MANAGEMENT TIPS

These tips are written by reflux parents for the benefit of reflux parents, based on their own experiences. They are of a general nature only, and are not meant to replace medical advice. Different techniques work for different refluxers so trial and error is needed to identify any that may work for you. If you have any concerns, please discuss these with your child’s doctor or Child Health Nurse. 

• Feed the baby while they are upright.
• Keep baby’s body straight with their head higher than their stomach.
• Keep your baby upright for at least 30 minutes after a feed.
• Avoid exposure to tobacco smoke.
• Avoid overfeeding- if the baby vomits, wait until the next feeding rather than feeding them again. (Check with the doctor or Child Health Nurse that their intake is appropriate)
• Consider using a dummy; the swallowing action may help. Talk to your child health nurse if you have any concerns.
• Avoid vigorous movements or bouncing the baby.
• Put baby in the pram and rock it backwards and forwards over a bump in a rug, etc. Better still; go for a walk outside if you can - the screaming never seems quite so loud in the great outdoors.
• Leave a TV or radio or ‘white noise’ CD on for background noise so that the baby is not easily startled by loud noises.
• Use products to help keep baby upright or help calm them, such as an automatic baby swing, bouncer and/or baby hammock as suitable. Never let them fall asleep unsupervised in these devices as they are not designed as sleeping products.
• The best time to lay your baby on the floor is when their tummy is empty i.e. before a feed
• Change nappy before a feed. Take care to avoid lifting baby's legs to change a nappy; try rolling the baby to the side instead.
• Avoid any tight clothing around the waist such as tight nappies, elastic waistbands.
• Consider offering a spoonful of thickened milk (formula or breastmilk) following the feed. Discuss this option with your child’s doctor first.
• If the baby is bottle-fed, it may be worthwhile trying AR (anti-reflux) formula, or a hypoallergenic one. Speak with your child’s doctor.
• Some reflux children may suffer from food sensitivities (e.g. cow’s milk protein; soy protein) and may need dietary restrictions (or the mother may consider an elimination diet). If you suspect foods may be responsible for your child’s condition, it is essential to discuss this with your health care provider. Do not change your or your child’s diet before seeking medical advice. Talk to a dietitian.
• Put your answering machine on/take the phone off the hook when you get a chance to rest.
• Invest in a portable phone if possible. This allows you to keep in touch with friends and family whilst still attending to the baby's needs. It is also perfect to keep beside you during baby feeding times, as the phone almost always rings after you get settled.
• Contact a reflux support organisation for further information and support. The effect on the baby AND the family can be devastating and support groups can provide more detailed information, and offer the emotional support you may need.
• Burp baby frequently during the feeds (as tolerated).
• Try feeding smaller amounts slightly more frequently (unless this upsets baby). Frequent large feeds can trigger reflux.
• If your baby is under 12 months of age, elevating the head of the bed is not supported by evidence from research studies (Craig, Hanlon-Dearman, Sinclair, Taback, & Moffatt, 2004).
• Elevating the head of bed may be helpful in reducing episodes of reflux in a child who is over the age of 12 months
• For children over the age of 12 months, adapt the management strategies to suit e.g. avoid lying down for several hours after meals, eat smaller meals more often etc

Works Cited
Craig, W. R., Hanlon-Dearman, A., Sinclair, C., Taback, S., & Moffatt, M. (2004). Metoclopramide, thickened feedings, and positioning for gastro-oesophageal reflux in children under two years (Review). Cochrane Database of Systematic Reviews (3), Issue 3. Art. No.: CD003502. DOI:10.1002/14651858.CD003502.pub2.