While my son was in the NICU, one of his neonatologists told us that most premature babies struggle with reflux because their digestive systems are underdeveloped. There’s lots of research to support this.
About 70-85% of babies have reflux symptoms in the first couple of months of life, later resolving without intervention in 95 % of infants by the time they’ve reached their first birthday. The primary cause is relaxation of the transient lower esophageal sphincter (LES). Regurgitation is the most common symptom of infant reflux, but choking, gagging and coughing with feedings can also be symptoms as well.
In diagnosing, and later trying to prevent, my son’s reflux, we went through several investigative phases prior to his NICU discharge. The main focus among the primary neonatologist and nurses was trying to figure out if my breastmilk was worsening my son’s reflux.
- Phase 1: After my son had finally graduated to bottle-feeding, he was returned back to bolus feeds to ensure he kept his milk down. This was heartbreaking since my son really enjoyed eating once he started.
- Phase 2: Resumed bottle feeds with only hydrolyzed formula while I went on a non-dairy diet. I marked my “non-dairy milk” with a special label to indicate it was pumped during my dairy fasting period. The milk was stored in a freezer in the NICU unit.
- Phase 3: Barium swallow study: My son drank a bottle of formula with contrast dye so that his upper GI tract could be seen upon x-ray. This came back normal.
- Phase 4: Slowly reintroducing my breastmilk in a few feeds in addition to a new elemental formula.
- Phase 5: Breastfeeding and elemental formula with no restrictions.
During Phase 3, the nurses insisted that my breastmilk was causing my son’s painful reflux because it’s thinner and would only bottle feed him the formula. I was, however, allowed to breastfeed as much as I wanted.
The Verdict…
My son did not have an allergy to dairy and the only thing contributing to his extreme reflux was his prematurity. Another neonatologist said he didn’t understand why I was instructed to change my diet as dairy allergies in babies isn’t diagnosed as is commonly thought.
I’d read that medication could alleviate my son’s painful symptoms, but my son’s NICU policy was only to medicate in cases of severe reflux. According to the nurses, my son’s reflux was not considered severe.
One neonatologist said he didn’t believe in treating infants with reflux because new research showed it would have a negative impact on his “digestive biome”, potentially causing future problems with his immune system. This school of thought would keep my son experiencing painful reflux for the remainder of his stay in the NICU.
When my son came home, I breastfed and supplemented with the prescribed elemental formula. After every formula feeding, I could smell the digestive acid and my son would writhe in pain.
Our son also began to have seizure-like episodes resulting in several calls for an ambulance. Finally, he was admitted for observation and we learned that he was having Sandifer syndrome episodes caused by his reflux.
We saw a pediatric gastroenterologist who immediately gave us a prescription for Prilosec. He didn’t prescribe Zantac because he said the effects were short-lived, as the drug typically becomes ineffective after a certain period of taking the medicine.
We told him what we had been told about the “digestive biome disruption theory” and he said that the study was done on a small number of older adults and applied across the board to all patients, including babies. He also added that when reflux is causing Sandifer episodes that a prescription is warranted.
The Prilosec made my son a “happy spitter”, no more Sandifer episodes or discomfort after eating. We were also switched from the prescribed elemental formula to a milk-based formula with no problem.
A few other things that helped were:
- Sitting him upright after feeding, whether by holding him over my shoulder, on my lap or in the mamaRoo. I learned this trick from the NICU nurses.
- Using a wedge under our son’s Pack n’ Play napper, and later his mattress, so that our son slept at a 45 degree angle. This was recommended by an emergency room doctor that saw our son, as well as a NICU nurse. The NICU nurse told us that even though a flat surface is recommended for SIDS prevention, a wedge placed under the mattress can help significantly with reflux symptoms. The wedge helped significantly, and lessened our worries that he would choke on spit-up in the middle of the night. A good wedge that we found was the hiccapop crib wedge.
- Supplementing with a formula for sensitive digestive systems. I haven’t produced as much breastmilk as my son needs so I supplement with formula. Similac Pro-Sensitive has been the best formula so far that we have tried. Less spit-up and my son enjoys the taste.
- Thickening his feeds. We were advised by our son’s gastroenterologist to use oatmeal cereal to thicken our son’s milk and to weigh it down so that it doesn’t come back up so easily. We were advised against rice cereal to lessen the chances of constipation. We were even advised that we could add it to breastmilk (even though in the NICU I was told it wasn’t possible).
We use Gerber Single-Grain Baby Cereal.
At 7 months actual (5 months adjusted) we are finding that our son really is maturing out of the reflux. Spit-ups have decreased, and he sleeps on a flat surface now.
Bottom-line – if your baby is suffering like ours was, investigate your options with a pediatric gastroenterologist.