If you are bottle feeding and you are using an Anti-Reflux formula, we recommend using a variable flow teat. This allows you to manage the feed more effectively. At the start of the feed when baby is hungry, use the medium flow side of the teat. As the feed progresses, baby can get tired as it is a thickened feed. You can change to the faster flow side of the teat if needed at this point but be careful that it is not too fast for baby.
The manufacturers of all anti reflux formulas recommend that the bottle is shaken to mix the formula. In general, the instructions will be to roll the bottle upright between the palms of hands for 5 seconds as soon as the scoops of powder have been added. Then shake bottle for 20 seconds and leave it to stand for 7 minutes to allow it to thicken. Sounds straightforward doesn’t it. But the skill you want is making up the formula with as few air bubbles as possible. Many of the mums who come to see us have said that they prefer to stir the powder into the water. Why? Well, they feel that shaking the bottle can add air bubbles to it and as we know, that’s exactly what you don’t want. In a survey where we asked mums if they shake or stir, 63% of mums said they shake the bottle to mix it and 37% said they stirred it.
In our opinion, all bottle feeding should be done in a paced way, allowing baby to control the feed, and preventing them from becoming overwhelmed by the flow of milk. This is particularly true for reflux babies. Lying a baby back in your arms and holding the bottle almost vertical over them can mean that they can become overwhelmed by the force of the milk coming into their mouth as gravity increases the flow. As a baby must breathe and swallow at the same time, having a fast milk flow will interfere with this process and baby will gag. They also take in too much air as the feed quickly to manage the increased flow. The best position for paced or controlled feeding is to hold baby in a semi-upright position, as opposed to lying down. This helps baby to control the flow of milk better. He only needs to be slightly reclined so that the bottle isn’t pouring down into baby’s mouth. Lay the bottle teat across baby’s lips (pointed up) when baby starts rooting and opening his mouth. Let baby pull the teat into his mouth and close his lips on the base of the teat. Once latched on, keep the bottle just above horizontal. This allows baby to control the flow of milk better without taking in air. This also helps the bottle to last the entire length of a normal feeding, usually 10–20 minutes, rather than baby gulping a bottle down in 5 minutes.
When changing your baby, prop him up on a wedge or pillow so that his head is higher than his bum. To clean the bum, turn baby to the side rather than lifting his legs up. Change baby before a feed rather than after. You may need to change again after the feed but keeping baby in the propped-up position will help.
Car seats can be troublesome for some reflux babies due to the position they find themselves in. You must buy the car seat before baby arrives so you can’t try it on, so to speak. Even though your baby will be in an elevated position in his car seat, being slumped will put pressure on his tummy and aggravate reflux. Some seats keep baby more upright than others and some babies are very slumped in their car seat. It depends on the depth of the seat and the age of the baby. New-born babies are often too small for their car seats. They’ll be in it until they are 18 months old after all! Most car seats come with little inserts for new-born babies to help them stay upright. If your baby still looks slumped in their car seat, placing a soft towel or blanket folded under their bum will reduce the depth of the cup and keep them more upright. If you are doing this, do ensure that the safety of the car seat isn’t compromised, and that baby is secure.
Tummy time is very important but can pose a problem for reflux babies. Rather than lying baby on the floor for tummy time, consider lying them on a wedge or an exercise ball to keep them in an elevated position while on their tummy. Timing of tummy time is key too. Aim for when baby is happy and content and not within 90 minutes of the last feed.
Soothers have positives and negatives when it comes to reflux babies. Some love the soother, other never take to it. Sucking a soother can help baby swallow back down any stomach contents that may reflux up. Sucking also stimulates the wave like movement of the gut, helping to move any wind along the digestive tract. Saliva produced in the mouth has a slight antacid effect and can help in a small way as it’s swallowed. And of course, the sucking action is instinctive in a baby and therefore has the added benefit of calming an upset baby. Worth noting though, if you are breastfeeding, it is often recommended that you do not offer your baby a soother for the first six weeks while feeding is becoming established. Talk to your Lactation Consultant about this if you have any concerns.
Keep baby in an upright and straight position if possible, during feeds and for at least 30 minutes afterwards. This helps to keep food in the tummy by gravity. Reflux babies tend to like to over the shoulder position for this very reason, they are upright and straight. You can also lie baby on their tummy on your lap. Keep one knee higher than the other so that baby’s head is higher than the bottom.
We often hear from parents that their baby loves being upright with their head on the parent’s shoulder. In this position the parent will be moving around, and baby is content. But try to sit down and you will be told very firmly that’s not allowed! A tip for this is to use a gym ball. Sit on the gym ball with baby held upright. You can gently bounce on the ball or move back and forth. This is also a very handy tip for when you are putting baby in their car seat. Reflux babies don’t like the car seat and can become quite distressed. Once baby is secured in the car seat, gently bounce the seat on the gym ball. It’s a game changer, I promise!
Find the cause (or causes) of your baby’s reflux symptoms and treat that first. Just treating the reflux symptoms will have a very limited and short-lived effect.