Posseting and Reflux
This is common in babies, due to an immature or weak valve between baby’s stomach and esophagus. This allows the milk to escape from the stomach and flow back up, sometimes bringing stomach acids with it. There are several forms of reflux, ranging from simple to serious.
Posseting refers to bringing up milk after a feed. It’s annoying because it’s messy, and worrying because you wonder whether the baby’s getting enough nourishment. Posseting causes no pain or discomfort, and is no cause for concern if baby is happy, feeds well and gains weight. It usually settles at around five months when baby is sitting.
This more severe form of reflux can be similar to adult heartburn – discomfort or a burning sensation due to stomach acids leaking back into the baby’s sensitive esophagus, along with the milk, causing inflammation. The condition can be difficult to diagnose, because the milk does not necessarily come out of baby’s mouth (as in posseting). Milk or stomach acid may only be regurgitated as far as the esophagus or throat. This form of reflux does cause the baby discomfort and there is usually disruption of feeding, and possibly sleeping patterns. Baby may cry during or after a feed, pull off the breast, arch his or her back, become rigid, writhe, kick or throw out their arms.
- If there is blood in baby’s vomit.
- If baby is losing weight or has poor weight gain.
- If baby has a recurrent cough.
- If baby is persistently unsettled, crying, or fighting feeds.
- Your doctor may order investigations which can show if reflux is occurring.
- Your doctor may prescribe one of two medications: one helps empty the stomach more quickly and helps tighten the valve at the top of the stomach; the other cuts down on acid production by the stomach.
- Change nappy before a feed.
- Lay an adult pillow under baby’s head and shoulders on the change table.
- Wipe baby’s bottom by turning them sideways, rather than pulling their legs up to the tummy (which puts pressure on baby’s stomach and forces acid into the esophageus).
- Hold baby in a more upright position while feeding.
- After feeding, sit baby semi-upright in a baby chair or rocker for 15 minutes, to help settle the milk.
- Use a cloth nappy with folded sheet on top to catch the spillage and cut down on washing.
- Raise the head of baby’s mattress by 30 degrees by using folded towels under the mattress (if it’s a bassinet) or a folded adult blanket under the mattress (if it’s a cot). If this makes the bassinet or cot dangerously shallow, try phone books under the legs of the bassinet instead.
- Some experts advise giving the baby a powder (which you mix with breast milk, baby’s formula or cooled boiled water) to thicken the contents of their stomach and help keep down the milk. If baby’s on formula, you can try a formula which has thickener already added.
- It’s worth checking with your Child Health Nurse to see whether there is a Vomiting Infants Support Association in your area or contacting the Reflux Infants Association.
- But if baby is happy, alert and putting on weight, it’s best simply to put up with the inconvenience.
- Put bib on before a feed. Look for big bibs with small necks for better coverage (double terry toweling ones are very absorbent).
- Choose those with elastic around the neck, or Velcro fasteners, which are easy to whip on and off. Make sure the bib is wide enough to cover the shoulders, and extends around the back of the neck, to catch those unexpected possets.
- When burping, hold baby gently — don’t pat or jog up and down.
- Put towels or plastic on the floor around you when feeding.
- Give baby tummy time on the floor before feeding, not after.
- During floor play, lay baby on an absorbent quilt, which can be thrown into the washing machine.