The regurgitation represent a frequent reason for consultations. In most cases there is nothing to be concerned about. “They are part of the normal maturation stages of the digestive system of the child,” reassures Dr. Marc Bellaïche, gastro-pediatrician, at the Robert Debré hospital (Paris). They often start to fade when the child begins to sit up, around six months, then disappear between 12 and 15 months.
Why is baby spitting up?
THE’infant stomach is very small: he has the size of a hazelnut at birth, of a golf ball at one month. ” One baby drink between 130 and 150 ml per kilo of weight and per day, explains Dr Bellaïche. If we transpose this for a weight ofadult, that would amount, for the latter, if it weighs 60 kg, to swallow 8 liters of liquid ! So we quickly understand why a baby spits up!
So that feeding it goes as well as possible, here are the advice to follow whether it is for thefeeding with milk, the baby bottles or the food diversification, while reassuring the mother, who is rightly still worried.
Can you breastfeed a baby with regurgitation?
the breastmilk is the best food for the growth of the infant, because it is 100% adapted to the ‘little man’. There is therefore no question of stopping breastfeeding when an infant is regurgitating.
A 1992 study shows that breast milk is digested faster and easier than infant milk (source 1). Staying less long in the stomach, this decreases the risk of reflux. Gastric pH after breastfeeding is also lower than after consuming a bottle of infant milk, which also speeds up gastric emptying.
The study also showed that there are virtually twice less reflux within four hours of breastfeeding and after taking a bottle.
Dr Jean Lalau Keraly simply advises a mother who is breastfeeding her infant “to stop at least once during the feeding in order to let her baby burp. This little break allows him to empty his stomach of the air absorbed, and therefore to reduce the risk of reflux. “
When should you add a thickener to breast milk?
What is the strong ejection reflex?
Some moms have very large squirts of milk. “This is called the ‘REF’ or strong ejection reflex », Specifies Laure Mathis, osteopath. These powerful streams of milk that get into baby’s mouth can promote regurgitation. What to do then? “You just have to massage the chest before breastfeedingextract the first milk, before breastfeeding her baby, explains the osteopath. It suffices, then, to give him this first milk in a bottle. ”
What is a milk thickener?
Those moms who have heavy milk jets may also be recommended to express their milk and of thicken it with a thickener like Gelopectosis, the Gumilk…
What is that ? From processed corn starch. You should know that these thickeners are difficult to dissolve in milk. Must therefore mix them well to avoid lumps.
Foods to Avoid by Breastfeeding Moms
the Coffee, the tea, the spices, the mint, the licorice, the raw vegetables, the onions… Favoring acid secretions in the stomach, it is preferable to limit or even eliminate them.
What infant formula to give to baby in case of regurgitation?
Several solutions are possible. “We have to offer toddlers the most suitable formula possible”, says Dr Marc Bellaïche, gastro-pediatrician. If the recommendations recommend a pre-thickened milk, in clinical practice, as a first step, the doctor can make a different choice.
Goat infant milk
They have one protein profile ensuring better digestive comfort to the infant because the caseins of goat’s milk form a looser curd in the stomach which allows better attack by digestive enzymes and easier digestion. “These milks require fewer chemical steps for their preparation,” says Dr Bellaïche. But beware, each milk has its peculiarities, and it is preferable to use those that have been the subject of clinical studies.
Which milks to choose? Capricare (lab. Pediact, the only milk that has been the subject of clinical studies), Capréa (Babybio), Premichèvre (Prémibio), Infant milk made from Holle Bio goat’s milk, Junéo Goat…
Pre-thickened milks (anti-regurgitation – AR)
“The pre-thickened milks are made from corn, rice or carob starch”, informs the gastro-pediatrician.
Good to know: the carob tends to speed up transit, while therice or corn starch has the opposite effect, it constipated, according to feedback from some parents, but never demonstrated by clinical studies.
“Although available without a prescription, but only in pharmacies, they should not be purchased by parents without first asking the opinion of the attending physician,” recalls Dr Lalau Keraly.
Which milks to choose? Blédilait AR (Blédina), Biostime AR (Polive), Célia AR (Lactalis), Gallia AR (Gallia), Guigoz AR (Nestlé), Modilac AR (Sodilac), Nidal AR (Nestlé), Novalac AR + (Novalac), Nutriben AR (Nutriben), Picot AR (Lactalis)…
Are anti-reflux milks effective?
There is no anti-reflux milk! ” The anti-regurgitation milks allow to limit the number of these from 60 to 75% », Specifies Dr Bellaïche.
Those based on starch are liquid in the bottle. They thicken in the stomach. Those made from carob flour thicken directly in the bottle. They therefore require a suitable pacifier.
Their price is higher than a classic infant milk.
GERD: what if it was an allergy to cow’s milk proteins?
Replacing conventional milk with goat milk or thickened milk may not have given satisfactory results, as may breaks for burping and waiting 20 to 30 minutes after meals before to put baby to bed. “When these hygienic and dietary maneuvers have failed, we then propose protein hydrolysates, explains the gastro-pediatrician. A two to four week empirical trial is done with these milk substitutes to see if the reflux is not due to cow’s milk protein allergybecause there is no biological test to detect it. ”
The child is then seen again a month later to see if there has been any improvement. Normally, we have to go on an exclusion diet – reintroduction. That is, the infant must again be fed standard milk to see if it regurgitates again. This proposal is never well accepted by mothers. “This is why, sometimes, the child is left under hydrolyzate if the result on regurgitation is spectacular,” reassures Dr. Bellaïche.
Which milks to choose? Alfaré (Nestlé), Allernova (Novalac), Aptamil HA (Milupa), Galliagène progress (Gallia), Novalac Riz, Nutramigen (Mead Jonhson), Pepti-Junior (Nutricia), Pregestimil (Mead Jonhson), Pregomine (Milupa) …
Preparing the bottle properly for an infant who is regurgitating
It is also important to take some precautions when preparing the bottle:
- Respect the quantity of milk: 1 measure for 30 ml of water.
- Start by pouring in the water and then the powdered milk, and not the other way around.
- Dilute the milk well by shaking the bottle to avoid lumps.
- Do not heat the bottle in the microwave to avoid any risk of burns to the esophagus.
- Do not bottle-feed too quickly.
- Do not increase the volume of the bottle.
Choosing the right bottle nipple
The pacifiers often have several rates : 1, 2, 3. It is important to give the bottle by directing the teat to flow 1 so that the milk does not flow too quickly. Silicone teats are also less flexible than rubber ones, which also reduces the amount of milk flowing at the same time.
Also think about ‘anti-regurgitation’ pacifiers which allow circulate the air freely in the bottle.
What brands make it? Advent, Dodie, Le Biberon Français, MAM, Nuk, Tigex, Tommy Tippee …
A special regurgitation bib
Regurgitation often causes small irritations in the folds of the baby’s neck. To limit this inconvenience, Bib’up offers a ‘second skin bib’. It is equipped with a silicone collar which conforms to the baby’s morphology and prevents regurgitation from passing. (On sale at Aubert, Bébé9, Berceau Magique, La Redoute from 6.50 euros.)
GERD and food diversification: how to do it?
“Dietary diversification is offered to infants between the age of 4 months and 6 months,” says Dr Lalau Keraly.
Before the age of 4 months, there is a risk ofincrease allergic manifestations but also deficiencies in iron, calcium, essential fatty acids, the daily consumption of milk then no longer being sufficient.
Regurgitation and reflux do not modify the methods of food diversification, ”adds Dr Bellaïche.
The latter starts, preferably, at lunch, with a few spoonfuls of mashed vegetables or fruit compote. “If the food is given mixed in the bottle, it ballasts it and there is willingly less regurgitation,” says Dr Bellaïche.
GERD in children: should certain foods be avoided?
” The Orange juice, due to its acidity, promotes gastroesophageal reflux, informs Dr Lalau Keraly. It is therefore to be avoided. »In general, it is not introduced into the child’s diet until around one year of age, and it is not essential!
Source 1: “Influence of breast versus formula milk on physiological gastroesophageal reflux in healthy newborn infant “, HJ Heacock et al, Journal Pediatric Gastroenterology Nutrition 1992.