Helping: Reflux and Sleep

Babies who suffer from reflux or silent reflux often have difficulties with sleep. Reflux can cause
discomfort and pain, which can make it harder for the baby to fall asleep and lead to frequent awakenings during the night, resulting in short naps and interrupted nighttime sleep.

Why do babies get reflux?

There are several different reasons why some babies suffer from reflux, and it can be difficult to
determine the cause of each individual case. Sometimes the cause is never found. It can be due to various factors; therefore, it often involves trying different approaches to help your baby. Please always remember to consult with professionals such as your doctor and/or health visitor.

After being seen by a doctor some babies are treated for reflux with acid-suppressing medication.

What is reflux?

Reflux is a condition where the contents and stomach acid from the stomach move back up from a baby’s stomach into the oesophagus and possibly out of the mouth in the form of spit up or vomit. In adults, it is often referred to as heartburn or acid reflux.

A baby spitting up, even frequently, does not necessarily mean he/she has reflux. It is quite common for babies to spit up. However, if spitting up is associated with discomfort and pain due to a higher content of stomach acid, it is called reflux. A baby can also have silent reflux, where there is no visible spit up, but the stomach contents and acid flow back up into the oesophagus, which can be quite uncomfortable.

Possible causes of reflux:

  • Allergy/sensitivity to cow's milk or other foods
  • Delayed establishment of gut flora
  • Gut flora imbalance
  • Body tensions
  • Tight frenulum (tongue-tie)
  • Gas in the stomach

How does reflux affect sleep?

Most babies who suffer from reflux will have difficulties in getting sufficient and good quality sleep, as reflux often significantly disrupts sleep, which can be extremely frustrating for the baby as well as the parents.

Reflux often worsens when the baby is lying down, especially on his/her back, because gravity and anatomy cause more backflow of stomach contents from the stomach. This can make it difficult for the baby to fall asleep, as there might be frequent disturbances with discomfort and pain every time milk and stomach acid flow back into the oesophagus. Additionally, each time the baby needs to spit up. You might notice the baby is restless, possibly smacking his/her lips/swallowing, and making gasping/whistling sounds.

You may also find that the baby wakes up very frequently, possibly with a lot of crying. Moreover, naps are short because it is difficult for the baby to transition from one sleep cycle to the next.

It is tough to have a baby who sleeps too little or has very disrupted sleep. Partly because you need to be very attentive, even at times when you need sleep and rest yourself. But especially because it can be a significant worry not being able to help your baby get the sleep, he/she needs.

Help your baby get better sleep!

If your baby suffers from reflux and has difficulties sleeping, try not to stress too much about it. I
know it's easier said than done but remind yourself you are doing everything you can and doing it as good as you can. It's not your fault your baby's sleep is challenging, and it's not your baby's fault either. It's due to physiological factors beyond anyone's control. Try not to worry too much about future sleep problems either. Focus on making each day as manageable as possible. If
there are habits you want to change, wait until your baby feels better.

Measures to improve sleep for babies with reflux:

  • Keep the baby upright for 15-20 minutes after feeding and before sleep
  • Ensure the baby is fully burped after breastfeeding/bottle feeding
  • During breastfeeding/bottle feeding, keep the baby’s head slightly inclined
  • Put the baby to sleep with the bed head slightly elevated (under supervision)
  • Allow the baby to use a pacifier when going to sleep, as it can help reduce reflux
  • Movement – being rocked
  • Let the baby sleep upright in a baby carrier/sling
  • White noise

Luckily there are several steps to try before putting your baby to sleep to help reduce the frequency and severity of reflux. These steps can help calm your baby's nervous system and
distract him/her from any discomfort, like being rocked, listening to white noise, and sucking on a pacifier.

Some steps might not make sense or work for you, but worth trying.

Take care of yourself

Many parents of babies with reflux find everyday life challenging. There can be a lot of crying, little or poor sleep, not many good moments, a lot of stress and worry, and perhaps doubts whether you are a good enough parent. There might be a sense of guilt because the baby is having a hard time and because sometimes you just need a break. You might also feel less happy than you think you should.

If you find it hard, it’s because itishard, not because you’re not doing a good job. You are
doing better than that. It's not due to your efforts your baby cries or has difficulties; it’s despite your efforts. So, give yourself a pat on the back and trust me when I say things will get better.

Take shortcuts whenever possible. Accept help from friends and family when they offer – or ask for it yourself. Use available aids that can give you a break and thus more energy. It’s OK to save your strength during tough periods.

A mattress stiffener for the baby hammock might help

If you use a baby hammock, you might consider introducing the mattress stiffener at the bottom of the hammock earlier than the recommended 3 months if your baby suffers from reflux. This can help your baby turn the head more easily and get rid of spit up. However, it's important to be extra vigilant with your baby in the hammock if the mattress stiffener is introduced earlier than the recommended age. The baby can roll onto his/her stomach more easily with the mattress stiffener in the hammock, and the baby might not be strong enough in the neck to lift the head from the
mattress and breathe properly. Therefore, always keep your baby under supervision when sleeping in ways other than recommended by health authorities. You can read more about this here Prevent Sudden Infant Death Syndrome and avoid Uneven Head Shape and Flat Head Syndrome – Brochure for parents