Reflux, feeding and sleep
Arching, crying after feeds, and a baby who will not lie flat. If reflux is genuinely part of this, sleep advice comes second - and one of the most commonly suggested fixes is unsafe.
3 min read
Some degree of reflux is normal in babies: the muscle at the top of the stomach is immature, and milk comes back up. Most of it is what clinicians call happy spitting - messy, entirely harmless, and requiring nothing except muslins. It usually peaks around four months and resolves by around a year.
It becomes a medical matter when it causes pain, feeding refusal or poor weight gain. At that point, no amount of schedule adjustment will help, because the problem is not sleep.
Signs it is more than spitting up
Pain around feeds. Crying during or after, arching backwards, pulling off and on repeatedly, a distressed rather than messy baby.
Refusing feeds. Or feeding briefly and then fighting it. A baby who associates feeding with pain will start avoiding it.
Poor weight gain. The single most important sign, and the one that most clearly separates a laundry problem from a medical one.
Unable to settle lying flat. Sleeping only upright, on a person, or waking within minutes of being laid down.
Frequent hiccups, coughing or a hoarse cry. Especially with unexplained night waking.
The thing not to do
Do not tilt or prop the cot mattress, and do not use wedges, positioners or nests. Raising the head of a cot is widely suggested and it is not recommended: babies slide down into positions that compromise their airway, and any incline increases risk. Safer-sleep guidance is unambiguous - a firm, flat mattress, on the back, whatever the reflux.
Nor should a baby with reflux be put to sleep on their front or side. The back is the safest position for every baby including those who spit up; the airway anatomy protects against choking.
Never tilt the cot. Whatever the reflux, the mattress stays flat and the baby stays on their back.
What does help
Holding upright for twenty to thirty minutes after feeds, before putting them down. Smaller, more frequent feeds rather than large ones. Winding thoroughly and unhurriedly. Slower-flow teats if bottle feeding, and checking positioning and latch if breastfeeding - an infant feeding specialist can be genuinely useful here.
Where reflux is confirmed and troublesome, your GP may consider thickened feeds, a trial of a different formula, or medication. That is a decision for them, and it is worth going rather than persisting alone.
What happens after the reflux is treated
Sleep usually improves substantially, and it does not improve immediately. A baby who has spent weeks associating lying down with discomfort takes a little while to unlearn that, and the first fortnight after treatment often looks disappointing.
Give it two or three weeks before assuming the reflux was not the problem. In the meantime, keep the upright period after feeds, keep the routine steady, and hold off on any settling work until feeding is comfortable - a baby still in discomfort cannot learn to settle, and the failure will look like a failure of the method.
What to take to the appointment
A week of notes: when the feeds are, how long they take, what happens during and after, how much comes back up, what the crying sounds like and when. Plus the weight history from the red book, which is the single most useful thing you can bring.
A short video of a difficult feed helps too, since your baby will feed perfectly in the consulting room. Reflux is assessed largely on the history, so a specific record is worth considerably more than a description of how bad it has been, and it makes a ten-minute appointment far more productive.
When to stop troubleshooting
See a GP for poor weight gain, feeding refusal, persistent distress, blood or green colouring in the vomit, projectile vomiting, arching with pain, or difficulty breathing during feeds. Any of these mean the sleep question waits until the feeding question is answered.
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