Is Reflux The New Colic?

As more and more babies are being diagnosed with reflux, La Leche League Leader Jane Maasdorp suggests we ask why.

With an alarming number of mothers being told (or deciding for themselves) that their babies have reflux, it is tempting to ask – as Penny van Esterik did of the ‘insufficient milk syndrome’ – is gastro-oesophageal reflux (GOR) a ‘biological epidemic or a cultural construction?’ In other words, is it really a condition that is suddenly affecting 30–70% of the world’s babies, including breastfed infants, or is there more to it than meets the eye? 

Is reflux really on the rise?

While regurgitation is one of the main reasons that mothers of young babies seek a doctor’s appointment, almost all posseting is normal and not a medical problem. One possible cause of GOR is an immature lower oesophageal sphincter (LOS), so it is especially common amongst pre-term infants, but even then is not pathological. Spitting up is self-limiting and disappears in over half of infants by 10 months, in 80% by 18 months, and in 98% by two years of age.

More seriously, however, there could be an association between the prevalence of GOR and the growing rate of C-section births, where babies are deprived of the microbial wash of a vaginal birth, there is increased antibiotic use, and delayed first intake of breast milk, inadequate and scheduled breastfeeding, and giving water and non-human milks. 

Demystifying reflux in breast babies

Reflux is much less severe in breastfed babies, because breast milk empties from the stomach more quickly than non-human milk. Also, breast milk is a natural antacid, more intestine-friendly, and soothing.

Mothers of these high-need babies should be encouraged to enjoy the relaxing effect of maternal hormones while breastfeeding. Should there be undue spitting up, whatever the cause or severity, nursing mothers will benefit from helpful information so ‘reflux’ does not become the same unhelpful and scary label as ‘colic’.

Helpful advice to give parents:

  • Babies will be more comfortable if nursed more frequently, taking in smaller amounts each time. 
  • It may also be helpful to feed on one breast for a two- to three-hour period before switching to the other side, to enable Baby to enjoy slower secretions and avoid over-filling the stomach.
  • Babies who are fed in a more upright position are helped by gravity to stop the milk coming back up.
  • The ‘biological nurturing’ position, with the mother reclining at a comfortable angle, and the baby lying prone down her torso, may help prevent regurgitation and a fast let-down reflex.
  • Avoiding dairy products while breastfeeding may help to reduce reflux symptoms.
  • As gulping in extra air aggravates reflux, responding to early feeding cues before Baby cries can minimise this problem. 
  • Keeping Baby upright for at least 30 minutes after feeding will help (in a sling or other baby carrier), so his torso stays extended, not slouched or buckled (as it would be in a car seat).
  • Babies with reflux often sleep more comfortably and safely on their tummies, or on their left side, according to Dr William Sears. When sleeping on the left side, the gastric inlet is higher than the outlet, so this helps gravity keep the food down and allows for stomach emptying.

This article was originally published in Sensitive Midwifery Magazine

La Leche League Leader Jane Maasdorp holds a BA (Hons) in Social Anthropology; is a guest lecturer in paediatrics at the University of KwaZulu-Natal; and has presented sessions in the WHO/UNICEF Lactation Management Training, TOT and Breastfeeding Counselling Courses.