You can’t make it through the newborn days without a few spit-up mishaps, but what do you do when those “mishaps” become consistent and interfere with sleep?? Today I’m sharing how to help your baby with reflux (minimal or severe) get the sleep they can despite the discomfort.
You don’t want to miss:
The 3 types of reflux and the one that’s most common
When to see/talk to your child’s pediatrician
Practical ways to help your baby get to sleep without aggravating their reflux.
PLUS… The best way for YOU to get some sleep!
Links and resources:
The study referenced in the episode: Effect of nonnutritive sucking on infant gastroesophageal reflux
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Hey there, this is Michele Dispirito with Goodnight Families and you're listening to the Sleep and Sanity podcast where I help you with your little ones' sleep and hopefully help you find your sanity along the way. Today we are going to be talking about newborn reflux and how to get sleep despite that, or as much sleep as you possibly can.
So stay tuned.
This episode is brought to you by The Newborn Cheatsheet. This contains the wake windows for your newborn as well as the five ways to help settle your newborn. This is a PDF printout that you can hang on your fridge or wherever you like, and also has two images that will fit your phone perfectly. So to grab your cheat sheet today, go to goodnightfamilies.com/newborncheatsheet or you can head to the show notes for the direct link.
What is reflux?
So just to be clear, just about all babies have at least a little bit of reflux. The ring of muscle between the esophagus and the stomach, known as the lower esophageal sphincter, isn't fully matured in newborns (along with a lot of other things). Having this immature development of that sphincter makes it easy for the stomach's contents to back up into the esophagus and eventually out of the mouth, known as reflux. When that reflux is combined with a hiccup or burp, it's easy for that to fully come on out as spit up, in case you were interested.
The 3 types of reflux in newborns
The commonplace reflux is known as gastroesophageal reflux (GER) and it is rarely serious and decreases in frequency as the baby ages and then commonly completely resolves on its own by 18 months old. But don't worry, it will likely not be causing major issues that long.
Now, on the other hand, there is gastroesophageal reflux disease (GERD) and it's a chronic condition that requires a diagnosis from a doctor and intervention to prevent damage to the baby's esophagus and mouth. This is one that often medication is used to help resolve issues including helping them with sleep. Not necessarily sleeping medication but because the GERD is more under control they, in turn, are able to sleep.
There's also another form of reflux known as silent reflux that's caused by the same weakness of that sphincter but there's far less spit-up involved. The spit-up just doesn't make it completely out of the mouth. It just comes up into the esophagus causing pain and discomfort for the babies that struggle with that condition.
Here are some of the symptoms of reflux, whether it's just the "common reflux" or the more severe. Obviously, the severity of the symptoms depends upon the severity of their reflux.
They pull their legs up while crying, seemingly in pain.
They are constantly spitting up forcefully.
Their spit-up is green or yellow fluid. (This is the bile that's coming up.)
They spit up blood or material that looks like coffee grounds.
They arch their back while crying.
They constantly have hiccups.
They refuse food (to nurse or take a bottle).
They have disturbed sleep.
They're unusually irritable after eating
They have a chronic cough.
If your baby is showing a lot of these signs or you're concerned, definitely talk to your pediatrician!
If they have a more serious case of reflux, the doctor can prescribe medication that will ease their pain and discomfort, which will then, in turn, help them eat better, sleep better and just be overall happier. But then if they aren't diagnosed with GERD, then you can know for sure and rest a little bit easier knowing it isn't anything majorly severe. It’ll just be, you know, another thing to work around.
How does reflux affect sleep?
The main reasons why reflux interferes with sleep are because...
The safest position for babies to sleep in to help reduce SIDS (on their back, flat, on a firm surface) is also the worst position to be in when dealing with reflux.
When babies are struggling with reflux, they feel discomfort or pain often, so even when they do get to sleep, it's harder for them to stay asleep from the discomfort and pain waking them up.
How can you ease the reflux?
So before we get into the specific practical tips on helping them sleep better, here are just a couple of things that you can do to help reduce their reflux which, in turn, can help with their sleep.
Keep a log of when your baby eats, sleeps, and feels discomfort. There's a good chance that you're already logging all the things because pediatricians really like to know all the things. So if you're not already doing that, go ahead and start doing that. Also, if you're breastfeeding, you can keep a log of what you're eating, and when to potentially find maybe possibly a correlation between what you're eating and your baby's reflux symptoms. But typically, the reflux is only correlated to what you're eating if there's an actual allergy. They aren't typically bothered by spicy foods of the like because, if you think about it, babies that are born in countries where spicy foods are the norm, don't necessarily have a significantly greater chance of having reflux. So like I said, take this with a grain of salt. It's something to potentially keep an eye out for but not something to stress yourself over.
Hold your baby upright for 20 to 30 minutes after they eat. In the early newborn stage, it's going to go right into the time that they need to be sleeping, so it's okay if you end up holding your baby for most, or all, of their naps - that is completely fine! Once they're able to stay awake a little bit longer, you'll be able to hold them upright, and then you can start working towards laying them down for their nap.
Definitely comfort your baby often. You can work towards gradually weaning them away from the sleep associations as they grow and their reflux improves. Like I mentioned in the last one, it's totally fine to be holding your baby a lot in this stage because the top priority right now is helping them with the reflux more so than them sleeping independently, which 99% of newborns are not sleeping independently anyways, so it's okay!
Feed your baby often and in small amounts. I typically say to feed every two to three hours, but a baby with severe reflux, or more than usual reflux, may need to or want to eat more often. That is totally okay. Feeding in small amounts is going to help their body hopefully contain that content without spitting it up.
Burp your baby often while you're feeding them. Taking lots of little breaks to burp them will help get rid of any little gas bubbles before they push out other things with them.
Chiropractic care has been shown to help significantly for some newborns. If you choose this route, definitely use a chiropractor that is well-educated in taking care of newborns. Talk to your pediatrician to see what they have to say/if they have any recommendations.
Practical ways to help your baby sleep when they have reflux
So now on to some practical tips on helping your baby that has reflux to sleep somewhere other than your arms.
Remember, reflux or not, this is the newborn stage, too! Don't necessarily think that any sleep issue is because of the reflux - newborns sleep sporadically and chaotically whether or not they have major reflux.
1. Get them to sleep then transfer them to their bassinet or crib
Since they're going to need to be held upright for a good 20 to 30 minutes after they eat, that time will likely run into the time that they need to be sleeping, so you can definitely get them to sleep while they're in your arms, then transfer them to the bassinet or crib. For a greater likelihood of them staying asleep, only transfer them once they're in that heavy sleep state - when their eyes are not fluttering and they’re a limp noodle.
Really, the biggest difference in this scenario is that you're going to be holding them a little bit longer (potentially) upright because of that reflux.
2. Use a baby swing
If you don't want to worry about having to transfer them, but you still want them upright, you can put them in a baby swing. The swings are typically inclined enough to help reduce reflux. Definitely buckle them in and you or someone else needs to stay awake to keep an eye on them.
3. Use a stroller and/or car seat
Put them in a stroller and/or put them in their car seat. Be sure, again, that they are buckled in as if they're going to be in the car whether or not you’ll be getting in the car. Then you can go for a car ride or you can go for a walk. Getting fresh air, and some vitamin D from sunlight is beneficial for everybody. I don't know if this is scientifically true, but I could imagine that it would help with reflux because it's just overall so beneficial to be outside.
4. Use a baby carrier
For daytime naps, you can use a baby carrier. This will keep them upright and they can snuggle and sleep. Plus, you’ll have both arms free!
Having that “perfect” sleep environment is going to be very beneficial. There's a chance that they might have day/night confusion (another typical newborn struggle), so helping get that corrected by having daylight stimulation throughout the day and having things calm and dark during the night is going to really help, too.
How do you get a baby with reflux to sleep at night?!
Because obviously, you want to be sleeping too!
First, what not to do. It's not safe for them to be sleeping in an upright position. A lot of the baby gadgets that moms of babies with reflux used to use are now recalled (and were never safe to sleep in, to begin with). So the best thing that I can suggest when it comes to helping your baby sleep at night in their crib or bassinet is to implement tip one above - keep them upright after feeding for 20-30 minutes and help them to sleep as much as they need, not laying them down until the 20-30 minute mark or later. They may be waking pretty often to eat if they're eating and small and out amounts. But again, the same kind of things that you do during the day.
If you're worried that you're going to fall asleep while holding them upright, put them in a safe place upright - so if you need to buckle them into their swing or their car seat, you can do that! Do your best to keep an eye on them anyway!! But it's safer for them to be buckled into their car seat or their swing and you fall asleep than it is for you to fall asleep with them in your arms in a chair or anywhere else.
If that is a concern, definitely have them buckled safely upright so that way they are upright, but have every intention of having them lay down in their bed. The hard part with having them buckled in the swing or the car seat, of course, is needing to transfer them and that is always a “who knows what's going to happen?” situation. So ideally, you're able to hold them and get them back to sleep, and then when they're completely zonked out, you can lay them gently, gradually into their crib or bassinet.
The biggest difference (on paper) with sleep for babies with reflux is how long you have to hold them up after eating and how much comfort they're going to need because of the reflux.
How to soothe a baby with reflux
A common way that we like to help soothe newborns is through the pacifier.
Recently I found a study that looked at the effect of non-nutritive sucking on infant gastroesophageal reflux. The study looked at the effects of essentially pacifier usage, non-nutritive sucking, or not getting nutrients from a pacifier (non-nutritive sucking) on infant gastroesophageal reflux (which is the reflux we're talking about). To quote, “the results were that infants with pathologic reflux frequency might best avoid a pacifier use while in the beneficial prone position.” So what they're saying is it's best for babies with reflux to not lie on their back using a pacifier but in the seated position, the pacifying effect of non-nutritive sucking may be useful in decreasing reflux events as well as in reducing crying behavior.
👍 Thumbs up to using the pacifier when they are in the upright position.
👎 Thumbs down potentially when they are lying on their back for using the pacifier.
Other ways to soothe fussy newborn is the swaddle, a sound machine/white noise, a dark room, walking around with them, and swaying.
These are all things that, again, newborns that don't have a ton of reflux issues are going to benefit from. When it comes to reflux, it's just typically more involved/more comforting and attending to.
For more information about soothing a fussy newborn, check out episode 18 of the podcast. Even though you do have the added struggle of reflux, these tips are still going to be very helpful for you.
The best way for YOU to get sleep
If your little one is not getting a lot of sleep in the safest place for them to be sleeping, then definitely call in some reinforcements. (I so hope this is an option for you!!) Help or not, sleep every chance you get!!
I hope that you were able to get some tips to try out and most of all, just take that pressure off of trying to get your baby to sleep independently. I know that some moms are just ready for their babies to sleep in their cribs and not in their arms all the time. And I understand how hard that is and I wish there was an easier answer that I had for you on how to make that happen. But, unfortunately, I don't, so I hope that these tips are what will help!
I am always here for you if you need any one-on-one support I offer support through the newborn days. Also, a lot of this information that I just shared with you is actually directly out of my Newborn Sleep Guide, which is available for purchase. So if that is something that you're interested in, definitely check that out.
As always, here's to your sleep and your sanity.
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