is playing with it in a very BLW way. I also share a banana with him everyday by chopping it onto a plate and eating it with him sat on my knee. He can’t really grab a piece of the banana yet, but when I’m holding some he grab my hand and shoves the banana in his mouth (then gags and spits it out, but luckily because his reflux is silent, that is ok for us).

  17. joy says:

    I have had a baby with reflux and it is so hard he been on three lots of medication regulary and he would never lay down to sleep . I was at the end of my teather until a lady in a cafe told me about this ambyst nest hammock one word AMAZING he actually managed to sleep without choking .It made life so much easier for me and if this helps a new mum whos at the end of her teather im glad to recommend this

  18. Rac says:

    Thanks Eleanor, the first paragraph of your article and it pretty much sums up what we are going through with our one month old. Also breastfeeding, so suffering sore nipples, exhaustion, and tired baby from long and frequent feeds… A healthcare professional friend recently told me to get ds checked out for toungue and lip tie and sure enough he has one and that could be causing/aggravating his reflux! More info here: http://www.tongue-tie.org.uk/tongue-tie-information.html
    The trouble we’re having is getting doctors to recognise that the long feeds are a problem as they will not do anything as long as weight gain is ok. Have people had any success with getting doctors to recognise the emotional toll of reflux and to treat the cause of reflux rather than the symptom?

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