James’s tiny body would writhe the second James started sucking at a bottle. After only a few minutes, he’d pull off the nipple and start wailing in pain. We’d watch as tummy spasms turned into whole-body convulsions and ended in formula fountaining from his tiny mouth. This vicious cycle continued the entire feed. It was followed by at least 30 minutes of bloodcurdling screams that rivaled Caleb’s colicky screams a month later and more puking. The Nightmare on Our Street was in full effect by James’s second feed at home.
After two days of this, I finally called the pediatrician after hours in hysterics. I was practically incoherent, but James’s screams communicated what I couldn’t. “Sounds like infant reflux,” she said. “I’m calling in a prescription to the 24-hour pharmacy right now. Come to my office first thing Monday morning, and we’ll talk options.”
Gastroesophageal reflux (GER) is a common feeding issue in preemies, and since our babies were born at 28 weeks, Chris and I knew we would likely experience it with at least one of them. We weren’t prepared for the experience to be a battle.
It took 1 specialist, 8 months, 5 formulas, 2 medications, 1 probiotic, 1 thickener, 2 diagnostic tests, and a combination of practices to get James’s reflux under control. Oh yeah, and Caleb and Danae had reflux, too—although not as severe. Between the three of them, we learned five key strategies for dealing with infant reflux.
Infant Reflux Tip #1: Get help from a GI specialist.
I can’t stress this enough. I know that you love your pediatrician and are confident in their medical background and abilities. Same here. But a pediatrician’s knowledge and clout extend only so far. That’s when you need someone with specific knowledge and experience to step in.
Our pediatrician referred us to a pediatric gastroenterologist (GI specialist) within the first month of the Tagalongs coming home. After three different formulas and a few weeks of the histamine blocker Zantac didn’t work, she knew she’d come to the end of her expertise with infant reflux. And our insurance wouldn’t allow her to order more specialized medications or tests. The specialist diagnosed the babies with Gastroesophageal Reflux Disease (GERD), partnered the proton pump inhibiter Prevacid along with Zantac, and worked us through two more formulas before settling us on the amino acid-based formula PurAmino. She helped us determine the best thickening agent for our babies (oatmeal) and advised us on adding in a probiotic. She ordered an upper GI series and a swallow study to rule out additional feeding issues that could be complicating the GERD. And she brought in a dietitian to help monitor weight gain and advise on additional measures we could take to counteract the havoc infant reflux was wreaking on James’s physical development.
Most importantly, she went to bat for us with our insurance over covering the triplets’ formula. PurAmino runs around $40 per can. We averaged ½ can to 1½ cans a day. Adding that expense in with diapers, wipes, and medication alone would have put us in the poorhouse. Thanks to her, we managed to stay financially secure with some strategic planning and pinching of pennies.
You might be hesitant to add in additional appointments with an additional doctor who suggests that you take steps that complicate your life (e.g., avoid certain foods if breastfeeding or pumping), recommends that you use formula when you want to use breastmilk, and prescribes medications you don’t want to give. We certainly were. But that specialist wasn’t there to act as dictator over our lives. She was there as a teammate working with us to best help our babies. You may require several teammates to get your babies through that first year or their entire lives. That’s OK—great even! They say it takes a village to raise a child, and when you have multiples, you need all the villagers you can get.
Infant Reflux Tip #2: Incline, incline, incline.
You’re paying for all the shtuff that goes with reflux, so why not utilize something that’s free? Gravity is one of your BFFs when helping your babies battle infant reflux. It’s a lot harder for stuff to come up if gravity is keeping the body parts that need to stay closed down. Keep your babies in an upright position for at least 30 minutes after they eat, and place them at an incline to sleep.
I’m fairly certain that every baby-related sleep or seated item in our house was at an incline. Leachco Podsters, bouncers, Rock ‘N Plays, and swings all had inclines. We even placed a crib wedge underneath the babies’ mattresses when we transitioned to cribs. And we were religious about placing James in the item with the steepest incline. Our nanny would even cart him downstairs in “James’s bouncer” (the Fisher-Price Comfort Curve) to help her do bottles before placing him down for his naps.
With so much inclining, you’ll want to make sure your babies get plenty of time on flat surfaces or use positioning techniques to help with the development of their head shape.
Infant Reflux Tip #3: Pace and burp.
Preemies struggle with pacing, and reflux babies are notorious for being hard to burp. This double whammy can make feeds take incredibly long—something no parent who has to feed three babies wants to hear.
When it comes to pacing your reflux babies, pay close attention to bottle tilt. If the tilt is too low, your babies will take in too little at a time, which translates to them taking forever to eat. A tilt that’s too high can lead to your babies taking in too much at a time, which can lead to gulping. Both can increase the amount of air the babies take in and cause gassiness that adds to your babies’ discomfort. The trick is to find a middle ground that works for your babies. And once you do, you still need to actively manage their feeding. They might need a lower tilt or a higher tilt depending on time of day and how they’re doing.
The NICU sent us home with instructions to burp every 20 mL. Yeah … About that … In theory, it was a great idea; burping more frequently reduces gassiness. In practice, with three babies, it was an awful idea—especially if they don’t burp well. After a few weeks of this, we came up with a new game plan:
- Burp two to three times during the feed, with the final time coming at the end.
- Resume feeding if no burp is produced after 1 to 2 minutes of burping.
Now if the babies were displaying discomfort or we instinctively knew they had a burp in them, we broke from the plan. We even tried different methods of burping if the one we were most comfortable with wasn’t producing results. And we always made sure to get a burp out of James—especially at the end. If we didn’t get one from him when he was done, we knew we were in trouble.
Infant Reflux Tip #4: Prepare for puke.
It’s going to happen—a lot. Especially in the early days as you play trial and error with figuring out what works best for your babies. Feed your babies in clothes you’re fine with throwing away. (You will.) Have as many burp cloths and cleaning rags on hand as possible. (You’ll need them.) Plan to replace your carpet at some point in the future. (It’ll be stained.) Don’t plan on passing on baby clothing to your friends. (It’ll be crusted with puke.)
Chris was James’s Designated Feeder the first 3 months James was home. I couldn’t handle seeing my baby in so much pain, and I had difficulty managing him because I was trying to pump while feeding to save time. Chris fed James in promotional shirts he got at work and old, too-short gym shorts. In the early days, he stayed in the clothing until it was too saturated in puke to be comfortable (about two feeds—on a good day). When he returned to work, he changed the minute he set foot in the house—before he even came in to greet us.
We kept three baskets full of burp cloths in the feeding area and made sure at least two were always full. James tended to puke at least once a feed, and I couldn’t exactly “drop” Caleb or Danae in the middle of feeding to run around looking for something to sop up the puke with. The carpet in the loft looks like small bombs exploded on it, and I heavily sorted through our first 6 months of baby clothing before gifting it to friends.
Also prepare yourself mentally. Try to maintain a sense of calm—even when your babies projectile vomit the entire remnants of their bottle across the room.
In the beginning, the Tagalongs weren’t too bothered by James puking. They’d just blink and glance at us like, “Yup, he puked. Again.” But as they got older and were more aware of what was going on, they began to be bothered by it—James especially. He’d cry, and if you let out a startled shriek or sprang to your feet in alarm, he’d cry harder. “Comfort first and clean later” became our motto. It made the entire ordeal go much smoother and communicated that we were more concerned about his well-being than in clean carpets.
Infant Reflux Tip #5: Monitor growth and development.
The thing that surprised us most about infant reflux was how much it affected growth and development.
The growth part wasn’t too shocking. It makes sense that if you struggle to keep down the thing providing calories and nutrients, you’re going to have a tough time gaining weight. Poor James was so thin for so long. At his 12-month appointment, he weighed in at just below the 25th percentile for adjusted age. It wasn’t until he was declared reflux free and moved to strictly table foods and whole milk at 15 months that he started packing the weight on and closing the weight gap between him and his siblings He’s still thin, but we chalk that up to genetics at this point. If you watched him down spaghetti or guzzle milk, you’d never guess he spent the first 9 months of his life puking up everything he ate.
The effect on development was the most alarming. To keep the acid and puke down, James “self-treated” by arching his back and neck. What seemed smart on his part quickly showed itself to be quite the opposite. James had torticollis, and he arched in the direction of his head tilt, worsening the torticollis to the point that the left side of his neck became about as solid and strong as a steel trap. NBD right? Wrong. This inhibited everything from his ability to participate in tummy time to his ability to reach for objects above him to his ability to roll over. It also contributed to his plagiocephaly, which began to affect his facial symmetry. As with the growth part, all of this made sense. It’s difficult for your body to develop in other areas when it’s so focused on doing one thing (not puke) in one area (the stomach).
As we got James’s reflux under control, his torticollis corrected, and development caught up. Regular physical therapy sessions through early intervention, aggressive positioning techniques, and consistent treatment with a DOC Band (helmet) played a huge role in counteracting the damage reflux had done. Now, at 2½, he’s developing on par with his age group.
A Final Word
Reflux will kick your butt, but it does come to an end. Most babies outgrow infant reflux by age 1. Fight the good fight. Get the help you need, conduct trial and error until you find what works, and stick with your approach.
The following webpages provide good general info about reflux.