Infant Reflux at the Center of Safe Sleep Guidelines (Spoiler Alert: They Are The Same For Everyone)
The Rock n' Play recall of 2019 is only the beginning. In the Washington Post article, "Fisher-Price invented a popular baby sleeper without medical safety tests and kept selling it, even as babies died," writer Todd C. Frankel shares, "...Many parents — and a few doctors — still contend an incline helps babies who have reflux, which often causes them to spit up. But medical studies have shown little support for this..."
And in this new Romper.com article, "Why Smart Parents Make Bad Sleep Decisions," where an interviewee shares, “My daughter slept overnight in the Rock n’ Play next to our bed, because she had reflux and we felt more comfortable with her sleeping propped up...”
The long and short of it is that the long-time advice of putting your reflux baby in an inclined position is not only being communicated as ineffective, but clearly stated as a huge danger to all babies. As stated in the Washington Post article, "In 2009, the same year the Rock ‘n Play debuted, two leading groups of pediatric gastroenterologists, building on accumulating evidence, released international consensus guidelines on managing stomach problems in babies, finding that elevating an infant’s head actually worsens gastric reflux."
View the full policy on HealthyChildren.org.
As more education and awareness gets out there, who knows the amount of families out there experiencing the guilt of having used these types of products, or turned to car seats or other sleep-deprivation-driven "lifesavers" to learn they are anything but that, and especially for the families who have faced unimaginable tragedies.
Armed with more knowledge today than I had five years ago, I am on a new and focused journey to learn how reflux families can employ the safest sleep conditions for their children, and share in any way I can. It's not lost on me how impossible it can be to help a reflux baby achieve rest (and forget about the parents in charge). It felt like an eternity of short and restless naps for near 18 months.
While I didn't have a Rock n' Play, I was recommended to use a crib wedge under the mattress as my son got older, and my reliance on the car seat haunts me to this day, captured in my post The Tipping Point. I didn't think once, not to mention twice, for the six months before this event happened (where my son actually tipped his car seat) when his airway could've been easily compromised due to poor head control and dangerous positions.
I get it. I have been there. This is not easy. I am relearning all I knew and humbly walking down this path.
Watch for more from Down With Spit Up as I work through my site to update and inject the most recent and research-based guidelines regarding safe sleep. I am not, and have never been, a medical professional. That's who I've relied on when it comes to these serious sides of reflux and other tummy troubles. While it doesn't solve the answers of how to manage the reflux, those like me, now on the other side, might sleep better trying to get the right information, in the right hands.
Check out the following infographic from First Year Cleveland - Safe Sleep Heroes:
When I look back on our reflux times, I'm left in a state of wonder:
According to the article, "Babies with reflux tend to have trouble sleeping through the night and taking long, restorative naps, since their discomfort makes it hard for them to stay asleep." In a similar article, Baby Sleep Site founder Nicole Johnson shares practical tips, and a bit about her breastfed "happy spitters." Happy is a relative term during these times. Just ask Holly Klaassen from The Fussy Baby Site.
Still we must go on, whether we are going it alone, or have an army of help among us.
Unverified Baby Reflux Sleep Tips
I've lived long enough to know that I am not an expert in anything. What works for one family, won't work for another, or will sound downright foolish. What I do know is to keep safety in the center of your sleep solutions. Here are some tips for baby and family.
Hopefully, one day, far from now, when you're back to your eight hours a night, you'll be able to hazily reminisce about these times. Maybe not wonderful, but certainly amazing.
View more baby sleep posts on DownWithSpitUp.com
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A baby’s scream. A carseat toppled over on the ground. A panicked mothered shaken in fear.
No, this wasn’t the scene of car accident. This was the floor of a warm, carpeted bedroom, where a baby was put to nap while his mom dozed off.
A strong, restless six month old who woke up and rocked himself back and forth until the carseat tipped over.
I was quick to grab him, but the mere seconds of the incident left me in a state of shock, fear, shame, and guilt.
Car seats for napping: This is what parents of reflux babies do when they are literally run to the ground, so their child can be elevated and possibly sleep. That’s what comes up when you search for reflux solutions. That's what your colleague says they did with their baby. That’s what I did because I thought it was the right thing. Turns out it’s wrong, very wrong.
According to CribsForKids.org, in step with the AAP Safe Sleep Guidelines, "If an infant falls asleep in a sitting device, he or she should be removed from the product and moved to a crib or other appropriate flat surface as soon as is practical. Car safety seats and similar products are not stable on a crib mattress or other elevated surfaces."
It doesn’t seem real as I share it to this day. In fact maybe two or three people even know this story. It represented the breaking point in what was a chaotic blend of life's duties, sleep deprivation and desperation.
Even if the situation doesn't require hospitalization or constant medical attention (sadly it does for so many), there are other serious risks and issues beyond the illness that surround reflux, colic and more. They are to be taken seriously even when others won't.
The gravity of parenting isn’t in making your mistakes and learning from them. It’s when you are truly giving your all, doing all you believe is right, and everything can still fall down around you.
Our only hope is to find strength through serving something far beyond ourselves.
The AAP Safe Sleep Guidelines speak volumes about protecting newborns and infants. If you read closely, they also reinforce the sleep challenges of families with reflux babies, including the glaring dangers of sitting devices (car seats, swings, slings) for routine sleep, as well as elevation strategies.
CharliesKids.org, a nonprofit dedicated to educating parents on safe sleep practices, regularly publishes critical information, including the Dos and Don'ts of Safe Sleep (image featured at the end of this post).
With the commonality of reflux as a feeding issue, and now 18+ months of "reflux relief" under our belt, there are clear things I would have done differently with information available today.
It's said hindsight is 20/20. When you don't get a good night's sleep for 18 months, the memories are blurry, but the big lessons are clear and stick with you.
My son was a reflux baby right out of the gate. Many experts in the field argue that reflux, colic, and related infant issues are myths, or overblown by overly concerned parents. Our reflux was real: I knew from the projectile vomit that no bib or burp cloth could hold.
I've reflected on my experience while it's still fresh enough to help others feeling this burn for the very first time.
What would I have done differently?
Pushed the reflux medication discussion
As controversial as it is, my gut — and my son’s packing on of the pounds — was telling me to wait it out (along with doctor’s orders). I'm certain something could've helped our situation while we waited out our "laundry problem." Perhaps even a small intervention would've increased his comfort and ability to achieve some gainful rest.
Asked for help
I felt completely and solely responsible for my circumstances. Layer in my husband's temporary work relocation, my full-time job as a marketing director, and early intervention for my then two year old. I should have asked for 24 hours to get my head back on straight, or in the least, regular support in-home. In the least I should have been blatantly clear within my circles at the severity of the situation, including the stress and sleep deprivation, and the side effects therein.
Sought extended leave options
I’m a worker bee, plain and simple, and financial supporter of my family, and didn’t consider short-term disability or other medical leave options or means to extend maternity leave. He needed continued care and I could've maintained a bit of sanity. Sleep deprivation is much more amplified when you add your career back in, which feels like 100% more to your plate. And yes, the other 100% doesn't go away.
Ditched the car seat, swing, etc. for sleep relief
It’s dangerous and unnatural, and yet where most turn for reflux relief (read any of the big forums) to get a wink of sleep. There are solutions out there to support safe and solid sleep as the AAP guidelines recommend. One close call is one too many. And on top of that, especially for new parents, the majority of media images out there depict unsafe sleeping situations for infants (thanks to CharliesKids.org for sharing this link as well!)
Enjoyed my newborn
Now we spent a lot of time together — mostly from the hours of midnight to 3 a.m. — but what could have been joy and bonding was mostly angst, soothing and problem solving. Can't they make a fragrance candle called "nuzzled newborn" to relive those precious moments?
Hugged my then two year old more
He got the short end of this stick, plain and simple. It’s hard enough being two and not being able to express your feelings, and then your parent giving 100% attention to the new baby because that’s how it goes. I try to make up for it every day.
What I don’t regret
General stats say about half of babies have some form of reflux, which increases for premature babies. For most, reflux is a temporary situation that resolves on its own. For many, it is scary and takes severe physical and mental tolls on the baby and family.
The AAP guidelines could be very discouraging for families at the end of their rope of stress and sleeplessness, and I want to share that there are ways you'll make it through. I don’t have any easy answers, but for most there is a beginning and end to this, and the most important thing is to keep yourself and baby safe during these trying time.
Even if your aren't going through it now, you may know someone that needs this message, which includes some coping advice. The lessons are also transferable and relatable to any concerned parent facing adversity in those early months, and good advice to those who are pregnant as well.
I want you to learn from my regrets and feel empowered over your circumstances, whether you are facing this today, supporting parents in their networks, or preparing for their own parenting journey.
How did you overcome the sleep challenges, or other obstacles, due to reflux and related issues? What advice would be helpful to other parents and caregivers?
Thanks again to Charlieskids.org for permission in sharing their resource and helpful list below!
In April 2015, an Oklahoma family lost their two-month-old son, Shepherd Dodd, because he suffocated when his in-home child care provider left him napping in a car seat. It's making the national news and social media rounds now because Shepherd's story is getting the attention of state legislators on the serious issue of safe sleep standards.
What is safe?
According to Dr. Erich K. Batra, as quoted in the The Journal of Pediatrics April 2015 article
"Cribs Are for Sleeping, Car Seats Are for Traveling: Danger in Using Sitting and Carrying Devices for Sleeping Infants," “Infants and young children should not be left unsupervised when using a sitting or carrying device due to the risk of suffocation and death.” The keyword here is unsupervised.
This article also sources seven main tips as outlined below:
And what about reflux babies?
Two words: ELEVATION and SLEEP. They do not work together, and even worse, can cause mounting risks.
A very common remedy to help alleviate reflux: elevating and or inclining your babies position after feedings (such as baby wearing) and for sleep and resting (such as using a crib wedge mattress or other solution). Mix in uber-stressed-out, ultra-sleep-deprived parents and/or caregivers, and hazardous situations can present themselves. As seen on various searches online, what works for some parents doesn't follow these guidelines, even if conducted under strict supervision.
In my home state of Ohio, the Department of Health, early in 2015, launched a "safe sleep" campaign to address one facet of high infant mortality rates, ranking fourth in the country (3 each week in the state). In their messaging, the concern of back sleeping and choking was broached, including links to a diagram on the National Institutes of Child Health and Development Safe to Sleep and SIDs prevention page.
In short, in my opinion, the situation of safe sleep is 100x more amplified for parents and caregivers dealing with reflux, silent reflux, colic and other common infant issues. It's a huge challenge creating a safe sleep environment for a baby that spits up in their sleep, or can't seem to sleep at all. It's goes beyond the crib and creating a safe physical, mental and emotional space for the whole family. Many families don't have the means to purchase a wedge or specialized reflux device or solution.
I can only offer two more words: AWARENESS and SUPPORT. That is my plea to everyone out there in these situations for themselves, and the friends, family members and even just acquaintances in your world. Parenting is tough, and scary, and requires vigilance - and in these early months - it can take more than you have to give. I hope we can continue to spread the word and build the support systems needed.
Parents prompt legislative study after baby dies while sleeping in car seat - Fox23.com
Cribs Are for Sleeping, Car Seats Are for Traveling: Danger in Using Sitting and Carrying Devices for Sleeping Infants - jpeds.com
Ohio's Infant Safe Sleep Campaign - Ohio Dept. of Health
Frequently Asked Questions for Safe Sleep - National Institutes of Child Health and Development
Parents Whose Baby Died Warn: Don't Let Babies Sleep in Car Seats: Parenting.com
CarSeatLady.com Cold Weather Tips
Look, I know zombies are really in right now. In fact, before I had kids I was in a zombie movie...really! It made RedBox ok? But I'm pretty sure the people I work with are starting to get annoyed with my daily audition for the Walking Dead.
If you have an infant with reflux or GERD (even silent) the chances are good that regular sleep is a fleeting memory. And what's worse, is that your not sleeping because the babe isn't sleeping, and you feel bad - real bad - because there's a sad reason for it. Even through the crankiness, all you want to do is take their discomfort away.
I've found lots of resources that explain WHY there is night waking and WHAT you can try to help. However, when I scour most forums, it seems that even through all of the remedies, good and restorative sleeping is not guaranteed - at any age - for you or the baby.
So instead of giving you all the tips that are supposed to help (just Google away for these), here are some tips for zombie mommies on what to do when nothing works.
What do you do knowing that sleep is not an option?
Spit Up Support Blog
Yea, I went there. Nearly half of all babies spit up, regularly. Some more, some less, and for many it's just plain scary.
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