I think, whether you are a first-time parent or if you have multiple kids, what makes newborns so difficult is that you have no idea what they want. A millionth time of picking up, settling, feeding, and burping. And baby is still unsettled. 

We turn to Google for help. There are mentions of serious-sounding medical terms such as reflux, GERD, silent reflux, etc. 

We get even more nervous. What are they, and do they apply to my baby?

Reflux symptoms

Case study: My baby is so gassy and fussy, she cries and arches her back in pain after feeding. She coughs/chokes on my breastmilk, pulls away from the breast, doesn't sleep much, and needs to be held/rocked literally all day long. At first, we thought this is a variation of typical baby behaviour. But, her behaviour has been consistent and she's been pretty miserable all day long. 

What is reflux? 

• Reflux happens when stomach contents rise into the oesophagus.
• There are 2 types of infant reflux - Gastroesophageal reflux (GER) and Gastroesophageal reflux disease (GERD). 

All babies have some degree of GER. It is sometimes uncomfortable, which can cause spitting up or vomiting. You may also come across a term called "happy spitters" used to describe them.

GERD, on the other hand, is a more serious and persistent case of GER. It is associated with poor weight gain because of difficulty feeding or loss of nutrients from frequent regurgitation.

Common signs 

1. Spitting up or vomiting. 

2. Crying during feeding. If breastfeeding, baby may want to suck the nipple but gets upset when milk comes out of it. For formula-fed babies, baby may start feeding then screaming in pain, pushing teat away, and then grabbing it back on and off. 

3. Some babies may gag (dry reach) and cough when feeding

4. Failure to gain weight

5. Abnormal arching 

6. Disturbed sleep

7. Uncomfortable in any position after a feed. Sometimes an upright or incline position will calm baby.

8. Grunting a lot 

9. Crying episodes are intense and lengthy

These signs are also quite similar to babies who are gassy and have wind pains. 

And what about silent reflux?

Similar to normal reflux, but instead of spitting out, babies with silent reflux swallow the regurgitated liquid. Hence, it may not be as obvious due to the lack of spit ups.

Gassy babies

• Baby gas is different from reflux. It can be caused by various reasons such as immature digestive tract, feeding, swallowing air, etc.
• When gas is trapped in baby, it can get quite painful for them.

Gas in babies can be attributed to numerous reasons. For instance, if baby drinks too fast, baby will end up gulping milk down which causes gas. This may be caused by mum's overactive letdown or a teat that has too fast of a flow.  

If baby drinks too slow from a slow teat, baby may suck in extra air when drinking. For formula-fed babies, stirring or swirling the formula can also minimise gas and pressure build-up.

Overeating can also cause gassiness in baby due to their immature digestive tract. 

 Common signs

1.  Baby may be irritable during feeding. If breastfeeding, baby may latch on and off the breast. 

2. Curls tongue upward, but not accompanied by sucking

3. Grimacing

4. Legs are pulled up to chest

How do I know if it is reflux or trapped wind?

Observe baby's behaviour and the frequency of baby's fussiness. Is baby's persistent crying round-the-clock? Is baby constantly unsettled and irritable? Is baby gaining weight well?

The truth is, it is difficult to know if it is trapped gas or reflux in young babies. Sometimes, a change in feeding/sleeping routine could help the issue. Unfortunately for many mums, there is no magic cure and we just have to suck it up and carry on. 

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