Positioning a Preemie baby with acid reflux (GERD)
While handling babies with acid reflux can be tricky, handling premature babies with acid reflux can be trickier. That may be changing, however.
Two studies published last month in the Journal of Pediatrics have found that post-feed gastroesophageal reflux (GER) in preemies is increased when babies are placed in the right side down or supine positions. Both studies looked at acid reflux in 35-36 week premature babies using state-of-the-art impedance monitoring (unlike pH probe monitors which record acidic activity in the esophagus, impedance monitoring allows doctors to look at non-acidic as well as acidic reflux).
While the idea that refluxing babies do better on their bellies isn't necessarily new information, right versus left-sided positioning has been more often contested among gastroenterologists. These two studies offer more support for belly sleeping and add to the debate of side sleeping. The fact that these studies were done in preemies is perhaps more newsworthy.
For parents with refluxing preemies the idea of belly sleeping creates a dilemma since we've been back sleeping our babies for over a decade. I face this belly-versus-back issue on a regular basis in my clinic. While no self-respecting baby doctor is able to flatly recommend belly positioning, the parents of the sickest babies soon find out that this is the only way that they can survive with their baby. The misery and choking of the sick refluxer often forces the issue. With that said, look to your doctor for advice since each and every little creature is different.
Can we apply these findings to full-term babies? Probably. While the intestinal motility pattern of a 35 week preemie is different that that of a 4-week-old full-term baby, their anatomy isn't much different. I suspect that plumbing may have been more important than squeezing in these studies.
Add positioning to your list of simple measures for making your reflux baby happier and healthier.
For those looking for more, check out J Pediatr 2007;151:560-561,585-596.
For more information on how to hold a baby with GERD, see: