Reflux and Baby Sleep

Does your baby have reflux? Welcome to the club.
baby with blue eyes
baby with blue eyes

Reflux and Baby Sleep

Does your baby have reflux? Welcome to the club.

What is Reflux?

All babies have reflux: it’s called spitting up. There’s a muscle at the bottom of your baby’s esophagus called a sphincter. The sphincter’s job is to keep food and stomach acids down where they should be, in the stomach. Here’s the thing: for the first 6 months of life, the sphincter isn’t fully developed, so remnants of your baby’s meal (mixed with stomach acid) will often pop back up past the sphincter, through the esophagus and out of your baby’s mouth.
That’s what we call spit-up.

Many babies don’t mind spitting up, even large amounts, multiple times a day. These babies are referred to as “happy spitters.” With these babies, the only thing you need to worry about is making sure you get a nice big burp after each feeding. Oh, and give up on the idea of having any clean clothing for the next few months. 

This kind of typical spit up can actually be good for your baby! The stomach acid that comes up as part of the spit up serves a protection against random bacteria your baby may have in her mouth. (Why might your baby have bacteria in her mouth? From sucking on her fingers that touched…everything.) So, some reflux can be a very good thing.


When Is Reflux an Issue?

The point where reflux becomes an issue is when it hurts. If you had heartburn when you were pregnant, you know how bad it can be. That fiery burn is what a baby feels after every feeding if she suffers from a bad case of reflux.

When a large amount of acid travels back up the esophagus, it can make your baby feel enormous discomfort and cause him to be very irritable during feedings, spit up a lot, and even projectile vomit. It also brings about one of the most frustrating parts of reflux: endless crying and screaming after each feeding as your baby battles the waves of acid rising in his little throat. 

Understanding that your baby really is in pain can help make the process more manageable for you. You don’t have a difficult baby – you have a baby struggling with a difficult condition.


Signs of Painful Reflux 

  • Frequent spitting up or projectile vomiting (more than 5 times per day)
  • Most feeds come with crying jags, irritability or fussiness
  • Arching away from breast or bottle during feedings
  • Constant hiccups – especially “wet” sounding hiccups
  • Unrelenting irritability and overall unhappiness
  • Increased discomfort when your baby lies on her back, including arching her back
  • Chronic cough or congestion, when baby is not sick otherwise
  • Sour smelling breath
  • Excess saliva (looks like bubbles around mouth)
  • Poor weight gain or refusing feeds
  • Disrupted sleep

*If your baby is showing some of these symptoms but is not spitting up, he may have silent reflux. This is essentially the same thing as typical reflux, except baby swallows the acid back down instead of spitting it out.

baby on diaper


How does Reflux impact sleep?

Reflux has a big impact on sleep. Babies typically go to sleep after a nice full feeding, whether that’s for naps or bedtime. Laying baby flat (which always makes heartburn worse) right after a meal makes it easier for the acid to travel back up the esophagus, bringing with it waves of pain. That’s why a dream feed can often make things worse for reflux babies, rather than help.
Instead of giving their body time to digest their last meal, adding in another one brings a new phase of pain to deal with.

Because of this, reflux babies typically do not sleep well. Please know that this is nobody’s fault: not yours or your baby’s! It’s hard for anyone to sleep when they’re in pain. Rather than working on sleep, the answer is to work on the reflux first.

You may have heard of other parents putting their reflux babies to sleep in a car sear or at an inclined angle to help them sleep better or minimize the risk of choking. The American Academy of Pediatrics says that

1. Not only is inclined sleeping ineffective in reducing reflux
2. Sleeping at in incline places a baby at a greater risk of shifting into an unsafe sleep position
3. Sleeping flat does not minimize the risk of a baby choking during sleep, even with reflux babies. Babies have airway anatomy and mechanisms that protect against aspiration.

Your pediatrician can give you personalized medical advice regarding a sleeping position for your baby.


Tips for Reflux

Mercifully, many reflux symptoms lessen by 4-6 months and most babies completely outgrow their reflux symptoms by their first birthday. Until that point, here are some things you can do to make it a little bit easier.

Note: these suggestions are not medical advice. Be sure to speak with your baby’s doctor before trying any of these suggestions.

  • Keep your baby upright for 20-30 minutes after each feed. Let gravity help by keeping the meal down so her stomach has a chance to digest it before it can come back up.
    Outward facing, in front of a mirror or sitting in the bath. Head higher than stomach is the key here!
  • Avoid the car seat after feedings. Putting your baby in a reclined position on a bumpy ride will make things hard! Wait a bit before going out after feeds.
  • Give smaller, more frequent feedings. Double the number of feedings with half the amount of milk for each feeding. Instead of 4 feedings of 6 oz each, offer 8 feedings with 3 oz each. Smaller meals are easier to digest.
  • Burp baby frequently. Every 2 ounces when bottle feed or every few minutes when breastfeeding. Try these unusual burping positions that often work wonders for reflux babies! 
  • If you’re breastfeeding, try the koala hold. Feeding your baby while holding her vertically (instead of horizontally- visualize a koala holding her baby!) can help keep the feeding down.
  • If you’re bottle feeding, adjust the nipple size. A nipple that’s too big or too small can cause your baby to swallow extra air with the formula, causing more pain a few minutes later.
  • Offer a pacifier. The sucking motion helps your baby swallow the saliva in his mouth which can help guide the acid back down.
  • Formula feeding: switch to a non-dairy, non- soy formula. Milk protein (written as lactose, casein or whey on the label) and soy are often major players in exacerbating reflux.
  • Breastfeeding: consider eliminating dairy from your diet, bearing in mind that it can take some time for it to fully leave your system.
  • Discuss the possibility of medication with your pediatrician. Reflux is often over-diagnosed and while pumping your baby with unnecessary medication is not something you want to do, at times it can help.
  • Look out for possible causes other than reflux. An overlooked tongue tie, for example, can lead to intense discomfort after every feeding as your baby sucks in more air than milk because she can’t latch properly. Hyperlactation is another possible cause, where a breastfeeding mother produces more milk than the baby needs, and the gush of milk that spurts out with each suck is consumed without being digested properly. This can lead to stomach pain, gas and fussiness! Overtiredness and a lack of schedule is something that can cause your baby to be extremely fussy too.
  • Try a Probiotic. Talk to your pediatrician about which probiotic he recommends for your baby. This can reduce inflammation in your baby’s intestinal tract while balancing the bacteria levels in his gut.
  • Use a swaddle that’s not tight around the belly. If you’re still swaddling, use a swaddle that’s looser around the belly rather than snug. Less pressure on the belly means less discomfort for your baby.

Sleep Training and Reflux

Here’s the deal with sleep training and reflux: if the reflux is well-managed, sleep training can work out well. If the reflux is raging, painful and not under control, sleep training is not a good idea.

Sleep training always comes along with some level of crying, and when going through the process you need to feel confident that the tears are not because of physical pain that your baby is presenting. Because babies can’t tell us with words what is bothering them, there’s no way to know until your baby isn’t in pain anymore.

When your baby is struggling with reflux, the first priority is to get your baby the help she needs and help her as much as you can through this trying time. Sleep will come later. I know it’s hard. I’m sending you a hug.


Can The Newborn Sleep Shaping Course be helpful if your baby is struggling with reflux?

Yes, to some extent. I am confident it will teach you things you don’t yet know that will make the day-to-day process of caring for your newborn easier. You won’t get the same sleep- shaping results as a baby without reflux, but you will gain some more predictability and insights into this stage, giving you greater confidence and peace with your situation.

If your baby is older than 16 weeks and struggling with reflux, I recommend waiting to take the Baby Sleep Video Course until the reflux is under control (your baby is no longer in pain.) If your baby’s reflux is well-managed, the Baby Sleep Course is going to teach your baby to sleep 11-12 hours and take predictable, reliable naps each day. Click here to get sleep help.


Will starting solids help your baby sleep for a longer stretch at night?

You might have heard parents swear “as soon as we started solids she started sleeping 8 hours!” causing you to wonder if you should be feeding your baby real food too. What wouldn’t we do to gain a few more minutes of sleep at night?

Sadly, it doesn’t help. There is very little evidence that suggests a positive correlation between solids and longer stretches of sleep, and there is some evidence that suggests starting solids too early can disrupt sleep (just when you thought things couldn’t get any worse!)


3 secrets to get your baby
sleeping through the night!