Reflux and Sleep

When I first started working as a baby sleep consultant almost 14 years ago, hardly any parent I met had even heard the term “gastroesophageal reflux.”

Nowadays, it’s part of every mother’s vocabulary. If your child hasn’t been diagnosed with GER or GERD, chances are you know someone whose baby has.

There’s also a good chance that you know someone whose child has been misdiagnosed with it, because gastroesophageal reflux seems to have become the new colic when it comes to snap judgements for children who are having trouble sleeping.

I’m not suggesting that pediatricians are intentionally misdiagnosing babies with GERD. An accurate diagnosis can require a battery of tests, most of which are horribly unpleasant, and if your doctor sees reason to suspect GERD from the symptoms you describe, it’s typically more efficient to prescribe a proton pump inhibitor like Prevacid to see if that remedies the issue. Alternatively, many parents will raise a serious stink if they go into the doctor’s office looking for a prescription and don’t get one.

For those that don’t know, gastroesophageal reflux is caused by stomach acid escaping up into the esophagus, where there’s no protective coating of mucus, and irritating the tissue. It’s what we used to call “heartburn,” and is commonly associated with eating lots of greasy food, smoking, drinking alcohol or coffee, and stress.

“But my baby hardly smokes at all,” you’re thinking. Well, what’s happening when you experience heartburn is that the lower esophageal sphincter muscle, which separates the esophagus and the stomach, doesn’t close up tightly enough. In adults, smoking and alcohol can relax that muscle, and eating too much can put pressure on the stomach, pushing the acid back up.

In infants, that muscle hasn’t had time to develop yet, so it’s not always capable of doing its job as well as it should. This is why babies tend to spit up so much.

Alternatively, gastroesophageal reflux disorder, or GERD, is a digestive disorder that causes chronic acid reflux and is typically treated with medication, which is an important distinction to bear in mind. If your pediatrician tells you your infant is suffering from GER, that doesn’t mean they have GERD. The Mayo Clinic has a great online resource on infant reflux. If you think your child is suffering from GERD, I highly recommend you give it a read. Chronic reflux can do permanent damage to the esophagus, and can be seriously unpleasant for your baby.

When it comes to sleep training, GER raises some concerns. Is it really the right time to sleep train if your baby is experiencing pain and discomfort in the night?

Honestly, no it’s not.

Sleep training is about creating positive attitudes towards sleep, which is going to be difficult if baby’s getting chest pains whenever they lie flat in their crib. I promote teaching babies to fall asleep independently, but sleeping when you’re uncomfortable is a challenge for most adults I know. Being too hot or too cold, lying on a lumpy pillow, even an itchy bug bite can lead to a fitful night’s sleep for us grown-ups, so when a baby is experiencing actual pain, you can imagine that it’s going to be tough to form those positive feelings towards bedtime. (And for those of you who have never experienced heartburn, trust me, it really does hurt in a very uncomfortable way.)

The best thing to do in this scenario is to hold off on sleep training until baby’s had time to develop that lower oesophageal sphincter a little more, and can lie flat without discomfort. Talk to your pediatrician about this and keep an eye out for symptoms like coughing, spitting up, blood in baby’s stool, and difficulty breathing. Simply crying when they’re laid down is not necessarily a sign that they’re experiencing pain.

The good news is, infant reflux usually resolves itself at around the six month mark, which is the same point I find babies are getting ready to sleep through the night without a feed. So when baby learns to fall asleep independently, you can both start sleeping straight through the night.