Infant reflux, often referred to simply as spitting up, occurs when a baby’s stomach contents return up into the esophagus. While it can happen many times a day, infant reflux is generally considered benign if the baby remains content and is gaining weight appropriately.
Reasons Reflux is Worse at Night
Reflux symptoms can become worse for babies at night due to their horizontal position. When a baby lies flat, gravity no longer assists in keeping stomach contents down, allowing milk and acid to flow back into the esophagus more easily. This absence of gravitational aid means that any regurgitated material has a greater chance of lingering in the food pipe, potentially causing discomfort.
Feeding a baby shortly before sleep can also contribute to increased stomach pressure, which exacerbates reflux. A full stomach, coupled with the baby lying flat, creates an environment where contents are more likely to push against the lower esophageal sphincter (LES). The LES, a muscle at the bottom of the esophagus, may relax during sleep, further enabling stomach contents to move upwards.
During periods of wakefulness, babies swallow frequently, which helps to clear any refluxed material from the esophagus. However, during sleep, swallowing frequency decreases. This reduction in clearing action allows stomach acid and milk to remain in contact with the esophageal lining for longer periods, potentially leading to irritation and discomfort.
Identifying Nighttime Reflux Symptoms
Parents may notice signs indicating that reflux is bothering their baby during nighttime hours. Frequent waking, crying, or general fussiness during sleep can be indicators of discomfort caused by reflux. Babies might arch their back, particularly after feeds or when placed in a lying-down position, as a response to the burning sensation in their esophagus.
Other audible signs include gulping, swallowing, or choking sounds, which suggest that milk or stomach acid is coming back up. Parents may also observe wet burps or an increase in the amount of spit-up after night feedings. Persistent coughing or congestion, especially after lying down for sleep, can also be a subtle sign of reflux, as stomach contents may irritate the airways.
Practical Tips for Nighttime Reflux
Several non-medical strategies can help manage nighttime reflux. Adjusting feeding practices is often beneficial, such as offering smaller, more frequent feeds to prevent the stomach from becoming overly full. Thorough burping during and after feeds helps to release trapped air, which can reduce stomach pressure. Keeping the baby in an upright position for approximately 10 to 15 minutes after feeding allows gravity to assist in keeping contents in the stomach.
Regarding sleep positioning, it is important to always place a baby on their back for sleep, as this is the safest position and does not increase the risk of choking due to reflux. While some parents might consider elevating the head of the crib, products like wedges or sleep positioners are not recommended by pediatric organizations due to safety concerns. Some evidence suggests that sleeping in a semi-inclined position might worsen reflux symptoms.
For formula-fed infants, consulting with a pediatrician about different formula options may be helpful, although there is no evidence that specialized bottle teats prevent reflux. Breastfeeding mothers might explore maternal diet adjustments, such as eliminating cow’s milk protein, under medical guidance. Providing comfort measures like gentle rocking or offering a pacifier can also help soothe a distressed baby.
When to Consult a Doctor
While infant reflux is often mild and resolves, certain symptoms warrant immediate medical attention. Parents should consult a doctor if their baby is not gaining weight or is experiencing weight loss, as this can indicate inadequate nutrient intake. Forceful or projectile vomiting is another concerning sign.
Other red flags include:
- Green or yellow fluid, blood in vomit, or vomit that resembles coffee grounds.
- Refusal to feed or persistent difficulty feeding.
- Blood in the stool.
- Extreme irritability or signs of pain, such as constant arching of the back or inconsolable crying.
- Breathing difficulties like wheezing, choking, or pauses in breathing.
If severe symptoms persist despite home management, a healthcare professional should be consulted for further assessment and guidance.