What actually works for reflux?

[Cluelessasacucumber]

4 month old breastfeed but topped up with formula before bed, feel like they're constantly puking. Sometimes they get really unhappy and do lots of back arching, or will be squirming around at night. Dr prescribed gaviscon but aside from pastey poos I'm not sure it's done much. Often in sling or held upright but also likes being on tummy.
I had horrible reflux in pregnancy so I just feel so sad for little one going through this.
Anyone have anything the worked?

My breastfed baby had a dairy allergy. Reflux/puking was the only symptom. Once I cut absolutely all dairy and soy from my diet, he was a totally changed baby. Zero Reflux, started sleeping a lot better too. You would of course have to completely cut out the formula unless you go for dairy free formula (but the totally dairy free formula tastes horrible, breastfed babies don't tend to drink it).

Good news is he is 2 and can tolerate baked milk and cheese now. Still can't tolerate yogurt/fresh cheese/milk.

I would say it's not normal to still just have reflux at 4 months. There must be an underlying issue at this age.

My baby produced small to large (Exorcist style) spit up after every feed until able to sit up more and start on solids. Talk to your health visitor, as some reflux babies are recommended to start weaning at 17 weeks. However you and baby should get some relief soon. The era of muslins over everything shall pass!

Thanks both. I have spoken to health visitor and they've directed back to GP (which I will do) but definitely not recommended weaning before thry can sit up.
I have wondered about an allergy or intolerance but a few of my friends babies have CMPA and in them it was obvious -screaming from day one, rash etc. My bub is often pretty cheery, it's just the vomit and arching.

Mine was much better once sitting up and weaning too, and HV advised weaning early (5 months rather than 6). Made a huge difference.

I would check for allergies though, especially look at your own dairy intake.

My son had reflux and was on so many meds but the thing that helped most was being upright. Also he was nil by mouth for a few hours before an operation and that seemed to stop the reflux for a week afterwards. No idea why, maybe gave his stomach muscles a rest or something.

Nothing worked for my granddaughter. She couldn’t tolerate the carobel or the omeprazole. She ended up on Neocate formula and the only thing that stopped her being sick was Magic Mix (order from the French pharmacy online).

Dairy exclusion. I had 2 cmpa babies. One was screaming and rash, one was happy as larry but had reflux and gross nappies.

Another vote for dairy allergy

Another vote for sitting up and weaning. My DD vomited all her feeds until she was sitting up and on solids. Everything magically fell into place after that. She’s 16 now, tall and athletic, no long term effects! She’s also a twin and was the smaller of the two, her brother was very happy and settled from day one, no reflux.

Yeah GP told me that too. That my baby should also have a rash or bloody nappies etc and that reflux is just a laundry issue. Bollocks. I removed dairy and had ZERO vomiting within 7 days. Reintroduced it in my diet after 2 months, and all the reflux came back within 12 hours. Then took another few days for my baby to be ok again. It's important to note that IF it is dairy, it inflames their gut and slowly damages it. It's worth trialling no dairy as you need to think long term effects as well.

Have you had a really good feeding assessment from someone skilled in bf? (Not usually the GP) This is the first recommendation in NICE guidance but often missed. Sometimes there are tweaks with feeding that can help.

a lot of people jump to allergies but a lot of the time their stomach sphincter muscles just aren’t developed.

My baby is breastfed, and vomits / spits up a lot. But he’s happy as Larry, no rashes, good poops and if anything, is better after the odd bottle of formula (which has was more dairy than my breastmilk) so I’m confident it’s not allergies.

The GP said it often peaks around 4 months, and gets better with weaning.

Is he/she screamy and colicky or just sicky?

I have 2 DSs… one was screamy and sicky (like constantly screaming), one was fairly happy and sicky.

Baby reflux where they just bring up milk isn’t the same as adult reflux/ heartburn where it feels painful. It’s annoying with clearing up sick constantly but if the baby isn’t upset by it then try to treat it as a messy phase that will pass.

Look up magic baby burp on YouTube, I found that quite helpful, before and after feeds.

That's helpful to know @NorthFacingGardener, I hate to think of him being pain. He's sicky but mostly happy, not screamy, definitely not collicy, but does get grizzly/archy particularly towards end of day which is sometimes actually relieved by throwing up. It just seems excessive compared to his peers .

Interesting that everyone is saying either allergy or just gets better with time and sitting. If I was just breastfeeding I'd have no issue cutting dairy, it would be worth a go but he really seems to need the bottle at end of day which is pumped milk where possible but otherwise it's formula.

@Tunaboona what do you mean by gross poos? Colour, consistency, regularity?

I had to try 3 or 4 formula milk brands before finding one to suit DS. I was apparently the same.

Does baby vomit after every feed? Or is it just the bedtime formula feed? Are you paced feeding the formula bottle? How much formula are you giving at once? Why are you giving formula at bedtime? Is it part of a feeding plan, or is there another reason for it?

sorry for all the questions but it could be so many things causing this.

Thanks all and thanks @Ileithyia for trying to get to bottom of this! I'm going to leave thread now, I was naively hoping Id get an answer after recieving so much conflicting advice from various sources all ready. It's just really stressful not knowing how to help him, but I suppose no one can actually tell me and I'll have to try a few more things and just hope something does the trick.

Omeprazole helped mine with the pain but didn’t get rid of the vomiting completely. We also tried dairy and soy free but it didn’t help.

Carol Smyth’s why reflux matters book is well
worth a read.

Non allergic infant reflux is rarely acidic. He isn’t in pain which is why he’s cheery, it’s not like your pregnancy heartburn. He drinks milk and presumably eats little and often.

When we look at infant reflux we think is this

developmental- often family histories of digestive issues possibly preterm

anatomical - babies with airway issues like laryngomalacia have persistent tricky reflux

over feeding- high supply often explains a happy spitter

oral dysfunction- strong links with reflux

allergic- most babies in this group are profoundly miserable

feeding technique- bottle fed babies who sound like they’re gulping down a pint and drinking quicker than 30mls per 5 mins often get reflux. I’ve changed this before by simply changing bottle technique.

basically you need to see someone skilled who can work through it all with you but the above book is a great jumping off point.

The reason there is conflicting advice is it isn't one thing. It is a symptom. Babies are more prone to refluxing their stomach contents as the spincter at the top of their stomach isn't strong enough to hold the stomach contents.
If they have a tongue tie they can take in more air, it fills their stomach up and milk can come up with the wind or the mixture of milk and air gives them an unsettled stomach and they can reflux their milk.
They have a small stomach so it's a fine line between fed and happy and my tummy is too full and I feel queasy - especially as suckling can be done for comfort as well as for hunger
Fast letdowns can trigger reflux in breastfed babies as they can take on more milk than intended to or be trying to comfort suck and getting a tummy full of milk (see above) or if they are having a feed it can be like downing a drink and this then result in some of it coming back up
Teething and colds can increase as on top of the drink milk there is excess saliva and snot which mixed means there is more in the stomach and they are also probably feeling rubbish and wanting more comfort.
Dairy allergies can make the body try to get rid of the food that it feels is making them ill.

The first solution that works on the majority of the causes is to make it harder to bring up the stomach contents - being upright rather than lying down or making the stomach contents thicker with comfort milks or other thickeners such as carobel, gaviscon or magic mix. It's also why reflux tends to improve between 4 and 7 months.

Reflux can cause distress this can be because of the acidity of the milk. This is where omperazole can help as it reduces the amount of acid the stomach produces. If the acidity has made the oesophagus sore this can lead to comfort and over feeding and feeding soothes the pain.

My daughter had severe silent reflux and moderate sicky reflux which meant she was in a lot of pain and screamed constantly. Hers was caused by allergies but also a problem in its own right made worse by colds, teething and growth spurts. It was managed by high dose medication and she's still medicated aged 6. She was also suspected of having regurgitation syndrome alongside the reflux as her body had got into the habit of refluxing drinks.

My son had a bit of reflux. He was bad between 2 and 4 months in the early evening. I had a fast letdown and he wanted comfort but ended up getting a stomach full of milk. Using gaviscon for this feed only and introducing the dummy helped. He was generally a "happy spitter" and we didn't need to make any other adjustments

Omeprazole helped for my DD. She did not have a dairy allergy either.

I refused gaviscon after DS had tried it and it had constipated the hell out of him. He also threw up Carobel.