Parents of infants with acid reflux disease always want to know the best positioning for eating, sleep and play. Positioning is a simple, low cost treatment attractive to parents when faced with the other treatment options such as medication and expensive formula.
But it’s not always so simple. Keep in mind that positioning may be the only treatment needed for the baby with Gastroesophageal Reflux (GER) who spits up often but is otherwise healthy. A baby with Gastroesophageal Reflux Disease (GERD) may greatly benefit from positioning to promote digestion and decrease reflux events but may also require other treatments such as medication and a special diet. So, be sure to ask your doctor for advice before trying any new treatment, including positioning.
Two studies provide new insights
The Journal of Pediatrics just published new research on the effect of positioning a baby after mealtime and the number of reflux events. This type of research is important because parents and doctors have a hunch that positioning is important but, up to now, there’s been little research to confirm the theory. The new research may guide doctors in developing new treatment approaches and decrease the need for medication.
Study 1: In one study, the researchers measured the acid levels in premature infants using an impedance test (a test to detect acid and non acid reflux) just after a meal and then an hour later. They found that the infants’ stomachs emptied faster when they were placed on their right side. Then when the baby was moved to the left side one hour after a meal, reflux episodes decreased rapidly.
In this study, the researcher concluded that laying babies on the right side just after a meal and then moving them to left side one hour later decreased reflux.
Study 2: In the second study, the researchers studied premature infants with a diagnosis of reflux using impedance testing to measure acid and non-acid reflux events. Researchers observed the infants in four positions: back, stomach, left side and right side. They noted reflux episodes just after a meal and later after the meal had been digested. They found that stomach and left side positioning decreased reflux events. Further, left side positioning provided the lowest acid exposure after a meal and stomach positioning provided the lowest acid exposure later after a meal had been digested.
In this study, the researchers concluded that placing a baby with reflux on the stomach or left side after a meal was useful to decrease acid events.
Finding what works for your baby
Confused? You’re not alone. As a parent of a baby with reflux, it is confusing to sort out all of the treatment recommendations and advice from friends and family about the best way to hold your baby. You have probably used trial and error to find a way to hold your baby to decrease fussing and crying. It may not work each time and you might have a few different positions that have the best chance for success.
My first daughter was born in the era when stomach sleeping was recommended. I quickly found out that she preferred to sleep on her side or back. She settled faster and slept longer. Of course I was terrified that she would choke in her sleep and worried about her My refluxer, however, were born after the "Back to Sleep Campaign" and I was instructed to place her in the new, safe back positioning for sleep. After my little refluxer was sound asleep on my shoulder, I dutifully placed her in the crib on her back. The second her little back touched the Winnie the Pooh sheets, she would be awake and screaming. I would repeat this sequence over and over, until I gave up and spent the night holding her over my shoulder while propped up on pillows in bed. As I sat in the dark, I thought, "There must be a better way."
Right now the best advice seems to be this:
· Always place a baby on her back to sleep to reduce the risk of Sudden Infant Death Syndrome (SIDS).
· Try elevating the baby to a more upright position to avoid reflux.
· Talk to your doctor about your baby’s specific condition to determine the best treatment actions.
Parents’ personal experiences
Parents often tell me that placing their baby over the shoulder after a meal is best for decreasing vomiting and increasing comfort. Unfortunately, some parents end up holding their baby over the shoulder 24/7 if the baby is in a high level of distress.
It may be tempting to place the baby on her stomach in the crib after she had settled on your shoulder so you can both get some rest. There is the very strong evidence that placing a baby on her back for sleep greatly decreases the risk of sudden infant death syndrome so regardless of the severity of the reflux, parents are still instructed to place the baby on her back for sleeping at all times.
As researchers learn more about the pattern of digestion before, during and after meals, and the effect of positioning, treatments can be targeted to the actual causes of reflux and ensure that the treatment is successful.
Meanwhile, parents need to follow the advice of the doctor to develop a treatment plan that is designed to address the needs of each child. In the future, perhaps there will be new positioning recommendations based on larger studies to confirm the results of these studies. In addition, there is some evidence that elevating the baby to a more upright position reduces reflux. More research is needed to study all sleep positioning.
As I was reading the studies this week and reflecting on the sleep patterns of my children, I had a wild theory. What if the Back to Sleep recommendation decreased deaths from Sudden Infant Death Syndrome but increased infant reflux? I guess research will reveal answers to these questions in the future.