Reflux in babies – NHS

Reflux is when a baby brings up milk, or is sick, during or shortly after feeding. It’s very common and usually gets better on its own.

Check if your baby has reflux

Reflux usually starts before a baby is 8 weeks old and gets better by the time they’re 1.

Symptoms of reflux in babies include:

• bringing up milk or being sick during or shortly after feeding
• coughing or hiccupping when feeding
• being unsettled during feeding
• swallowing or gulping after burping or feeding
• crying and not settling
• not gaining weight as they’re not keeping enough food down

Sometimes babies may have signs of reflux but will not bring up milk or be sick. This is known as silent reflux.

Things you can try to ease reflux in babies

Your baby does not usually need to see a doctor if they have reflux, as long as they’re happy, healthy and gaining weight.

Do

• ask a health visitor for advice and support

• get advice about your baby’s breastfeeding position or how to bottle feed your baby

• hold your baby upright during feeding and for as long as possible after feeding

• burp your baby regularly during feeds

• give formula-fed babies smaller feeds more often

• make sure your baby sleeps flat on their back (they should not sleep on their side or front)

Non-urgent advice: See a GP if your baby:

• is not improving after trying things to ease reflux
• gets reflux for the first time after they’re 6 months old
• is older than 1 and still has reflux
• is not gaining weight or is losing weight

Urgent advice: Ask for an urgent GP appointment or call 111 if your baby:

• has vomit that’s green or yellow, or has blood in it
• is projectile vomiting (being sick with more force than usual)
• has blood in their poo
• has a swollen or tender tummy
• has a very high temperature or they feel hot or shivery
• keeps being sick and cannot keep fluid down
• has diarrhoea that lasts for over a week or has signs of dehydration
• will not stop crying and is very distressed
• is refusing to feed

Also call your GP or 111 if you have any other concerns about your baby.

Treatment for reflux in babies

A GP or specialist may sometimes recommend treatments for reflux.

If your baby is formula-fed, you may be given:

• a powder that’s mixed with formula to thicken it
• a pre-thickened formula milk

If the thickening powder does not help or your baby is breastfed, a GP or specialist might recommend medicines that stop your baby’s stomach producing as much acid.

Very rarely, surgery might be needed to strengthen the muscles to stop food or milk travelling back up. This is usually only after trying other things or if their reflux is severe.

Causes of reflux

Reflux usually happens because your baby’s food pipe (oesophagus) has not fully developed, so milk can come back up easily.

Your baby’s oesophagus will develop as they get older and the reflux should stop.

Page last reviewed: 13 December 2021
Next review due: 13 December 2024

On Benign Baby Spit Up

So in your blog (which I just discovered and am voraciously devouring backwards), you mentioned Ike was a “happy spitter.” Reading your description of him, I actually said out loud, “Holy shit,” and then read said description to my husband. You’re totally describing our boy, who’s almost four months old now and is pretty much covered in milk in various stages of digestion at all times from head to toe. We didn’t know this was unusual (he’s our first) and your blog was our first introduction to the idea that maybe that’s not what all kids are like.

I guess my question is, is there any danger involved in being a happy spitter, provided he continues to gain weight and doesn’t get listless? Reflux? Esophageal erosion? Is that a thing? When does it fade away? Does Ike continue to spit up now that he’s eating actual food?

Also, um, what is regular baby spitup like? How often does it happen and is it like fresh breastmilk or more like the cottage cheese variety of spitup? Just so I have a frame of reference.

I can’t believe I consulted one billion breastfeeding and baby websites and books and yours was the only one that mentioned this phenomenon. And I include my pediatrician in that list.

Thanks for your help!
Mel

Oh. GOD. The happy spitting. I’d blacked it out. Repressed it. All six months or so of it.

Which there! Is your answer to many of your sub-questions: Yes, it stops. No, there are no long-term dangers or lurking after-effects. We saw a marked decrease in the spitting up (affectionately known in our house as the turbo-hork) once Ike started solid foods. By the time he could sit up unassisted, it more or less stopped completely.

I wish I could better pinpoint the end for you, but it was more like one day Ike threw up and it occurred to me that huh, that hadn’t happened in awhile. (As opposed to happening after every feeding, usually multiple times.) Then at some point later I realized I couldn’t even remember the last time he spat up at all. The towering pile of burp rags was moved to a drawer and more or less retired. He no longer vomits or spits up or ANYTHING, AT ALL, EVER, in case you’ve come across comments that “happy spitters” are more prone to overactive gag reflexes or will always just throw up more often than other children. While that might be anecdotally true for some babies, my pediatrician thoroughly dismissed that concern when I brought it up.

And oh, did I ever bring it up. At EVERY appointment. I waved my hand impatiently through all the other developmental questions about sleep and milestones, because can we talk about the vomit? Because I really need to talk about this vomit. I’d had TWO whole other babies, and neither of them EVER spat up like Ike. In frequency or volume. Oh my God.

But at every appointment, the doctor said the same basic things:

1) If he’s gaining weight, he’s getting enough milk. Calm down.

2) Even though it SEEMS like a lot of milk is coming back up, it actually isn’t. Take a tablespoon of water and toss it on your bed and see how it matches up to the spit-up stains. Calm down.

3) If he was suffering from Gastroesophageal Reflux Disease (GERD) and required medication, he’d have other recognizable symptoms. He’d be a “scrawny screamer” instead of a “happy spitter.” He’d grimace, cry, go on nursing strikes, pull his legs up or basically exhibit signs of colic. A happy spitter just sort of sits around and casually yaks on himself and isn’t bothered by it in the slightest. No big thang, Mom, calm down.

4) It’s not an allergy. For one: “Food sensitivities in breastfed babies are not nearly as common as many breastfeeding mothers have been led to think.” For two: allergies manifest with symptoms like screaming, fussiness, obvious discomfort, colic, rashes, hives, skin problems, congestion, actual for-real vomiting, weird stools, etc. Excessive spitting without tummy discomfort points to an immature esophageal tract and probably nothing more. Calm down.

5) He’s going to outgrow this. Promise. There’s no telling WHEN (could be six months, could be a year), but it WILL stop and he WILL be okay. Alsocalmdown.

And my doctor was right. Ike wasn’t in pain and continued to nurse and gain weight like a champ. At around four months, the doctor DID say that we could maybe consider adding a tablespoon of milky cereal to his diet, since sometimes that seems to kinda…remind the esophagus to grow up and mature already. I think maybe she was just tired of listening to me complain about it.

I waited another month or so and offered Ike a tiny bit of cereal. We weren’t super consistent with it at first, but sure enough, the spitting up seemed to improve after that. It’s entirely possible that it was just a coincidence — that Ike’s digestive tract would have matured on its own by six months anyway — but I guess it felt good to at least THINK that we were doing something about it. Placebo effect for us poor, vomit-stained parents.

While Ike was my only happy spitter, you’d never know that now. He never gags or horks up actual food (outside of illness, of course) any more or less than any of my kids. He has no allergies or food sensitivities and is absolutely giant for his age. (16 months old and closing in on the 2T hand-me-downs, oh my GOD.) And I already barely remember the haze of months that I spent covered in every flavor and variety of baby spit-up.

(Which, to answer your last question in the most disgusting way possible: “Normal” baby spit-up can be runny, undigested breastmilk/formula…OR the curdled cottage-cheese kind. Basically just depends on how long he’s held it in before barfing it back up. At the peak of the happy spitting, we usually got hit with both kinds. Ike would nurse and yak a little up immediately, then randomly surprise us as soon as we put the burp rag down with a dose of the chunky variety. Babies! So disgusting and gross! God.)

Photo source: Zoonar/Thinkstock

Cottage cheese in a child’s diet: its useful properties, when you can start giving

Tiunova Elena

Published: 06/23/2023

Reading time: 4 minutes

3065

If your baby is 4 months old or older, your pediatrician and your mother have already talked to you about complementary foods. If their advice is very different from each other, then it may be difficult for you to decide what food and when to give your child.
WHO and the Union of Pediatricians of Russia offer similar dates for the introduction of complementary foods and products *, **. But 30 years ago the rules were different, so grandma might insist otherwise.

This contradiction also applies to cottage cheese. Here, in addition to the conflict of traditions and the position of expert doctors, statements like: “Cow’s milk products often cause allergies!”

Does your baby need cottage cheese?

Yes, needed.
Cottage cheese – healthy food: contains protein, calcium, phosphorus and vitamins*, ***. But the intestines of the child must be ready to absorb it.

How much curd can a child have?

Not much.

Pediatric experts offer to introduce the baby to cottage cheese when he is 8-9 months old. Cottage cheese is introduced after fermented milk drinks: kefir, yogurt.

And you can first introduce cottage cheese at 8 months, after 2-3 weeks – fermented milk drinks.
For the first time, it is enough to give one “pea” on the tip of a spoon*.

In the table below you can see the amount of cottage cheese in grams for children under one year old. The figures are taken from the website of the Union of Pediatricians of Russia**.

WHO does not write how much cottage cheese a child can up to a year. Their manual notes that fermented milk products, in principle, should be given to the baby for its proper development.

So you will benefit your baby if you start giving him cottage cheese from 8-9 months.

What about an allergy to cow’s milk protein (CMP)? It happens rarely.
It occurs in 2-3% of infants according to the Union of Pediatricians of Russia****.

You may suspect a CMP allergy in a child if:

• You are breastfeeding and the milk from your table affects his tummy

• After a fermented milk dish, the baby develops unpleasant symptoms: regurgitation, vomiting, constipation, colic, blood in the stool or shortness of breath. If shortness of breath, call an ambulance immediately. True, this happens very, very rarely. I’ve only seen this once in my life0003

• Your baby stubbornly refuses to eat dairy products

• Skin around the mouth itches and swells immediately after such a meal

• Child eats milk well, but gains little weight and often suffers from diarrhea****

If the allergy is not very pronounced, then it is difficult to diagnose. To still determine what causes problems with the tummy or skin, ask your pediatrician to help you. He will explain how the effect of different products on the child is monitored.

You can’t miss a CMP allergy if you monitor your baby’s reaction to milk and work with a pediatrician you trust.

What cottage cheese to give to a child?

Child.
Mom usually chooses from two options: buy in the store or find recipes for children and cook it yourself.

If you decide to feed your baby with ready-made cottage cheese, then:

• Buy cottage cheese labeled “for feeding young children” ***. There are more stringent requirements for such a product compared to the “adult”
• Choose cottage cheese without sugar

If your baby starts eating sweets early, he will get used to it. Then it will be difficult to instill in him the habit of eating healthy food. Sugar in the mouth is the main cause of cavities*.

If you are going to make your own cottage cheese:

• Buy the right milk. The best option is high-quality milk according to GOST. In cow’s milk “from familiar grandmothers” there may be dangerous microbes, for example, E. coli. If it gets into food, it will cause poisoning
• Use thoroughly washed utensils and clean gauze to wring out
• Use a recipe for children. Cottage cheese is prepared not only from milk, but also from baby yogurt. There are recipes for cottage cheese for children on the Internet, for example, on the forum of the Russian Medical Server*****.

What to do if your child doesn’t want to eat “how much the doctor said” cottage cheese? Correct the situation with love and patience.
There are 2 variants of the problem:

• does not eat at all
• only eats it.

Doesn’t eat cottage cheese at all – and at the same time there is no allergy to BKM. Then your ingenuity will help feed the stubborn baby with healthy food.

Solutions

• Add cottage cheese to other complementary foods: puree or kefir. Create your own cottage cheese recipes for children

• Mix cottage cheese with unsweetened yogurt and offer to dip food into it if your baby can already eat it

• Suggest another brand of cottage cheese for babies

• Serve cottage cheese in an interesting way: make a ball, make a muzzle out of it using pieces of fruit or vegetables

• If the baby turns away from cottage cheese, but drinks kefir or yogurt with pleasure, let them remain in the diet.

What is the result? You can do it.

If you treat this difficulty as an interesting problem, you will probably come up with more options.

Eats only cottage cheese. The main thing – let’s cottage cheese without sugar. Offer other food to a hungry baby, let him eat it on his own. It happens that they offer more than once or twice. Imagine that you are teaching a small alien to eat terrestrial food. Learning sometimes takes a long time.

If that doesn’t work, get your baby interested in mom’s plate. Place non-cottage foods on the edge of your plate at mealtimes. Sit your baby on your lap and let him take some off your plate and taste it.
Gradually you will find how and how to distract the baby from the desire to eat only cottage cheese. The main thing here is to calmly tell yourself that this too will pass.

• Curd is healthy.
• It is given from 8 months, starting with a “pea”. Norm by 1 year – 50 g.
• You can influence what and how much your child eats without pushing.
• Many problems go away with age and gentle treatment.

Links for details:

* Kim Fleischer Michaelsen, Lawrence Weaver, Francesco Branca, and Aileen Robertson, Infant and Young Child Feeding and Nutrition. – WHO Regional Publication, European Series, No. 87, 2003, Updated Reissue, xix + 369 pp. ISBN 92 890 4340 7.
** Website of the Union of Pediatricians of Russia
*** GOST 32927-2014 Cottage cheese for baby food.
**** Allergy to cow’s milk proteins in children. Clinical recommendations of the Union of Pediatricians of Russia, 2018
***** https://forums.rusmedserv.com/

Information verified by an expert

Tiunova Elena

Pediatrician of the highest category, nutritionist, candidate of medical sciences, associate professor of the department of faculty pediatrics and propaedeutics of childhood diseases, Ural State Medical University

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Contents of the article

• Does your baby need cottage cheese?
• How much cottage cheese can a child?
• What cottage cheese to give to a child?
• What is the result? You can do it.

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Constipation in a child while breastfeeding

Action should be taken based on the cause of constipation. With diagnosed organic constipation, the treatment of the underlying disease is prescribed by a doctor. Solving the problem leads to the normalization of bowel movements.

For functional constipation, doctors recommend:

1. Breastfeed

² .

Breast milk, containing the mother’s immune factors, provides the baby’s natural protection against infections, contributes to the formation of its intestinal microflora and the development of the digestive system as a whole ² . With weak lactation and lack of breast milk and unstable stools with a tendency to constipation in a child, doctors recommend supplementary feeding with adapted milk formulas with the addition of prebiotics ² . They contribute to the maintenance of the intestinal microflora, on which digestion is partly dependent ² .

2. Follow the diet of a nursing mother

The composition of breast milk directly depends on the nutrition of the mother, therefore, by changing the diet, it is possible to influence the baby’s diet ⁴ . For the work of the gastrointestinal tract of the baby, it is important to observe the water regime, vegetables, fruits, cereals, wholemeal bread eaten by the mother, that is, foods with a high fiber content ⁴ . It is necessary to limit the consumption of foods that provoke increased gas formation: cabbage, onions, tomatoes, rice, legumes, black bread, pears, grapes, mushrooms, pickles, smoked meats and spices ³ .

Prunes, dried apricots and simple boiled beets can be used as a natural laxative during breastfeeding for constipation in a newborn – you just need to include them in the diet.

Fermented milk products are useful for maintaining the intestinal microflora ² . But if a child is diagnosed with intolerance to cow’s milk, a nursing mother will have to completely abandon dairy products made from it ⁴ .

3. Maintain the child’s physical activity

A well-organized daily routine and physical activity is the most important factor in the treatment of constipation in a child ² . Physical activity is selected individually according to the age of the child ² . For newborns and infants during the first 5 months of life, their natural activity and special exercises are enough ² . It is very important that the clothes do not hamper the movement of the child and allow him to independently improve his motor skills in the process of learning the world.

4. Massage the belly

First of all, after feeding, it is imperative to keep the baby in an upright position so that he burps air, and then lay him down on his tummy.

Abdominal massage involves gentle strokes on the tummy in a clockwise direction, that is, in a circle, starting from the right iliac region and ending with the left iliac region. In this case, the child should lie on the back. At the end of the procedure, holding the ankles, alternately press the baby’s legs to the tummy. This stimulates the passage of gases and defecation.

5. It is wise to use drugs that reduce gas formation

A large amount of gas stretches the walls of the intestine, weakens its peristalsis and leads to colic. Dill water, light fennel tea, simethicone preparations may relieve symptoms associated with constipation ⁴ .

Medications to help mechanically remove gases from the intestines, such as a gas tube or enemas, are sometimes useful. ⁴ . However, their frequent use exacerbates the problem of constipation: the baby’s gastrointestinal tract begins to “lazy” and ceases to perform its functions independently ³ .

6. Microclysters MICROLAX®

Microclysters occupy a special place in the complex treatment of constipation in breastfed newborns . They promote bowel movements and thereby alleviate the suffering of the baby.

MICROLAX® for children from 0 years is designed for the smallest children, equipped with a special short nose and can be used from birth up to 3 years ⁶ . The drug contains sodium citrate, which displaces water from the feces, sodium lauryl sulfoacetate, which dilutes the contents of the rectum, and sorbitol, which stimulates the flow of water into the intestines ⁶ .

Reinforcing each other, the components of MICROLAX ^® can soften stools and make bowel movements easier ⁶ . In this case, the effect of the drug may begin in 5-15 minutes ⁶ .