Reflux and Sleep
Unfortunately, reflux and sleep challenges often go hand in hand! I often get questions about how to better manage sleep when a baby is struggling with reflux, and if sleep training is an option in these situations.
Before we dive into this, let me remind you that I am NOT a medical provider. My goal here is to provide you with a general understanding of reflux, challenge some common myths, and provide some strategies for managing sleep.
Let’s start with the basics- what is reflux?
In short, reflux refers to stomach contents flowing backwards- into the esophagus. Reflux is common and normal for infants as they have underdeveloped digestive systems and the little flap of muscle between the esophagus and stomach is not strong enough to hold down their stomach contents.
For many babies reflux is a non issue, they may spit up (some more than others!) but are not uncomfortable. If your baby fits this description and is healthy overall, consider it more of a laundry problem than a concern! BUT for other babies, reflux is severe and the acid coming up from the stomach causes pain and complications- this is called Gastroesophageal Reflux Disease (GERD)
Some symptoms of GERD include:
Forceful and painful spitting up (though some babies with GERD don’t actually spit up – “silent reflux” happens when the stomach contents only go as far as the esophagus)
Chronic cough, wheezing or congestion (in absence of illness)
Feeding refusal or fussiness at the breast/bottle
Fussiness after feedings
Blood in the stool
Being extremely difficult to soothe or calm
Poor weight gain
If your baby has any of these symptoms, or you feel concerned it’s so important they be seen by your doctor for appropriate diagnosis, management, and support. I also highly recommend seeking support from a medical provider or a International Board Certified Lactation Consultant (IBCLC) who is well educated in the diagnosis and treatment of oral ties. Though this is a new area of study and expertise, research indicates that tongue and/or lip ties can cause GERD symptoms.
How can I help my baby manage their reflux?
Feed your baby in an upright position, keeping their head above their esophagus. It can be trickier to keep your baby in an upright position while breastfeeding- try a tummy down, laid-back position (SO beneficial to check in with a lactation consultant for help with this!).
Burp frequently to prevent large gas bubbles (every 2-3oz, or between sides).
Hold your baby upright for 20-30 minutes after a feeding, to allow gravity to help keep things down. Sometimes parents find this hard if baby doesn’t want to stay in this position, or if they are trying to avoid baby falling asleep this way. Try turning your baby away from you for a walk around the house or spend some time looking out the window. Propping baby up on your legs for some face-to face interaction time can also work well!
Use a pacifier to allow for some non-nutritive sucking which can be soothing, and produces saliva and downward contractions of the esophagus (helps to keep things down).
Wear your baby in a wrap or carrier to allow for a comfortable, upright nap for baby and some hands-free time for you!
Separate feeding and sleep! When we feed to sleep we are often trying to lay baby down just after eating, leading to more reflux! Try to move feeding up a few steps in the bedtime routine to allow for some time to digest (a bath can be a great, upright post feed activity) and use an alternative soothing method to help baby fall asleep (pacifier, rocking holding etc.). This goes for naps too! An eat, play, sleep routine can be really helpful!
What not to bother with:
Propping baby up, or using a crib wedge. I know this may seem tempting, as elevation is common advice for adults suffering from overnight heartburn. Elevation does not bring the same relief for babies, and puts them in a unsafe sleeping position (Rosen, 2018). Its also important to note that laying baby down flat on their back does not increase the risk of choking or aspiration, as an infants airway anatomy protects them from this (AAP recommendations).
Starting solids earlier than recommended (it won’t help with sleep either- see my blog on feeding & sleep FAQ’s)
Adding baby cereal to your baby’s bottle to thicken feedings- especially without medical supervision! This can be risky for babies who may have uncoordinated suck swallow patterns.
Can I sleep train my baby if they have reflux?
Babies with GERD can be quite uncomfortable, and they require more care and comfort than other babies. Unfortunately this means that their sleep will likely be impacted both due to the pain they feel, and because of the way we have approached sleep while trying to keep them comfortable!
We know that independent sleep allows babies to sleep longer stretches at night between feedings, and eventually through the night once they are ready (here is a review of 52 studies!), but we can’t always establish this when reflux is at play.
In order to successfully sleep train we need to create positive feelings around sleep, which is going to be difficult if baby’s in pain whenever they lie flat in their crib. We also need to feel confident that any crying associated with sleep training is happening because a baby is frustrated and confused by changes to their sleep routines, NOT due to pain or discomfort.
The best thing to do if you feel your little one’s reflux is causing pain is to hold off on sleep training and focus on getting baby’s reflux better managed, or wait until they have had time to develop their oesophageal sphincter strength. It is helpful to note however, that simply crying when they’re laid down or waking up upon being transferred to the crib are not necessarily signs on their own that baby is experiencing pain (many babies without GERD struggle to sleep in the crib or wake easily once they are no longer in arms).
Please don’t let my advice to wait on sleep training discourage you! You can absolutely have a “good sleeper”! We just need to make sure your baby’s symptoms and pain are well managed first, before we make any changes to their sleep routines or expectations. In the meantime, it can be really helpful to focus on offering sleep to your baby when they have optimal sleep pressure, to avoid under or overtiredness (both make it really hard for baby to accept sleep!). This blog will help you determine your baby’s ideal wake window to ensure you are making sleep as easy as possible for you both.
Having a baby with GERD is extremely challenging.
As parents we need to do whatever it takes to help our babies feel comfortable, and this sometimes leads us to create sleep scenarios and habits that feel unsustainable and hard to change. I NEVER want you to feel guilty about this, providing comfort and doing whatever it takes to help your baby sleep is exactly the RIGHT thing to do! I know seeing your baby in pain is horrible, and I know the search for answers and treatment can be frustrating, but you are doing a great job! You truly are the best parent for your baby.
Once you and your baby have the reflux under control, we are here to help with the sleep part! We love working with babies who have a history of reflux, as moving away from feeding to sleep can be such a game changer for any lingering symptoms (and sleep quality!). We also know that even after your baby’s reflux is well managed, your worry meter is still really sensitive- you’ve been through a lot! Ensuring you feel comfortable and confident with the approach we take together is always our number one priority.
You can connect with us here to book a free sleep evaluation call to discuss how we can best support your family!