Sunday, August 22, 2010
There are so many babies diagnosed with reflux lately... I have been thinking off and on about why this may be. We know that formula-fed infants are more likely to have reflux than breastfed infants, but we still hear of so many breastfed infants with reflux as well. Apparently reflux was not common in babies 20 or more years ago, as my mother has commented, "What is up with all these babies with reflux now?" She just didn't know of any babies having reflux when she was raising babies throughout the 1980s.
So, one thought that immediately came to mind: The Back to Sleep campaign (which I believe was introduced around 1990, but don't quote me on that). Medical professionals used to advise parents to place their babies on the bellies to sleep, but research has shown that position to be associated with a much higher risk of SIDS. So it is now advised that babies are placed on their backs to sleep. Lying on the back is a position in which reflux is more likely to be irritating to the throat, since the saliva can pool at the back of the throat easily that way.
Now, the Back to Sleep campaign is not a bad thing in and of itself. If parents are going to be putting their infants to sleep in separate rooms by themselves, then it is safest for them to be on their backs - they are less likely to have a stop-breathing episode while on their backs.
Babies also spend a large amount of time on their backs at other times, not just overnight and at naps. Baby swings, strollers, and infant car seats also keep them in this position more often. Sometimes babies spend so much time on their backs that the backs of their heads get so flat that they must be fitted for a special helmet to help their head regain its proper shape. Surely this is not natural, right? But it is not surprising if a baby spends 10 hours on its back overnight, a few hours each day napping in that position, and then more time on its back in swings, infant seats, and strollers. The "bucket" infant car seat is something else that is a relatively new invention. In the days when my parents were raising babies, the car seat stayed in the car. The child was always removed from the seat to go in and out of buildings. Now, it is relatively easy to keep an infant in a carseat for large chunks of time each day. So, babies are spending more of both their days and nights on their backs now than they were in the 80s and earlier.
To counteract this flat-head syndrome, the "experts" began recommending something that is referred to as "tummy time." This is intentionally placing the baby on its tummy while awake, to encourage the lifting of the head and pushing up with the arms, and also getting the back of the head off a surface.
In addition to the time spent on their backs, babies have other things which might be exacerbating the reflux nowadays. Scheduled feeding is one thing that comes to mind. With a breastfed baby, the initial milk is thinner and gradually gets thicker and more filling as the feeding progresses. Thus, the longer a mother goes between nursings, the more foremilk there is at the next feeding. The fattier hindmilk is what the baby receives further into a feeding. Cutting off a feeding too soon may cause a baby to miss most of the hindmilk, and spacing his feedings out to once every three or four hours gives the mother's body more time to build the foremilk back up. Frequent removal of milk causes the baby to continue to get more hindmilk at each feeding. Getting too much watery foremilk and not enough of the thicker hindmilk could contribute to reflux symptoms. Sometimes doctors recommend that mothers thicken their milk by pumping it and adding rice cereal - but introducing solid foods (of which rice cereal is one) prior to about 6 months increases the baby's risk for allergies. Rice cereal is also likely to cause constipation in babies, so even if it seems to help with the reflux, it may cause other problems. Nursing the baby more frequently could aid in this. In thinking of nursing as more than just a set feeding time, mothering through breastfeeding leads to nursing for comfort and thus being done more frequently.
Mothering through breastfeeding also tends to include close contact with the mother, which includes the infant being carried around both while awake and while napping. An upright position in a sling might be helpful in reducing reflux. Neither of my children really liked to lay down in the sling unless they were nursing, but the upright tummy-to-tummy position was great for them.
Babies who co-sleep with their nursing mothers end up spending time on their sides at night as they nurse. Also, the mother may switch them from side to side during the night. Therefore, less time is spent on their backs even while they are sleeping overnight.
One last thought is that a bottlefed baby is being fed on his back in a reclined position, whereas the breastfed baby is more on his side, and in the natural position has his legs and belly lower than his head.
So, in looking at all this, it appears that it may be that our straying from the biological norms of infant care contributes to a higher incidence of reflux. Rather than introducing other solutions, perhaps we could go back to the root of the issue and make changes there? I am not saying that this is definitely why babies have reflux more often lately... I am sure there are co-sleeping babies who never spend time on their backs and are carried upright and still seem to have some reflux symptoms. But I haven't heard any speculation on why it is that so many babies are diagnosed with reflux lately, so I thought I would do a little speculating myself. Any other ideas to add? Has anyone read anything which discusses potential reasons for this infant reflux epidemic?