Friday, November 23, 2007

Babywise and Reflux

Me and Kaitlyn, my little reflux baby
Can you do Babywise if your baby has reflux? YES!

Kaitlyn has reflux. I have done BW with her since birth. While other mothers were sleeping all night holding there reflux babies sitting in a lazy boy, I was wondering how to get her to sleep longer than 8:30-5:30 (she was sleeping in her crib).

I think there are great benefits to doing BW with a reflux baby. I think it helps their acid regulate.

Crying can aggravate reflux, so there is a possibility of having problems with Cry It Out (CIO)--but I never experienced any.

You also have the likelihood that the baby can wake more often due to the heartburn. It will pass. But it is something to be aware of if you are having problems with early waking from naps or waking in the night. Having your baby CIO while they are in pain isn't really going to accomplish anything, especially when you take into account the crying aggravating the reflux.

Something that can help is to burp your baby frequently and efficiently during feeding and throughout waketime. Give burping another go right before nap or bedtime.

Despite these possible challenges, you can successfully do BW even if your baby has reflux.

Here are some standard tips for reflux:
  • Avoid caffeine. I went off chocolate altogether when Kaitlyn was about a month old, and that made a huge difference. I don't drink caffeine in any way, but people I have talked to who drank coffee and cut that out saw a HUGE difference. Every so often I would be at a reunion or party and forgot my chocolate strike (honestly, I forgot, but my mind probably blocked it out on purpose! Yum, chocolate) and eat a piece of chocolate cake or something and I would see a change (for the worse) the next day in Kaitlyn.
  • I have heard to avoid citrus, including tomatoes, so that includes all sauces and soups made of tomatoes. Citrus didn't seem to affect Kaitlyn, though.
  • Think back to when you were pregnant and got heartburn (if you did). Think of the types of food that gave you heartburn. Spicy, etc. That will do it to your baby.
  • I personally think the reflux is better to have more frequent meals in the day that are smaller rather than a few large meals. So I kept Kaitlyn on the 3 hour schedule (sometimes we do 3.5 sometimes 2.5) until she was almost 7 months old.
  • I do think a schedule is good for the reflux. There are definitely more factors to consider while doing BW though. Like if they are having pain during a nap and that is what wakes them, or is it one of the many other possible things that affect all babies? You have to weed that out.
  • Some moms find that their baby with reflux will reach the "milestones" later. The milestones I am referring to are sleeping through the night, sleeping 10-12 hours at night, or moving to a 4 hour schedule. Other moms see no difference. Just be aware that it is a possibility.
  • You can put your baby to sleep on an incline. I had Kaitlyn in a bassinet that we inclined the mattress by putting foam we purchased at a fabric store under it. My husband simply cut it at an angle. In the crib, I bought a mattress incliner from Babies R Us. She would slide down it and I am sure it caused her to wake more often, but at least she wasn't having her esophogus burned! I stopped the incline somewhere around 15 weeks. Many people go longer.
  • Nurse your baby if it is a possibility at all. I know it is hard for many women, especially when you factor in the foods you have to cut out of your diet. It is so worth it for your baby. Breast milk changes with the baby. The calories in an ounce of milk increase as the baby gets older. Formula doesn't do that, so you would have to give the baby more formula to get more calories, but that can aggravate their tummies. Breast milk is also easier on the digestive system. Here is an example from my life to illustrate this point. When Kaitlyn is 6.5 months old, I didn't even use a burp rag to burp her at home. She still spit up every so often, but rarely. At church every week I give her a bottle with formula. This is so I can stay and listen to talks, lessons, etc. and also so she can maintain her familiarity with bottles and so she will be okay with eating formula if need be. Now here is the interesting part. Every week at church after her bottle, my baby went from not needing a burp rag to needing a BLANKET to cover my lap or else I would be soaking wet before long. So I went from no burp rag, to blanket just from a bottle/formula. You read that formula is not as gentle on the stomach so reflux babies will spit up more if they eat it. I have found this to be true.
  • Some advice I got from a fellow Babywise mom who had a daughter with reflux was to not let the reflux become an excuse for you. Yes, you want to be sure you are attending to baby's needs, but don't be too quick to attribute all problems to the reflux. If you do, you may be ignoring the real problems.
  • Check out Babycenter.com and look up reflux and nursing--you will find all sorts of information. You will also find a bunch of people who at 6 months are still up every two hours at night and who hold their child for all naps and sleep in recliners with the baby at night. They are frazzled, I feel bad for them. They have accepted that it is just really hard with reflux. But it doesn't have to be that way. You will feel much better about any difficulties you experience with your reflux after checking this out.
Reflux is no reason to not follow the Babywise plan. You might need to make some adjustments for your baby, but that is true for all moms. You will likely find life with your baby with reflux much easier doing PDF (parent directed feeding) than moms who do otherwise.

Reader Advice:
  • John and Amanda said...
    I had to comment on this one! My baby had (and still does at 6 months) severe reflux issues as well as extreme fussiness/colic issues. We saw the doctor at 5 weeks old and started Zantac and it helped take the burn away, but not the constant spitting (I'm talking 1 - 2 ounces at a time). For me, I slept my baby swaddled and in his car seat. I know it sounds silly, but it worked for us! We also used Gripe Water a lot although I don't know how much it really worked because he still spit a lot. It wasn't until he was 4 months old that he became a "happy spitter." My advice to BW Moms with Reflux Babies: Babywise was a little more difficult to follow with a fussy/colicky/reflux baby, but it can be done. Things may look different in your routine with a reflux baby, but if you stick with it he/she will get there eventually!
    January 24, 2008 3:19 AM

  • nessa said...

    hi, I'm a mother of a 5 1/2 reflux baby named Garrett and i have followed babywise since he was born. There are a few things I wanted to share that helped my child with this issue, without taking medicine. I found that with his reflux cutting things out of my diet helped dramatically. I eliminate caffeine (including chocolate to my dismay) dairy, citrus, and minimized gas forming foods (broccoli, onions, etc). I even tested the food items by eating them one time in the week and found that he would have episodes of reflux for a few days after (especially to chocolate). I noticed after a few days of eliminating these items that his symptoms dramatically improved. Another item that helped was purchasing a wedge pillow from arpillow.com The pillow makes a huge difference. I wanted to let other reflux mom's know about the pillow because i've seen it work for my lo. He slept through the night after purchasing this pillow. When he doesn't sleep on it, he arches more after a few days and has more acid pain. (I've experimented) Another comment I wanted to make is at the dreamfeed. I held him up for 30-45 mins after feeding him, before putting him to bed. Another difficulty I found was giving him TUMMY TIME. Because laying on his stomach caused him to spit up more! So I started giving him tummy time when he awoke early from a nap, right before feeding him. In the beginning it only lasted about 5-10 mins. Depending on his hunger level. Then later around 4 1/2 months he started to enjoy it, and at 5 months became a rolly polly. There are ways naturally to help comfort our LO through reflux. AND yes they do need routine!

    Plowmanators said...

    nessa, thanks for all of your tips! It is good to have a variety of tips. I couldn't agree more about the caffeine.
Reader Questions
  • Jordan & Nikki said...
    A week & a half ago, my near 4 month old was diagnosed with acid reflux. I'm not sure what took me so long to figure it out...regardless, the hardest thing is that the medication isn't yet fine-tuned & she is still highly bothered at least 2x/day. It kills me to see her so upset - and then the spit up comes & she is as happy as a lark. At our follow-up Dr. visit, we should be able to adjust the medication, but until then, with the early nap wakings (i.e. less than an hour into the nap, clearly due to the reflux), should I just start the cycle anew? I guess I just feel frustrated that attempts at a schedule can be pushed aside due to reflux at any time. Is that normal?
    July 15, 2008 11:35 PM
    Jordan & Nikki said...
    Aside from needing validation of my frustrations, I do have specific questions. She sleeps from 6 pm - 6 am, with a dreamfeed around 10. She wakes as happy as a lark...I can't complain. During the day, she is able to fall asleep on her own, unless the reflux is acting up or she is overtired from it acting up. She does wake up in the middle of the night... she isn't hungry but I don't want to make her CIO to learn to go back to sleep, as it may aggravate the problem. She doesn't take a pacifier, so if I start to nurse her, she immediately goes to sleep. Any suggestions on how to wean her from that dependency? Or should I just appreciate that she is doing so well, considering the occasional pain?
    July 16, 2008 12:21 AM
    Plowmanators said...
    Nikki,I am glad you found it. I think if the NICU nurses hadn't pointed it out in Kaitlyn, I never would have noticed. I think I would start the cycle new, but give her about 20 minutes before feeding her if she will so you can be closer to the right interval. Eating too often can aggravate reflux. Though some need smaller amounts more often :).I do think you should be happy she does as well as she does, but I also think it is something you can work through. Once the meds are in place and working well, then I would give it about a week and then start to work on the night stuff. See this post for ideas on breaking it gently: Early Morning Feedings Before Waketime: http://babywisemom.blogspot.com/2008/01/early-morning-feedings-before-waketime.html I found that Kaitlyn was a little slower in reaching some of the big milestones because of the reflux, so if your daughter is the same way, keep that in mind (I mean STTN and 4 hour schedule).
    July 17, 2008 9:12 PM
  • mkk23 said...
    Hi there,Thank you so much for this blog! It has made this process so much easier. :) I know that you have mentioned that Kaitlyn had reflux, how did you know or the nurses know that she had it? What are the signs of a reflux baby? My 6 week old spits up a lot but I don't know how much is too much. We start our day at 7am and right now, it is 2:30pm... he has spit up about 12 times already. He definitely has had gas problems since birth - meaning he has always had a difficult time letting the gas/burps out. It has improved in the last week. Any advice would be greatly appreciated.
    August 12, 2008 2:36 PM
    Plowmanators said...
    You are welcome! I am glad it has helped. Kaitlyn had silent reflux, meaning she didn't spit up. What happened was she would spit up, then swallow it back down. She did her best to hold it in; it would even often come out her nose because she was trying so hard to keep it down. There are a lot of signs of reflux. I would google it and see what you find. It is also known as GERD. Some babies just spit up a lot.
    August 13, 2008 8:18 PM
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14 comments:

Beth said...

Hi,

My 6 month old was diagonsed with GERD at 6 months of age. We've been on Zantac to Prevacid adn back to Zantac while continuing to play with the dosage to find the right amount for her. She's the happiest and most smiley baby ever, but sleep remains to be the primary issue.

My firstborn also had GERD, but followed BW to the T and slept through the night at 6 weeks, so I'm at a bit of a loss as to what to do...if anything.

While I can't seem to get her to establish an exact nap schedule during the day, I have been able to get her 2-3 hours of day time sleep. We're still on a 3 hour feeding schedule, which I'd love to extend, but I know that night sleep is supposed to come first.

At night, I nurse at 7 pm and put her to bed. I do a DF between 10-11 and after that she wakes up anywhere between 2-3 times with waking at 7:30 am. The doctor has recommended feeding her when she wakes assuming that she wakes due to the reflux. She said that food will help push the acid back down. Since I fully nurse, this is beginning to get tiring after 6 months. When I do feed her at night, sometimes she wants a little food, other times she'll just use me as a pacifier. I've tried CIO several times, but it doesn't work for her. She'll cry for over an hour and not soothe herselve back to sleep at night.

I'm not sure if I should just continue on as I am in hopes that one day she'll STTN or if there is something else I should try. I'll probably start her on solids this week and am wondering if that might help too. Do you have any suggestions for this tired mama?

Beth said...

Correction...she was diagnosed at 1 month of age with GERD.

Plowmanators said...

Beth, that does sound tiring! I think solids have a good chance of working.

I don't know if I would do feedings every time she wakes. Eating activates acid. I would try soothing her back to sleep with a pacifier or whatever works for her and see if she sleeps better that way.

courtney murphy said...

HELP!
my first son was diagnosed with reflux at 3 months, he had silent reflux like kaitlyn. He responded beautifully to prevacid and although he struggled with sleeping, it was due to severe food allergies we didn't know about until testing at 6 months. My newborn baby girl has been a different story. She is miserable. On day 4 she spit up yellow bile and cried. I immediately took her to dr and put her on prevacid. That weekend she had constant diarrhea, a full body rash, and continued to be miserable. After 5 days on prevacid we pulled her off it and kept the Zantac. We are on week 4 and are MISERABLE! I am pumping and we are doing 48 hours of nutramigen formula. After a week on the elimination diet and no change the dr wanted me to try this. She barely sleeps ever and I mean ever. Sometimes the morning after 7am and midafternoon are her best stretched. Nights are awful. Lots of screaming and spitting/vomiting. I know breast is best but it's a last ditch effort. She has the worst gas an most intense screaming I have ever heard. She was born at 37 weeks and was 6 lbs. Any and all advice would be so appreciated. I barely make 3-4 hrs total of sleep in a 24 hr period. And I just want to help my baby so badly.

Plowmanators said...

Oh Courtney! That sounds so awful for your baby and you. Poor girl. First, have you tried giving her gas drops?

Second, is there something else besides zantac she could have? I know there are other meds out there, and I know zantac is the weakest and doesn't work long-term. I would look into that.

Third, it sounds like she has it really bad, and I don't have experience with that, so I will refer you to a reflux site that was created by a Babywise mom.

http://refluxrebels.com/

Joey and Whitney Plumb said...

I wanted to post a little about my baby girl with reflux in hopes of helping someone. The first 8 week were really really hard for us because we couldn't figure out what was wrong. At three week she was diagnosed with acid reflux and put on prevacid and it really helped as far as her pain but not the spitting up. That was fine because I can deal with spitting up and lots of laundry but there was still something up. The next thing we moved to was formula changes because I had to supplement a lot. We tried nutramagen which we thought was helping at first but then we realized it was making it worse. FINALLY at 8 weeks we found the right formula for her, she is lactose intollerant and the only formula with NO lactose is similac sensitive the orange can. She impoved dramatically from there and since we were no longer in survival mode we started her with just the schedule. She did great so one week later at 9 weeks we started the CIO and she did awesome it only took her 2 days maybe and it wasn't even every nap. I hope that gives hope to someone who wants to do babywise with their reflux baby. The schedule really helped give her time to spit up since the wake time was after eating. The inclined bed also really helped her and I had to adjust it so that she had something at her bum and on her sides so she didn't slide. We seem to be in a good groove now burping her half way through her bottle and at the end. We still deal with a lot of burp rags but she doesn't seem to mind spitting up at all. Also for wake time we simply put on a bib and wipe her face as it comes, and of course a lot of laundry :). She is now just a few days shy of 3 months old and doing great as far as her reflux, but she still is a normal baby with growth spurts and other little bumps in the road. she also just barely made it to 9.5hrs of sleep at night where she was at 7hs. from 8 weeks. Oh and I almost forgot gripe water(only the mommy's bliss brand) worked really well as far as helping her burp, it didn't eliminate any spit up but when she was younger it really helped. Now she does great at getting it all out on her own and doesn't really need it anymore. Hope it helped, and as always hang in there!

Joey and Whitney Plumb said...

Also I forgot to mention that her pacifier REALLY helped. I don't know where I read it but it helps them to keep the acid down better with all that sucking. She has always taken it and I would give it to her because I knew it made her feel better. I used to reinsert it durning naps but now that she is doing much better I only give it to her when I lay her down and she caught on really quick that she wasn't going to get it back in the middle of a nap.

Plowmanators said...

Thanks for sharing your story Whitney. I am sure it will help many parents!

Erin Wright said...

Could you just elaborate a bit more about your daughter's reflux during CIO? My daughter, 1.5 weeks old, started a rice starch milk-based formula to control her reflux and spitting up (though hers is silent too, she swallows it usually). It used to be so bad that it would wake her up early from naps, but now we do not have really have an issue with her reflux. However, when she gets upset and cries, the crying seems like it might be aggravating it, though of course I cannot really tell because she swallows anything that comes back up.
I was curious whether your daughter showed signs of the reflux when she was crying, and if so, how you knew that it wasn't causing her pain (so you could let her keep crying)? I really want to try CIO because she's having some difficulty getting herself to go to sleep on her own, but I'm just nervous she will be in pain and I won't be able to tell.

Erin Wright said...

Also, like so many others have commented, I love your blog and very much appreciate the time and effort you must put into it - it's wonderful encouragement just to be able to read about what you have done.

Plowmanators said...

Erin,

Thanks :)

This is a hard thing with reflux. If I even thought she might be in pain, I moved her to a swing for naps instead of her crib. It is something you get to know pretty quickly. When meds were right, the reflux did not bother her. But you often have to adjust meds (the ones weight-specific). So I would suggest if you think she is in pain, you don't CIO that nap. Kaitlyn took some naps in the swing still even until about 7ish months old (I am sure the exact age is somewhere on the blog--I just don't remember exactly). It didn't ruin her at all, so don't worry about that.

Josh Barron said...

Thank you for sharing these reflux in newborns remedies. My wife and I are really worried about our baby so we hope this works or we'll head to a doctor already.

Stephanie and Michael said...

Like others have said, your blog is very helpful. Thank you!! My 7 week old baby has severe reflux, and I was about to throw Babywise out! She is taking Prevacid, but I think she may need a higher dose because she still screams in pain often after meals.

Ideally, I would love for her to sleep from 8:30pm-8:30am at some point. Right now, she will wake up at about 1:30 and 5:30 to eat.

With Prevacid, she is supposed to take it 30 minutes before she eats. How does this work? How did you make it work? Do I give it to her at 8:30, feed her at 9. Depending on how she is feeding that day, she may be done at 9:15 or 9:30. Because I have to keep her sitting up for 30 minutes after she eats, she may not be able to go down for a nap until 10 (she is very fussy at this point)... She's not ready to stay up that long. Did you have any issues with that?

Having her sit up for 30 minutes after eating has also made organized wake time really difficult... How did you make it work with Katelyn?

Also, I have been trying to get my baby to sleep in her crib during naps. She sleeps in it without a problem at night, but for some reason struggles during the day. I am using the 4 S's, short/sweet sleep routine, and etc.

I don't have a swing, so when she wakes early and all of my attempts at getting her to go back to sleep fail, I carry her in a MOBY wrap so that she has a decent amount of sleep before her next feeding. I have found that it is the only thing that will work. In fact, with really rocky/hard days, she spends a lot of the day in a MOBY wrap. I have been using it for a week. Before I discovered it, she would just inconsolably cry for hours.

Would you recommend something besides carrying her in a wrap?

Brooke said...

Thank you for this post encouraging flexibility when a baby has reflux. My sweet baby girl (now 6.5 weeks old) was having terrible trouble sleeping almost from the beginning, and I KNEW something was wrong. I'm a first-time mother, so I didn't have a clue that reflux was a possibility, I just knew that she couldn't sleep except on her tummy lying on my chest while I was semi-upright... so that's what I did for her for a few weeks. My BW friends kept stressing my need to sleep-train and let her CIO, but it just didn't feel right. I switched pediatricians, and the new doc diagnosed her immediately.

With medication, she now sleeps in her crib in my room with no crying. And it turns out that smaller, more frequent feedings (every 2 hrs during the day) have helped her tremendously, even though my friends told me I was "doing it wrong." At night she sleeps well in two 5-hr stretches, which is perfectly fine by me; frankly, I'm not comfortable with trying to make her sleep 10-12 hrs given what I now know about reflux and frequent feeding.

Anyway, I think Babywise gets such a bad rap because of adherents like my friends who can't allow flexibility based on individual babies' needs. (Indeed, the book is likely to blame here, as it's written in such absolute terms -- doesn't admit the possibility that the 2.5-3 hr schedule just might not work for some newborns, or that sleep training isn't the solution for all ills.) Thanks for providing some much-needed balance! I'm so glad I followed my instincts with my daughter and refused to let her suffer so I could get more sleep. Now we're both sleeping well!

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