breastfeeding, chestfeeding, reflux, supplementing

Reflux…regurgitation…spit up

Whatever you call it, it’s pretty common for newborns. When our babies spit up often or forcefully it can be worrisome. We wonder if we ate something which is upsetting baby. Are we burping the right way and long enough? Should we change something about how we are feeding baby?

Let’s set the record straight with some facts about infant reflux:

Reflux is common and not a problem for most newborns.

  • About half of babies aged 2 weeks to 4 months have reflux (which just means they spit up once or more times per day). 
  • Most babies outgrow reflux by 6 months. 
  • Reflux is more common if your baby was born prematurely, has Down syndrome, or other conditions which affect neuromuscular function.
  • Symptoms peak at 4 months and gradually get better.
  • Very few infants have GERD (uncomfortable or painful reflux with additional symptoms like weight gain difficulty, crying, etc)
Newborn looking into the camera, blowing bubbles with their tongue sticking out.

Okay, so what causes it?

Overfeeding is one of the most common causes. Many parents are told to feed their babies every 3 hours which is less often than what most babies would like. Spacing out feeds means that baby may be taking larger volumes than their stomach can comfortably hold.

Laying baby down after a feed puts pressure on the stomach. Because the sphincter (a ring of muscle at the top of the stomach) is immature laying baby down after feeding or putting pressure on their belly can cause spit up.

Diet While most babies are not sensitive to anything in the parent’s milk, they can have spit up more frequently with formula feeding. Using the right formula which baby can digest more easily helps reduce the frequency of reflux.

Crying We all know that babies cry and sometimes it’s unavoidable like when you are driving and can’t comfort baby. And sometimes you can comfort baby but it seems like nothing is working…it happens to us all. Excessive crying can make reflux worse so talk with your provider to get to cause of baby’s discomfort.

Sometimes parents think baby is crying because of the spit up but it’s usually the other way around. Unlike adults, baby has a very acid in their stomach so it doesn’t burn or hurt when they spit up most of the time.

It’s developmentally normal. Spitting up that doesn’t bother baby or cause any problems with growth and development isn’t something to worry about medically.

What can we do to reduce it?

•Get a great latch! Have your baby’s latch and suck assessed by an experienced Lactation Consultant.

•Keep baby upright without abdominal pressure for 30 minutes after feeds. Babywearing works great!

•If you need to lay baby down and you can keep an eye on them try laying them on their left side. If you are doing tummy time, use a prop like a nursing pillow under their chest to keep pressure off the belly

Frequent burping, after each breast

•Frequent, unscheduled feeds.  Responsive feeding

•If using formula, use a hydrolyzed whey formula

•If using a bottle, use paced feeding techniques

As always, check in with your Lactation Consultant for tips and tricks! We are here to help!

❤ Megan Dunn, IBCLC

supplementing

Paced Bottle Feeding: Part 2

Bottle feeding. While we are here to promote and encourage skin-to-skin breast/chestfeeding we also know it’s a practicality that most babies will have a meal through a bottle.

Bottle feeding is a whole different ballgame than breastfeeding and requires some different skills. Breasts and bottles behave very differently!

Let’s look at some tips and tricks to help your baby bottle feed with comfort and with ease.

Slow down the pace.

You may have heard of paced bottle feeding. This is a feeding technique which slows down the flow of milk and is response based. We pay attention to how our baby is acting throughout the feed. Are they furrowing their brow? Do they look super focused while they gulp gulp gulp?
These are stress signs during a feed and baby is telling you with their body language that they need a break.

The bottle can be tipped down and rested on the lips while baby catches their breath and gets ready to start the suck-swallow-breathe pattern again.

Look at the baby in the picture. What do you notice?

She is sitting is upright. This helps baby to regulate their feeding and it slows down milk flow compared to an angled bottle.

Her lips are out and have a good seal on the nipple. She’s almost touching the ring with her lips.
Her cheeks look relaxed and in general she looks pretty chill. This is exactly what we are going for.

So why else might we want to use paced bottle feeding?

It can prevent reflux and spitting up.

Babies who are gulping in milk quickly have a tendency to swallow air, too. Their tummies become overfull and they will often spit up or act uncomfortable and squirmy. The sphincter, which is a little “rubber band”, at the top of the stomach is immature in infants until they are about 6 months so it’s really easy for milk to come back up.

Reducing the air in the stomach can help prevent reflux and overfeeding which are the main reasons little babies have spit up.

It prevents overfeeding.

Okay, so overfeeding can cause spit up or even make reflux worse and it causes parents to worry about milk supply. Most people make all the milk their baby will need but if baby is chugging down a big bottle without any breaks, they can easily overfed. This makes it hard to keep up on the pumping! Babies rarely need more than 4 oz for a feed (maybe 5oz occasionally). Feeding more than that actually stretches their stomach beyond normal capacity.

A slower feed also helps babies suck for longer which is super comforting. Sucking regulates stress hormones, breathing, heart rate, and helps baby transition to deep sleep. Slow down that bottle and you will have a calmer baby!

It can prevent gas!

Just like swallowing air can cause spit up, the same is true for the downstairs. Gassiness is just a part of life for humans but it shouldn’t be painful or cause colic-like behavior.
Paced bottle feeding can help prevent these discomforts.

Ready to give it a try? Here is the lowdown on how to do paced bottle feeding.

Part 1 here!

Megan Dunn, IBCLC

breastfeeding, supplementing

Paced Bottle Feeding

What is Paced Bottle Feeding?
Paced Bottle Feeding is a method of bottle feeding that allows the infant to be more in control of the pace of the feeding. This method slows down the flow of milk, allowing the baby to eat more slowly and take breaks. Paced feeding reduces the risk of overfeeding that may result in discomfort to the baby. This feeding method is recommended for any baby that receives bottles.

Many parents are worried about baby swallowing air or getting gassy with bottle feeding. The old-school way of bottle feeding often increases gas and air swallowing because the flow is simply too fast! Baby doesn’t have time to follow their suck-swallow-breath pattern and ends up accidentally swallowing air.

Just like you and I take breaks when we are drinking, baby needs them, too. Using a slower paced feeding method also teaches parents to recognize baby’s communication cues. Overall, the feeding is a lot more pleasant for everyone!

Caretakers and grandparents may need a refresher on how to give bottles in a way that respects baby’s needs. There are lots of videos on YouTube, Vimeo, etc which show how to do paced feeding. They all vary a little but this is how I teach it:

Paced Bottle Feeding Steps:
1. Choose a small, 4 oz. bottle and a slow flow nipple. Pick something baby can latch onto deeply, with fully flanged out lips.
2. Hold baby in your lap in a semi-upright position, supporting the head and neck.
3. When baby shows hunger cues, touch the nipple to baby’s lip so he opens his mouth wide.
4. Insert nipple into baby’s mouth, making sure the baby has a deep latch with the lips turned outward.
5. Hold the bottle flat (horizontal to the floor).
6. Let the baby begin sucking on the nipple with the bottle angled just enough to fill the nipple about halfway with milk.
7. Watch baby during the feeding: cues that baby may need a break can include leaking milk, hands held with the fingers wide apart, a creased brow, wide open eyes that look startled, gulping, or clicking noises
8. Every 2 minutes or if you notice any stress cues, tip the bottle down and remove it from baby’s mouth keeping the nipple just touching baby’s lips.
9. After a few seconds baby will try to latch back onto the nipple.
10. Continue this Paced Feeding until baby shows fullness signs – no longer sucking after the break, turning away or pushing away from the nipple.

After several days of Paced Feeding, babies often start to learn to pace on their own. You will notice them taking their own breaks, and then returning to feeding. Positioning the baby upright and holding the bottle in a flat position helps babies be in control of their own feeding.

Part 2 here!

Megan Dunn, IBCLC