Breastfeeding Positions For Reflux

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Introduction

Breastfeeding is a beautiful and essential bonding experience between a mother and her baby.1 However, for infants with reflux, it can be accompanied by discomfort and challenges. In this article, we will explore the importance of breastfeeding positions for babies with reflux and provide an overview of the condition.2

Importance of breastfeeding positions for babies with reflux

Breastfeeding positions can significantly impact babies with reflux helping to alleviate their discomfort and reduce reflux symptoms.3 By adopting specific positions, such as upright holds or side-lying positions, mothers can provide optimal support to their babies and promote better digestion. These positions can prevent the backward flow of stomach contents and reduce the likelihood of spitting up, improving the feeding experience for both you and the baby.

Overview of reflux in infants

Reflux, also known as gastro-oesophageal reflux (GOR), is a common condition in which the stomach contents flow backwards into the oesophagus. In infants, reflux is especially prevalent due to the immaturity of their digestive systems.4,5 It is important to understand the causes and contributing factors of reflux to effectively manage and alleviate the symptoms in breastfeeding infants.

Understanding reflux

Definition and common symptoms

Reflux occurs when the lower oesophageal sphincter (a muscle that acts as a valve between the stomach and the oesophagus) is not fully developed or is weak. This allows stomach acid and partially digested food to flow back into the oesophagus, causing irritation.7 

Common symptoms of reflux in infants include:

  • Frequent spitting up 
  • Discomfort during or after feeding
  • Irritability
  • Poor weight gain6 

It is crucial for parents and caretakers to be able to identify these symptoms to seek appropriate management strategies.

Causes and contributing factors

Several factors can contribute to reflux in infants including: 

  • Immature digestive system – one of the primary causes of acid reflux in babies, as their muscles and structures involved in digestion are still developing
  • Underdeveloped lower oesophageal sphincter – this can allow stomach contents to flow back up and into the oesophagus more easily
  • Faster-than-normal rate of stomach emptying in your baby
  • Certain foods in your diet – consuming spicy or acidic foods and even caffeine. while you are breastfeeding can exacerbate reflux symptoms in breastfed babies8

Breastfeeding positions 

Upright or koala hold

Description and benefits

The upright or koala hold is a beneficial breastfeeding position for babies with reflux.9 In this position, the baby is held upright against the chest, allowing gravity to help keep the stomach contents down. The upright position reduces pressure on the baby's abdomen, promoting better digestion and minimising reflux symptoms. This position also provides an opportunity for increased eye contact and bonding between you and your baby.

Step by step guide

To achieve the upright or koala hold:

  1. Sit in a comfortable chair with good back support
  2. Use pillows or a nursing pillow to support your arms and the baby's weight
  3. Hold the baby's head and neck with one hand and support the baby's body with your other arm
  4. Bring the baby's mouth to the breast, making sure the baby's head is slightly elevated
  5. Ensure a good latch by aiming the nipple towards the baby's upper lip and allowing the baby to take a wide mouthful

Side lying position

Description and benefits

The side-lying position is another effective breastfeeding position for babies with reflux.10 In this position, the baby lies on their side while breastfeeding, which can help prevent the backward flow of stomach contents. The side-lying position offers benefits such as improved digestion, reduced pressure on the baby's abdomen, and enhanced relaxation for both you and your baby. This position is particularly useful for night-time feedings, as it allows both of you to rest more comfortably.

Step by step guide

To achieve the side-lying position:

  1. Lie on your side on a comfortable surface, such as a bed
  2. Use pillows or a nursing pillow to support your head, neck, and back
  3. Place the baby alongside you, facing your breast
  4. Support the baby's head and neck with one hand and guide the baby to latch onto the breast
  5. Ensure a comfortable and secure latch, allowing the baby to nurse while lying on their side

Semi upright position

Description and benefits

The semi-upright position is another excellent option for babies with reflux.11 In this position, the baby is reclined and supported, with their head and upper body elevated. The semi-upright position offers benefits such as reduced pressure on the baby's abdomen, improved digestion, and minimised reflux symptoms. This position can also be helpful for babies who experience difficulty swallowing or have a weak suck.

Step by step guide

To achieve the semi-upright position:

  1. Sit in a comfortable chair or use a nursing pillow to support the baby
  2. Place the baby on your lap, facing your breast
  3. Support the baby's head and neck with one hand, ensuring their head is slightly elevated
  4. Bring the baby to the breast, allowing them to latch on comfortably
  5. Ensure a proper latch by aiming the nipple towards the baby's upper lip and allowing them to take a wide mouthful

Rugby hold

Description and benefits

The rugby hold, also known as the clutch or underarm hold, is a popular breastfeeding position for babies with reflux.12 In this position, the baby is held under your arm, with their legs tucked under your side. The rugby hold provides benefits such as improved digestion, reduced pressure on the baby's abdomen, and better control and positioning for both you and your baby. This position is particularly useful after a caesarean delivery or if you have twins.

Step by step guide

  1. Sit in a comfortable chair and use pillows or a nursing pillow for support
  2. Hold the baby facing you, with their legs tucked under your arm on the same side you are breast-feeding
  3. Support the baby's head and neck with your hand, ensuring their head is slightly elevated
  4. Bring the baby to the breast, allowing them to latch on comfortably
  5. Ensure a good latch by aiming the nipple towards the baby's upper lip and allowing them to take a wide mouthful

Combining positions

Using a combination of positions

In some cases, using a combination of breastfeeding positions can be beneficial for babies with reflux. You can switch between different positions during a feeding session to help improve digestion, relieve discomfort, and reduce reflux symptoms. This flexibility allows you to find what works best for your baby's comfort and needs.

Recommended sequences or transitions

When combining positions, it is important to observe your baby's cues and comfort level. Experimenting with different sequences or transitions can help find the most effective combination for your baby. For example, starting with the upright or koala hold to initiate the feeding and then transitioning to the side-lying position for a more relaxed and comfortable experience may work well for some infants. However, it is essential to adapt to your baby's individual preferences and needs.

Additional tips

Burping techniques

In addition to using appropriate breastfeeding positions, implementing proper winding techniques can help relieve discomfort and reduce reflux symptoms.13 Winding your baby frequently during and after feedings can aid in the release of trapped air and promote better digestion. Gently patting or rubbing your baby's back or holding them upright against your shoulder are effective techniques for winding.

Adjusting feeding schedule and frequency

Adjusting the feeding schedule and frequency of feeds can be beneficial for babies with reflux.14 Offering smaller, more frequent feedings can help to:

  • Prevent the stomach from becoming too full 
  • Reduce the likelihood of spitting up and reflux

Pay attention to your baby's cues and feed them when they show signs of hunger, ensuring they have enough time to digest before the next feeding.

Potential dietary modifications

If you suspect that your diet is contributing to your baby's reflux, it may be worth considering potential dietary modifications. 

Certain foods in your diet can worsen your baby’s reflux symptoms such as:

  • Caffeine 
  • Spicy foods 
  • Acidic foods
  • Dairy products

Experiment with eliminating these foods one at a time to see if there is any improvement in your baby's symptoms. It is crucial to consult with a healthcare professional or a lactation consultant before making any significant dietary changes to ensure that you and your baby are receiving adequate nutrition.

Seeking professional help

If your baby's reflux symptoms persist or worsen despite trying different breastfeeding positions and implementing the aforementioned tips, it is advisable to seek professional help. A paediatrician or a lactation consultant can provide further guidance, assess your baby's condition, and recommend additional interventions if necessary. They can offer personalised advice and support to help manage your baby's reflux effectively.

Summary

Breastfeeding positions play a crucial role in managing reflux in infants. The upright or koala hold, side-lying position, semi-upright position, and rugby hold are all effective options that can help alleviate discomfort and minimise reflux symptoms. Combining positions and using transitions between them can provide added benefits. Additionally, implementing winding techniques, adjusting feeding schedules, and potentially modifying your own diet while breastfeeding can further aid in managing reflux. Remember that every baby is unique, and it may take some trial and error to find the positions and strategies that work best for your baby. Seeking professional help when needed ensures that you receive appropriate guidance and support. By utilising these strategies and seeking professional advice, you can create a more comfortable and enjoyable breastfeeding experience for both you and your baby.

References

  1. Palmér L, Ericson J. A qualitative study on the breastfeeding experience of mothers of preterm infants in the first 12 months after birth. Int Breastfeed J [Internet]. 2019 Aug 1 [cited 2023 Jul 18];14(1):35. Available from: https://doi.org/10.1186/s13006-019-0229-6
  2. Orenstein SR. Management of supraesophageal complications of gastroesophageal reflux disease in infants and children. The American Journal of Medicine [Internet]. 2000 Mar 6 [cited 2023 Jul 18];108(4, Supplement 1):139–43. Available from: https://www.sciencedirect.com/science/article/pii/S0002934399003538
  3. Friedman C, Sarantos G, Katz S, Geisler S. Understanding gastroesophageal reflux disease in children. JAAPA [Internet]. 2021 Feb [cited 2023 Jul 18];34(2):12. Available from: https://journals.lww.com/jaapa/Fulltext/2021/02000/Understanding_gastroesophageal_reflux_disease_in.1.aspx
  4. Tighe M, Afzal NA, Bevan A, Hayen A, Munro A, Beattie RM. Pharmacological treatment of children with gastro‐oesophageal reflux. Cochrane Database of Systematic Reviews [Internet]. 2014 [cited 2023 Jul 18];(11). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008550.pub2/full
  5. Huang Y, Tan SY, Parikh P, Buthmanaban V, Rajindrajith S, Benninga MA. Prevalence of functional gastrointestinal disorders in infants and young children in China. BMC Pediatr [Internet]. 2021 Mar 17 [cited 2023 Jul 18];21(1):131. Available from: https://doi.org/10.1186/s12887-021-02610-6
  6. Hegar B, Dewanti NR, Kadim M, Alatas S, Firmansyah A, Vandenplas Y. Natural evolution of regurgitation in healthy infants. Acta Paediatrica [Internet]. 2009 Jul [cited 2023 Jul 18];98(7):1189–93. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2009.01306.x
  7. Lee YY, McColl KEL. Pathophysiology of gastroesophageal reflux disease. Best Practice & Research Clinical Gastroenterology [Internet]. 2013 Jun 1 [cited 2023 Jul 18];27(3):339–51. Available from: https://www.sciencedirect.com/science/article/pii/S1521691813001133
  8. Rybak A, Pesce M, Thapar N, Borrelli O. Gastro-esophageal reflux in children. International Journal of Molecular Sciences [Internet]. 2017 Aug [cited 2023 Jul 18];18(8):1671. Available from: https://www.mdpi.com/1422-0067/18/8/1671
  9. Thomson SC. The koala hold from down under: another choice in a breastfeeding position. J Hum Lact [Internet]. 2013 May [cited 2023 Jul 18];29(2):147–9. Available from: http://journals.sagepub.com/doi/10.1177/0890334413478690
  10. Park J, Thoyre S, Knafl GJ, Hodges EA, Nix WB. Efficacy of semi-elevated side-lying positioning during bottle-feeding of very preterm infants: a pilot study. The Journal of Perinatal & Neonatal Nursing [Internet]. 2014 Mar [cited 2023 Jul 18];28(1):69. Available from: https://journals.lww.com/jpnnjournal/Abstract/2014/01000/Efficacy_of_Semielevated_Side_Lying_Positioning.13.aspx
  11. McOmie R. Children with gastroesophageal reflux disease: a guide to therapeutic and pharmacological treatments. Occupational Therapy Capstones [Internet]. 2011 Jan 1; Available from: https://commons.und.edu/ot-grad/267
  12. Committee (LEAARC) LEA and AR, Spencer B, Campbell SH. Core curriculum for interdisciplinary lactation care. Jones & Bartlett Learning; 2022. 875 p.
  13. Cremonesini L. Gastro-oesophageal reflux in infants: A common concern for parents. Journal of Health Visiting [Internet]. 2014 Apr [cited 2023 Jul 18];2(4):188–95. Available from: http://www.magonlinelibrary.com/doi/10.12968/johv.2014.2.4.188
  14. Tobin JM, McCloud P, Cameron DJS. Posture and gastro-oesophageal reflux: a case for left lateral positioning. Archives of Disease in Childhood [Internet]. 1997 Mar 1 [cited 2023 Jul 18];76(3):254–8. Available from: https://adc.bmj.com/content/76/3/254

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Dr. Lewis Spencer

Doctor of Philosophy - PhD, Biomedical Sciences, General, University of Derby

Lewis is a PhD graduate, where his research focus was on obesity and diabetes treatment with GLP-1 Receptor Agonists. He also has 6 years' experience as an Associate Lecturer in Sport and Exercise Physiology and Research Methods. He is now working as a Health Information Specialist.

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