Acid Reflux in Babies?

Or is it Lactose Overload?

Acid reflux in babies is a problem I hear about really frequently in my work day. Many babies I see have been diagnosed with reflux and are on drugs to help settle the acid in their stomach.  Looking into the research regarding reflux in babies though there really is little evidence to support the percentage of babies I see who are having trouble with "reflux".

If I look at the various different presentations for acid reflux in babies some of them don't include actual vommiting - so called silent reflux - and I'm sure this can be really confusing for new parents.

• Now every mother I've seen with a "refluxy" baby will tell me that their baby was screaming in pain
• Most will mention that they were back arching and struggling to breastfeed
• Some will talk about how they were really unsettled most of the time, particularly when placed on their back and were better when being held in an upright position.

Now all these things make sense for a baby who is suffering from pain of acidic stomach juices coming back up the food pipe, BUT, and this is a big but, they also make sense for a condition that is a little less talked about.

Lactose Overload

The term lactose overload sometimes makes mothers think that their baby muct be allergic or intolerant to dairy and that they must have to go off dairy to have any impact on their baby's pain. This is not the case.

A baby with lactose overload in fact is having trouble with a hind milk/fore milk imbalance. What I mean by this is that they are getting lots of sweet fore milk and not enough fatty hind milk to balance it. This causes wind and bloating in the bowel, making them very uncomfortable and unsettled.

Often but not always, their mothers have a really large milk supply (and fequently a very forceful let down reflex too) which makes it difficult for the baby to feed easily (cause of them pulling off the breast during a feed).

This oversupply sometimes means that the baby is getting more milk than they need and so they posit (a small vomit) the excess milk up after the feed.
They have a lot of gas build up causing pain in the guts which can sometimes lead to excess burping, and in a younger baby's case some more positing - even a long while after a feed.

The gas build up makes them uncomforable when lying down making them arch their back during feeds, and be very unsettled when lying down.

Now the clincher - a baby with lactose overload will have green frothy bowel motions, lots of gas and trouble passing wind (sound like colic anyone?).

So... Acid Reflux in Babies, or Lactose Overload, or Both? And What to Do About it?

So you've got an unsettled baby, who is probably making you very tired from constant carrying and bouncing and not sleeping. What do you do?

First of all, if you think lactose overload might be part of the problem it's important to get that fore milk/hind milk imbalance addressed.

• Try using breast compressions. This technique is incredibly useful to help your baby get more hind milk and can help increase the amount of milk they are getting in general. Start doing the compressions once your baby stops swallowing much milk (see these video so you can get an idea of nutritive and non nutritive sucking)
• If you are bresatfeeding every one to two hours, and your baby is taking a long time to feed (an hour or more) it is worth getting your baby checked by a lactation consultant.  It is unlikely that they are latched on well and aren't going to be getting enough milk
• If your baby is putting on lots of weight try feeding from one breast at a time, using breast compressions until they stop swallowing milk, and then swap

If these steps don't work, it is more likely that you are dealing with reflux as well, go and see your doctor.

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