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:
Before I had a reflux baby, I had a drooler.
Not the typical kind of baby drool that can be swiftly wiped away. The spurting, angry, gnashing of teeth (well gums) kind of drool that demanded permanent bibs and frequent clothing changes.
This drool was so pervasive that it caused skin irritations on the mouth and neck for several months. We assumed he was having teething issues 24/7 from a very young age, and well before his first chompers popped. As first time parents, we didn't know what to do or if it was something more serious. Looking back I should've been more inquisitive - he also had extreme fussiness and colic-like symptoms - it could have been silent reflux.
If my second child was a next-level drooler I guess I didn't notice; or it came out with his regular reflux and I was none the wiser. Or I was so foggy from not sleeping that I dealt with it and don't remember. I would later learn that drooling can be a side effect or aggravated by reflux, due to the acid burn build up at the back of the throat, and as shared in the Recognising the signs of Reflux article via BabyBoo.ie and the What to Expect Spotting and Treating Infant GERD article.
So when faced with a dreadfully drooly situation, what should you do? Is it normal development? Is it a sign of reflux or other condition? Does it require more immediate medical attention?
According to HealthyChildren.org, "Drooling and Your Baby," drool is typically a good thing for development, but there is a difference between typical drool behavior, and possible medical emergencies, such as: viral infections, windpipe issues, choking and seizure. Check the article for the full table and reference.
As far as tips for keeping baby safe and comfortable during times of drool, I recommend adequate bibs and soft burp cloths for wiping; the use of a barrier cream or petroleum jelly ointment on skin affected by rash or irritation due to the drooling; and frequent clothing changes to prevent the wetness and discomfort of the neck and chest. Drool is a mess, even when it's normal, and keep an eye on how it progresses.
As with everything shared here, and any time your instincts are saying something isn't quite right, consult with your pediatrician or GP for the official download.
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The debate on the existence of the condition known as "colic" means nothing to the desperate parent seeking to softly soothe or simply calm down a screaming newborn or infant.
Beyond the sheer discomfort to the baby and disruption to the family, it can become a 24/7 terror, especially for new parents. See the article Postpartum Depression & Colic - Risk Factors, Warning Signs by Shoshana Bennett, Ph.D., or My Baby Cried More Than Yours and Noone Knows Why, by Elizabeth Preston.
While reflux ruled the world of my second child for nearly two years, with my first I experienced incessant crying, colicky symptoms, and intense fussiness, for at least the first two months. If I didn't go through it myself I might find myself seeing the side of the doubters, but it was a level of crying and discomfort that I really couldn't explain, fix, or wish away; we just had to get through it.
That all said, I didn't document this time of my life or how I coped (and frankly blacked out most of it). Fortunately I was recently connected with a very helpful management guide - and extremely accurate title - for parents: How To Soothe Your Colicky Baby Without Losing Your Mind via MomsLoveBest.com and author Jenny Silverstone.
Check out an infographic from the guide below and click to learn more.
View more colic posts on DWSU and thanks to Jenny for sharing this with us!
Learn more about how to soothe your colicky baby at Mom Loves Best
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Extra Dose of Guilt: JAMA Study Shows Increased Allergy Risks For Infants Exposed to Acid-Suppressive Medications and Antibiotics
New study results from JAMA Pediatrics states that "Early exposure to medications that can alter the micro biome, including acid-suppressive medications and antibiotics, may influence the likelihood of allergy."
Of the 792,130 infants researched, the study found that those given H2 blockers or P.P.I.s (typically prescribed for reflux and GERD/GORD) "were more than twice as likely to have a food allergy as those who were not." Check out the NYTimes article "Giving Babies Antibiotics or Antacids May Increase Allergy Risk," for all the details and commentary.
I've written before about the weight of medication decisions for families of babies with reflux. For many, and with severe cases and situations, there is no choice in the matter; medication may be the only option in addition to other medical interventions.
From following reflux experts, bloggers and general recommendations online for more than five years now, I have not seen a more a polarizing topic than this one.
For us and our "happy" spitter we chose to wait-it-out (while I cried-it-out each night). We managed the massive spit ups while watching the weight gain and other factors as the weeks passed by. And spoiler alert: our child still has some allergies and sensitivities/tummy troubles. While there is no winning here, I can say that I'd rather know all I can and have access to all information out there. Studies like this are here to inform and not to add to guilt or anxiety either way.
So what's a parent to do? Educate yourself - weigh the risks - know the score - and continue to do what you and your doctor think is the best course (even if just for the day in front of you). Don't be afraid to reassess on the regular, and change directions when you need to.
How do you respond to the new study results?
Photo by Glenn Carstens-Peters on Unsplash
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.
This list has been updated each year for the past three years, but the core tips and tasks have remained the same.
I started this site on the premise that although every situation is different, there are common threads that bind families and caregivers managing reflux, colic and related issues in their homes.
Check out below and let me know what we're missing here!
BONUS TIP: Pay it forward. Though we're all in this together, every single situation is unique. From preemies to older to children, and from one solution to the next. We can all benefit from the sense of community created when families open up and share their stories.
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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!
Editors note: This post originally appeared in 2015 on the Down With Spitup blog. More resources and information has been added throughout the years.
Read this first!
First off, I would recommend reading this post before you Google image search these terms. It will better prepare for what you need to see but maybe don't want to see. If I'm too late, my apologies!
Secondly, I've seen a lot of chatter (and/or moms going quite mad) over the past few years specific to this.
Either they didn't notice, didn't know of connections to their infant's issues, or simply didn't even know it was "a thing." Count me in to this group.
Once educated the conversations can change dramatically with your docs, lactation consultants, etc. Read on for info and updated resources.
And don't beat yourself up if some answers are literally right under their nose!
What is tongue-tie or lip-tie?
I found these simple explanations on the Australian Breastfeeding Association site:
"Tongue-tie occurs when the thin piece of skin under the baby's tongue (the lingual frenulum) is very short and restricts the movement of the tongue. The tongue is not free or mobile enough for the baby to attach properly to the breast."
"An upper lip-tie is where a piece of skin under the baby’s upper lip (the labial frenulum) is very short or thick and is pinned too tightly to the upper gum. This can restrict movement of the upper lip preventing it from being able to flange or ‘pull out’."
There's also information online regarding lower lip ties, and the issues that may be involved.
As you can imagine, both conditions can cause challenges in breastfeeding and proper feeding overall.
The reflux and colic connection
What's more, according to MommyPotamus' EPIC POST on Diagnosing Tongue and Lip Ties, "Unfortunately, the symptoms are often misdiagnosed as other conditions like colic, reflux, and failure to thrive because many pediatricians and lactation do not know how to properly identify them." This article goes into detail on diagnosing this condition, including an incredible list of symptoms and graphics and photos to review.
And according to the Dr. Gharheri site dedicated to these issues, "babies who have tongue-tie and lip-tie commonly take in significant amounts of air." The article continues, "Sometimes, an audible clicking or gulping sound is heard. Parents can often feel or hear air in their child's stomach, and burping doesn't always work to get it out. This air can act as propellant, causing silent reflux, spitting up or even projectile vomiting." You can view the full article here.
Babies that are bottle-fed can have the same issues: taking in too much air because of an inadequate seal. I exclusively used Dr. Brown's for both of my children to try and remedy the extra air.
So, what's the deal?
Fortunately, or unfortunately, this is one of those gut parenting situations that I talk about so frequently. You or your doctor might come to the conclusion that your little one indeed has a tie, and can discuss courses of treatment.
According to The Leaky Boob's "Basics of Tongue and Lip-tied Related Issues: Assessment and Treatment" the
frenotomy/frenectomy is a relatively routine procedure done by a variety of physicians, with minimal risks and quick recovery involved. However, as the article states, there is a risk of reattachment.
Whether this will correct or lessen your child's reflux and colic symptoms will be unique to your situation, but as in all cases, the more factors you can eliminate as the source will help you and child get closer to finding the right solutions for you.
My advice to start is to simply to open their mouth, look closely and then blow up Google with some comparative image searches.
There's so much you're caught up in as a new parent, or while balancing multiple kids and babies, sometimes the answers are right under your (their) nose.
Maslow's Hierarchy of Needs. Physiological, safety, love/belonging, esteem, self-actualization.
Moms and Dads of High-Needs' Babies: A shower every once in a while.
Whether you're tackling common newborn and infant issues such as reflux, colic and sleep issues, or more complicated and chronic challenges in your life, for every child there is a cause to care (and an incredibly important reason to take care of yourself).
My message to you - as always - is to hang in there and find a way to make yourself smile amidst the chaos.
Perhaps it's volunteering to help other families in need, or as simple as demanding to drink your coffee hot.
I encourage you to not only find your favorite activities, but also your "non-negotiables," and call on them regularly to build strength, renewal and energy to take on whatever challenge is ahead.
Best wishes to you this season and for many smiles in 2017.
This post title could've been "holding on by a thread." That's how many parents and caregivers feel when it comes to making their newborn or infant comfortable amidst reflux and related issues.
While the primary advice is to try and keep your baby upright, the actions are easier said than done, when the discomfort reigns and sometimes around the clock.
Below are few tips I found in my own experience and sources around the web:
Straight up holding
For the first six weeks I gave new meaning to baby wearing, as in holding upright and on my chest (and others). It was why I wore a white sweatshirt for that same time too as you couldn't see all the spit up daily. Tough on the inconvenience meter, and my back eventually, but also necessary in my case.
This "Reflux Relief" list on Breastfeeding Quest gives a variety of options for holding and positioning. Parents.com has bottle feeding best positions post as well.
Spoiler alert: the constant companionship didn't spoil the child. He just told me the other day that he needed his space while he played his legos.
I tried with both of my sons the wraps and slings for actual baby wearing but failed both times. Both kids screamed until they were out Tara Greaves, author and former reflux parent blogger at https://aftertheraincomessunshine.com, shared earlier on this site that she "went through three different ones before going back to the first...it was the only way I got anything done in those early months when she needed to be held upright all the time."
See more on InfantReflux.org's Infant Reflux and Babywearing: A Happy Coexistence
Pure physics and logic would say that nothing tight (clothing, diapers, etc.) around the baby and its core would be smart in these cases. However, swaddling, aka "the fourth trimester," is typically recommend to try with reflux babies because it creates a soothing effect against the agitation that can make reflux worse. In my case, finding swaddle swagger was about all I could do to catch a break.
Check out this post on Ergo baby from sleep consultant Rebecca Michi "Swaddling our Newborns," and specifically the part on reflux help.
What did you do to keep holding on, and more importantly, would you have done anything differently?
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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