Baby Led Weaning

Reflux advice from Someone Who’s Been There…

by Aitch

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 – they also reiterate that health-care professionals should be your first call for personalised advice for your baby.

Good luck and have fun!