9 Tips For Chronic Spit-Up & Reflux Babies

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What’s the difference between regular spit-up and reflux?

When my son was 3 weeks old, he was diagnosed with moderate to severe GER (gastroesophageal reflux). It was both scary and sad watching him writhe in discomfort and cry as he spit up most of his milk. Once we learned how to better manage his symptoms, we still had a big mess on our hands. We left a trail of spit up like Hansel and Gretel with cookie crumbs. I lost many a good shirt to milk-tainted shoulders!

Most babies spit up to some level. The muscle between the esophagus and the stomach, the lower esophageal sphincter (LES), is underdeveloped in most babies until around 6 months of age or later. There are some babies who hardly ever spit-up (yay!), but many moms will agree that spit-up is a part of daily life.

Babies who don’t experience pain or discomfort with spit-up are called “happy spitters.” Acid reflux, on the other hand, is often painful (or at least uncomfortable) and can cause issues like weight loss, hoarseness, congestion, and even ear infections. It depends on the level of severity, but some babies need more serious attention than others. Reflux babies, as they are often called, may need a formula change, elevated sleeping arrangement, or medication.

The signs of reflux in babies include:

• frequent hiccups and/or coughing

• arching back during feeding

• irritability during feeding

• difficulty swallowing

• gagging or choking

• disturbed sleep

• wet burps

Many articles recommend holding a reflux baby in an upright position for at least 30 minutes, but this task becomes more challenging as your baby becomes mobile - not to mention that it doesn’t provide much relief for babies with silent reflux. Silent reflux is less noticeable because it doesn’t always involve spit-up. However, it can be more painful than typical infant reflux as the acidic contents are sliding up then back down your baby’s esophagus and sometimes flowing into the larynx (voice box) and nasal passages.0

Of course, this causes baby to become irritated and uncomfortable and may require some type of intervention, such as medication or a thickener in baby’s breast milk or formula. Look for some of the tell-tale signs above if you think your baby may be struggling with silent reflux.

During the 7 months we dealt with GER (both silent and spit-up), I learned a few helpful remedies and tips that will hopefully prove constructive for you and your sweet little spitter.

No. 1

Medication is not the only way to reduce the acidity in your baby’s stomach. Many babies dealing with reflux are prescribed infant versions of Zantac and Prevacid. This was our pediatrician’s first line of defense. My son was on Zantac for a while until I learned about Nat. Phos. 6X. Nat. Phos. 6X a homeopathic remedy that relieves gas, hyperacidity, and indigestion. Whereas prescription medications like Zantac actually decrease the amount of acid the stomach makes, Nat. Phos. (Natrum Phosphoricum) is a cell salt that works by generating the body’s ability to break down acids without slowing digestion or neutralizing the acids that actually help digest foods. Cells salts like Nat. Phos. 6X remedy imbalances of minerals in the body and provide relief from common ailments - like hyperacidity. It is available in different potencies: make sure you use the Nat. Phos. 6X potency for your little one as Nat. Phos. 30X is for adults.

No. 2

Determine if you actually need to burp often. You may have read or been told that reflux babies need frequent burping, but this method is not necessarily best for every baby. When we burped my son every 1-2 ounces, as instructed, we noticed that it seemed to cause more discomfort for him. Then, I read in Moms On Call, a resource for new moms written by pediatric nurses, that it is best to burp baby a third of the way through her bottle. Each time she latches to the bottle is another chance for air to enter, so more pausing to burp can actually cause more burps and/or gas. It may not be appropriate for all infants, but it’s worth testing to find the strategy that gives the most relief to your baby!

no. 3

Avoid overfeeding and use a pacifier. Overfeeding, of course, can cause the same reaction that it causes in adults - bloating, gas, and an upset tummy. But for little ones with reflux, they often overfeed as a way to comfort themselves without you even realizing it! It’s hard to do, but the only way to help manage this is to learn their feeding tendencies and track how much they are drinking per feeding and per day. The highest recommended amount of formula I’ve seen is 34oz per day. Obviously, that’s impossible to track if you are breastfeeding. But watch for signs that your baby is no longer hungry but is still sucking. Often, this looks like your baby stopping after eating, showing reflux signs (wiggling, arching back, fussing, coughing, etc.), then trying to feed again. You can also use a pacifier to help soothe them, as it stimulates the flow of saliva and downward contractions of the esophagus.

No. 4

Thicken your baby’s formula. Many parents are concerned about introducing grains into their baby’s diet too early (i.e. before 6-9 months), and rightfully so. There are studies indicating that babies have trouble digesting grains until they begin producing amylase (a digestive enzyme) around 6 months of age. Also, rice cereal - the most commonly recommended thickener - contains high levels of inorganic arsenic, which is not straight poison but is linked to cancers when eaten frequently over a long period. This element makes it into basically all our food coming from the ground, but rice really soaks it up compared to other grains. I prefer to use real, whole food when possible, so we used organic oatmeal cereal to thicken my son’s breast milk (pumped) and formula, and this worked really well for him.

Then, there are commercial milk thickeners like GelMix and Aptamil, but these are typically made from tapioca maltodextrin and bean gum - so are they really better than grains? Unfortunately, I think this is one of those “necessary evil” situations, and the most important thing is helping your baby keep breast milk or formula in their belly where it belongs. If you think this may help your baby, talk to your pediatrician for advice on how much to thicken. (Most recommend starting with 1 teaspoon per ounce.)

No. 5

Place a layer of thin blankets or a durable crib mattress cover under the fitted sheet on the crib or bassinet. As much as we’re working to prevent baby from spitting up on himself during sleep, it still happens when everyone has nodded into dreamland. A protective under-layer helps absorb the liquids if your baby spits up in his sleep - not to mention that he may appreciate the extra comfort. For safety, the crib sheet should still fit snugly, keeping your under-layer tight against the mattress. If the sheet is loose or not fitting properly over the edges, you may need to create a thinner layer. 

No. 6 

Use play mats around the house wherever you can. My son was 7 months old when his reflux began to subside. Before that came rolling, crawling, sitting up and playing with toys. I was cleaning spit-up from the carpet, baby toys, crevices in the wood floor, in between the pages of books…until I created a play zone in a couple rooms. If you don’t want to buy multiple play mats (those things can get expensive!), you can use yoga mats or some other type of foam mat to cover a surface area designated specifically for play.

No. 7

Don’t be afraid to try various sleeping positions. Parents are strongly cautioned against allowing baby to sleep on his tummy or using a wedge pillow to position him on an upright angle - and far be it from anyone to encourage you to do something with your baby that makes you anxious about their safety. Personally, we found that elevated sleeping and some supervised tummy sleeping as our son gained head and neck control did relieve his reflux symptoms. How could it be? This was such a trial and error time for us as new parents, and it made me curious. I had seen one chart in particular that shows stomach sleeping to be less safe for reflux infants. I dug into the research.

While the rate of SIDS did decrease with the Back to Sleep campaign, there are other factors within the data; for example, the rate of motherhood smoking had a significant decline in the same years. Parents also began to religiously swaddle their babies. Nonetheless, the science indicates that back sleeping correlates with safer sleeping. For some moms, however, reflux symptoms - such as choking and gagging - are just as scary as SIDS.

Reflexes help baby cough up regurgitated milk, but her head must go to the side in order to avoid choking. Studies have shown that sleeping on your left side can help relieve GER symptoms and that stomach sleeping is easier on baby’s digestive system (the position allows them to more easily pass trapped gas and spit up fluids without working against gravity). There are other concerns with back sleeping, such as an increase in flat head syndrome and ear infections. The point is: don’t be backed into a corner with scare tactics. If you think your baby is suffering with reflux, try alternate positions while keeping a close eye on them.

No. 8 

Put a bib on baby until it’s time to go somewhere. I remember feeling annoyed when I would have my son all dressed and ready to go only to look down and see his whole front covered in regurgitated milk. Since he is the firstborn, I was also trying to salvage his outfits for future siblings. (Sorry, guys - mommy tried!) Rather than creating extra work for myself - and getting frustrated about something trivial - I started dressing him in “expendable” clothing. Whether it was old clothes or bibs, it didn’t matter if they got drenched. With the invention of affordable silicone bibs and paper travel bibs, many moms aren’t buying the traditional cloth bibs. But having even a few of these on hand can help a great deal. You can also shop consignment for “spit up” onesies!

No. 9 

Use a soft flannel or receiving blankets as burp cloths. Real burp cloths tend to be smaller in size (which make them more compact to travel with), but for a baby with reflux a regular old over-the-shoulder burp cloth hardly does the trick. A receiving blanket or small flannel blanket, however, slides snugly over your shoulder or knee and is handy for several rounds. Take care not to use a muslin or other thin breathable blankets, as the milk will just seep through to the other side. 

Hopefully you’ve found some effective ways to reduce your baby’s spit-up struggles, such as changing infant formulas, using special feeding bottles, and having a calm feeding time. But when spit-up is still a frequent part of the day, these 9 things in particular really helped us with our “reflux baby.”