Ashwin Lewis
Reflux, also known as gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD), is a common condition in newborns and babies. It can cause discomfort and pain, making it difficult for babies to fall asleep and leading to sleep deprivation for both the baby and the parents. While there are strategies to manage reflux, such as keeping the baby upright after feeding and burping them frequently, the recommended sleep position for newborns with reflux is a topic of concern for many parents.
| Characteristics | Values |
|---|---|
| Sleeping position | Newborns and babies under 12 months with reflux should be put to sleep on their back. |
| Sleeping surface | The surface should be firm. |
| Inclination | Some sources suggest that a 30-degree prone position can help reduce reflux. However, this contradicts safe sleep recommendations, and the American Academy of Pediatrics (AAP) recommends against it. |
| Feeding | Feeding more frequently but with smaller volumes may make the baby more comfortable at night. |
| Burping | Burping the baby frequently during feeds can help decrease acid reflux. |
| Post-feeding | Keep the baby upright for 20-30 minutes after feeding to help reduce reflux. |
| Pacifiers | Pacifiers may help with reflux by increasing saliva flow down the esophagus, helping to get fluids back into the stomach. |
| Bedtime routine | A bedtime routine can help calm the baby and make them ready to sleep. |
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What You'll Learn
Safe sleep positions for newborns with reflux
As a new parent, it can be distressing to see your newborn struggle with reflux and sleep. Reflux, or gastroesophageal reflux (GER), is a common condition in newborns, and it can lead to disrupted sleep patterns and pain. While there is no one-size-fits-all solution, there are some safe sleep positions that can help alleviate your baby's discomfort and improve their sleep. Here are some recommendations for safe sleep positions for newborns with reflux:
Back Sleeping Position:
Despite concerns about reflux, it is recommended that newborns under 12 months with reflux be placed on their backs to sleep. This position is proven to reduce the risk of Sudden Infant Death Syndrome (SIDS) and is considered safe by the American Academy of Pediatrics (AAP). Newborns have an automatic gag reflex that prevents choking, even if they spit up due to reflux. This position ensures that any fluid or spit-up is safely coughed out or swallowed.
Inclined Position:
Some caregivers and healthcare providers recommend placing newborns with reflux at a slight incline to reduce symptoms. While the AAP advises against this, some studies have shown that a 30-degree incline in the prone position reduces GER. However, it is important to note that inclined sleep positions may not be safe for newborns and can increase the risk of SIDS.
Left Lateral Position:
The left lateral position, where the baby lies on their left side, can help reduce the number of reflux episodes. This position aids digestion and passive burping, making it more comfortable for the baby. However, sleeping on the side or front is generally discouraged due to the potential risk of SIDS.
Upright Position:
Keeping your newborn upright for 20-30 minutes after feeding can help reduce reflux. Holding them upright or placing them in a carrier can help with digestion and prevent spitting up. A bedtime routine and frequent burping during feeds can also help soothe your baby and reduce reflux symptoms.
Feeding Strategies:
Feeding your baby more frequently but with smaller volumes may improve their comfort at night. Bottle-fed babies are typically fed every 3-4 hours, but more frequent feeds may settle their stomachs. It is important to note that constant feeding may lead to a cycle of feeding to soothe the burning sensation, which can then cause further reflux.
Remember, if your baby's reflux is severe or there is a family history, consult your pediatrician to rule out conditions like Gastroesophageal Reflux Disease (GERD) or food allergies. They can provide personalized guidance and recommendations to help your newborn sleep better and manage their reflux.
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How to reduce reflux after feeding
Reflux in newborns is common and usually gets better by itself by the time they turn one. It is caused by the baby's food pipe (oesophagus) not being fully developed, allowing milk to come back up easily. While reflux is usually not a concern, it can be challenging to manage and cause sleep deprivation for the baby and the family.
- Burp your baby during and after feedings: Excess gas in the baby's tummy can cause them to spit up, so burping can help avoid this buildup.
- Keep your baby upright for about 30 minutes after they eat: This helps prevent spit-up.
- Avoid overfeeding: Speak to your paediatrician about how to avoid overfeeding. Your baby's tummy can only hold so much at one time, and pacing feedings can help prevent reflux.
- Thicken feedings: Speak to your paediatrician about this option. Adding a thickening substance to breast milk or formula can make it thicker and help reduce visible symptoms of reflux, like spitting up.
- Feeding pattern changes: Your paediatrician can advise on changes to feeding patterns that may help reduce reflux.
- Inclined sleeping position: Some sources recommend placing infants with reflux at an incline to reduce symptoms. However, the American Academy of Pediatrics (AAP) recommends that infants be placed supine to prevent sudden infant death syndrome (SIDS).
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Signs of reflux in newborns
Reflux, also called gastroesophageal reflux (GER), is a common condition in newborns. It occurs when the sphincter, a ring of muscle at the end of the oesophagus, doesn't work correctly, allowing stomach contents, including food and stomach acids, to flow back into the oesophagus. This can cause a burning sensation and pain, which can wake the baby up frequently during the night or prevent them from falling asleep.
Spitting Up
Spitting up is one of the most obvious signs of reflux in newborns. If your baby has reflux, they may bring up milk during or shortly after feeding. However, it's important to note that reflux is different from vomiting. Reflux is effortless, while vomiting is forceful.
Silent Reflux
About 8% of newborns experience silent reflux, which can be more challenging to identify. Instead of vomiting, babies with silent reflux may experience painful "heartburn" symptoms, such as a burning sensation and pain. They may cry or be fussy after feeds and find no comfort when burped. You may also hear a rumbling tummy. Silent reflux can disrupt their sleep patterns and make it difficult for them to fall asleep.
Discomfort after Feeding
Newborns with reflux may experience discomfort 60-90 minutes after feeding. They may arch their back during feeds, have trouble burping, or show signs of distress, such as crying or fussing.
Other Signs
Other signs of reflux in newborns may include a family history of reflux, a cow's milk allergy, or a blockage in the oesophagus or intestine. If you suspect your baby has reflux, it is important to consult your paediatrician or healthcare provider for personalised guidance and recommendations.
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How to help newborns with reflux sleep better
As a new parent, it can be distressing to see your newborn in pain and struggling to sleep due to acid reflux. Acid reflux in babies is a common condition that happens in the first few months of a baby's life. Here are some tips to help your newborn with reflux sleep better:
Burp your baby frequently
Burping your baby frequently during feeds can help decrease acid reflux and related symptoms. Experts recommend burping your baby in a position either over your shoulder, upright on your lap, or on their tummy laying over your legs. It is also recommended to wait for 20-30 minutes after feeding before putting your baby to sleep. This will help ensure their body has digested the meal.
Follow a bedtime routine
Routines before bedtime can calm your baby so they are ready to sleep. A familiar routine can help your baby with reflux fall asleep more easily.
Put your baby to sleep on their back
Putting your baby to sleep on their back on a firm surface is proven to reduce the risk of Sudden Infant Death Syndrome (SIDS). The American Academy of Pediatrics (AAP) also tells parents not to worry about their baby choking if they spit up because of reflux while asleep. Babies have an automatic gag reflex that prevents choking.
Avoid certain positions
Certain positions, such as in a swing or car seat, can cause pressure on the baby's stomach and make reflux symptoms worse.
Inclined sleep position
Some caregivers independently incline their infants to improve sleep and reduce reflux symptoms. However, the AAP does not recommend elevating a baby's head for sleep as it may not be effective in reducing reflux and may compromise respiration.
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How to support parents of newborns with reflux
As a new parent, it can be distressing to see your newborn in pain or discomfort. Reflux in newborns is common, and it can affect the baby's sleep, causing further exhaustion for the parents. Here are some ways to support parents of newborns with reflux:
Understand Reflux and Its Causes: Reflux, also known as gastroesophageal reflux (GER) or acid reflux, occurs when food or milk from the baby's stomach travels back up into the oesophagus or food pipe. This can cause spitting up, vomiting, or a burning sensation in the throat, leading to pain and irritability during and after feeding. Reflux is common in newborns because their digestive tracts are still developing, and it usually resolves by itself as the baby's muscles develop and their oesophagus matures.
Recognize the Signs and Symptoms: Newborns with reflux may exhibit various signs, including frequent spitting up, vomiting, crying, fussiness, or a rumbling tummy. In some cases, reflux may be described as "silent," with less obvious signs such as fussiness after feeds and difficulty finding comfort when burped. Understanding these signs can help parents identify reflux and take appropriate action.
Sleep Position and Environment: Parents should follow safe sleep practices recommended by pediatricians. Putting the baby to sleep on their back on a firm surface is advised to reduce the risk of Sudden Infant Death Syndrome (SIDS). Inclined sleeping positions between 10° and 28° may be recommended by healthcare providers to reduce reflux symptoms, but these positions should be used with caution and under medical advice. It is important to avoid putting anything directly under the baby's head and never use a pillow for babies under 12 months old.
Feeding Techniques and Routines: Parents can try feeding their baby in a more upright position and keeping the baby's head gently raised during the day, especially after feeds. Burping the baby frequently during feeds can help reduce reflux and related symptoms. Establishing a bedtime routine can also help calm the baby and prepare them for sleep. Feeding smaller amounts of milk more often and changing the baby's nappy before feeding are other strategies to consider.
Medical Advice and Support: Encourage parents to seek personalized guidance from their pediatrician or healthcare provider if they are concerned about reflux. They can assess the baby's symptoms, medical history, and family history of reflux to determine the best course of action. In some cases, medications or treatments may be recommended, especially if the baby has gastroesophageal reflux disease (GERD) or other underlying conditions.
Supporting parents of newborns with reflux involves providing them with information, reassurance, and practical strategies to manage reflux and improve their baby's sleep. It is important to emphasize that reflux is a common condition that usually resolves as the baby grows and develops.
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Frequently asked questions
Newborns and babies under one with reflux should always be put to sleep on their back. This position does not increase the risk of choking as a baby's gag reflex will force them to cough or swallow any fluid. Sleeping on the front or side is discouraged.
To help reduce reflux in your baby after feeding, keep them upright for 20-30 minutes after they finish. You can also try feeding them more frequently but with smaller volumes. This may make your baby more comfortable at night.
Most babies have obvious signs of reflux such as spitting up. If your baby has silent reflux, they may cry or be fussy after feeds and find no comfort when burped. You may also hear a rumbly tummy.
