Could it be Reflux?

Research has shown that the acidity of breast milk is buffered in the first 2 hours after a feed - so know that this isn't burning the oesophagus and causing pain.

We know that vomiting occurs in 40% of babies, peaks at 4 months of age and occurs more frequently with the high levels of autonomic nervous system arousal associated with excessive crying.

A baby that is crying a lot will have her sympathetic nervous system dialed up chronically and this can result in more hyperarousal of the hypothalamus and SNS in what is called a "crying loop", which can be very hard to break.

Did you know that when the SNS dials up, the gut gets very active, and you are likely then to see some puking and the passing of a lot of flatulence or wind? It is now well accepted that the gut is like a second brain within the body, and it is influenced strongly by messages from the sympathetic and the parasympathetic nervous system which work in complimentary and balancing ways throughout the day. The flatulence and reflux you see is most likely in response to the SNS being dialed up.

The question we need to ask then, is why then is baby crying after a feed?

It is normal infant behaviour to cry when put down, however, an important step is to have a feeding assessment done to look at any positional instability of fit and hold. This can occur if the way a woman’s breast and body is fitted together with her baby’s chest and body, results in compromising good milk transfer. Take a look at our pictorial support on the About Breastfeeding page to get some idea if this is happening, as your baby may not be feeling satiated enough after a feed.

Feed spacing in breastfed babies not a solution to control for milk puking. Nor is limiting the time your baby is at the breast to avoid 'overfeeding', because this will prevent them from drawing the final fat rich milk which releases gut hormones that signal a full belly. These help your baby to go to sleep.

Frequent flexible feeding where each breast is offered at least 12 times a day is encouraged.

Making sure a baby burps has been a long-held belief to aid good settling. However, burping is not always necessary, and hearing a burp come up is not something that needs to be chased before putting a baby back to bed after a feed. If done at all, it needs only to be with very gentle positioning that will not disturb the contented space a baby is usually in at the end of a feed, as this has a direct hormonal and biological relationship to sleep.

There is one particular condition in babies though that does lead to a lot of gassy flatulence.

Women who have a very generous supply of breastmilk can sometimes find their baby is quite gassy and develop an oval shaped distension to their tummies. In these circumstances it is possible that the amount of lactose the baby is drinking from your milk is greater than the ability of their gut to break down this sugar, which then ferments and creates the abdominal symptoms. This is called Functional Lactose Overload and you can get guidance from Newborn Home Care or a Lactation Consultant to manage this.

Just know that very few babies have a genuine medical reflux problem that may potentially be helped with medication. Turning to reflux medication when it is not strongly proven as needed, has been shown to offer no benefit over taking a placebo medicine. These drugs carry an increased risk of trouble-some side-effects for your baby such as respiratory and gastrointestinal infections, allergy, bone fracture and asthma.

The latest research into cry/fuss problems and the concept of reflux in babies can be explored at ndc.institute.com.au/resources.