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Infant Sleep & Reflux

By Meg Brannagan ; Updated June 13, 2017

Caring for a baby can be exhausting sometimes, especially if a baby has reflux. Many parents of infants with reflux must spend extra time with feedings, change clothes frequently due to spit up and handle a potentially fussy child. Symptoms of reflux cause problems in many babies, and a non-invasive way to manage part of the problem is by changing some of the habits associated with sleeping.


Gastroesophageal reflux in infants occurs when acid and food in the stomach back up into the esophagus. In infants, this is seen as spitting up, vomiting or coughing. Some infants may be fussy with feedings, related to the pain of stomach acid contacting the tissue of the esophagus. According to the National Digestive Diseases Clearinghouse, more than 50 percent of babies will have some reflux by three months of age, but most babies no longer have symptoms by age 12 to 24 months.


Sleeping can affect an infant with reflux because the baby is typically placed in a lying down position to sleep. This reduces the effects of gravity and can allow stomach contents to flow backward more easily. Lying down, rather than maintaining a position of sitting up, can place pressure on the lower esophageal sphincter (LES), the opening that normally restricts contact between the stomach and the esophagus. Pressure on the LES compresses the stomach, forcing contents up into the esophagus.


Parents of babies who spit up frequently and who awaken from sleep with symptoms of reflux may need to change their babies' sleep position to better manage the situation. Elevating the head of the bed to a 30-degree angle or having the baby lie on his left side allows the effects of gravity to keep food and stomach acid down. Some parents of infants with reflux have their child sleep some of the time in a car seat for upright positioning. Choosing a car seat that prevents a baby from slumping forward can also reduce pressure on the stomach.


Timing of feedings around sleeping times impacts the amount of food regurgitated. Feeding a baby smaller amounts more frequently, and holding him in an upright position for 30 minutes before laying him down can reduce some of the effects of reflux. Thickening feedings with rice cereal has shown some positive effects, but the practice is controversial. Some infants can regurgitate thickened foods while sleeping, causing spit up, coughing or aspiration.


Non-invasive therapies may be used to manage reflux symptoms for the sleeping infant, but care should be taken to avoid possible dangers. Infants placed in a bed elevated at a 30-degree angle may slide downward after about three months of age. Special positioners can be used to protect a baby while sleeping. Some clinicians have recommended placing a baby prone for sleep, although this is not recommended in the campaign against sudden infant death syndrome. Parents should discuss with their physician the proper positioning of an infant with reflux. Infants who will only sleep on their stomachs may be prescribed an apnea monitor.

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