GERD in babies: which milks to choose and how to diversify their diet?
Baby regurgitation is mainly treated by maternal reassurance and by thickened milk or A.R. milk. Which milks to choose? Should certain foods be avoided during dietary diversification? The answers of DrMarc Bellaïche, gastro-paediatrician, Dr Jean Lalau Keraly, pediatrician, and Laure Mathis, osteopath.
Regurgitation is a common reason for consultation. In most cases there is no reason to worry. "They are part of the normal stages of maturation of the digestive system of the child", reassures Dr. Marc Bellaïche, gastro-pediatrician, at the Robert Debré hospital (Paris). They often begin to fade when the child begins to sit up, around six months, then disappear between 12 and 15 months.
Why baby regurgitates?
The infant's stomach is very small: it is the size of a hazelnut at birth, a golf ball at one month. “A baby drinks between 130 and 150 ml per kilo of weight per day, explains Dr Bellaïche. If we transpose this to an adult weight, it would amount, for the latter, if he weighs 60 kg, to swallowing 8 liters of liquid! So we quickly understand why a baby regurgitates!
So that feeding goes as well as possible, here are the tips to follow whether it's for breastfeeding, bottles or food diversification, while reassuring the mother who is still rightly worried.
Can you breastfeed a baby suffering from regurgitation?
Breast milk is the best food for infant growth, because it is 100% suitable for the ‘little man’. There is therefore no question of stopping breastfeeding when an infant regurgitates.
A 1992 study shows that breast milk is digested faster and easier than infant formula (source 1). Remaining less time in the stomach, it reduces the risk of reflux. The gastric pH after breastfeeding is also lower than after having absorbed a bottle of infant milk, which also accelerates gastric emptying.
The study also showed that there is almost half as much reflux in the four hours after breastfeeding as after taking a bottle.
In which cases should a thickener be added to breast milk?
What is the strong let-down reflex?
Some mothers have squirts of milk very important. "This is called the 'REF' or strong ejection reflex", specifies Laure Mathis, osteopath. These powerful jets of milk that arrive in the baby's mouth can promote regurgitation. What to do then? "You just have to massage the chest before breastfeeding, to extract the first milk, before giving the breast to your baby, explains the osteopath. It is enough, then, to give him this first milk in a bottle. »
What is a milk thickener?
Those moms with heavy milk squirts may also be recommended to express their milk and thicken it with a thickener like Gelopectosis, the Gumilk…
What is it? From processed corn starch. You should know that these thickeners are difficult to dissolve in milk. It is therefore necessary to mix them well to avoid lumps.
Read alsoFoods to avoid by breastfeeding mothers
Coffee, tea, spices, mint, licorice, raw vegetables, onions... promoting acid secretions of the stomach, it is best to limit or even eliminate them.
What infant formula to give to baby in case of regurgitation?
Several solutions are possible. "We must offer the toddler the most suitable milk preparation possible", says Dr. Marc Bellaïche, gastro-paediatrician. If the recommendations recommend a pre-thickened milk, in clinical practice, at first, the doctor can make a different choice.
Goat infant milks
They have a protein profile ensuring better digestive comfort for infants because the caseins in goat's milk form a looser curd in the stomach, which allows them to be better attacked by digestive enzymes and easier digestion. “These milks require fewer chemical steps for their development,” says Dr. Bellaïche. But be careful, each milk has its particularities, and it is preferable to use those that have been the subject of clinical studies.
Which milk to choose? Capricare (lab. Pediact, the only milk that has undergone clinical studies), Capréa (Babybio), Prémichèvre (Prémibio), Holle Bio goat milk infant milk, Junéo Chèvre…
Pre-thickened milks (anti-regurgitation – AR)
"Pre-thickened milks are made from corn, rice or carob starch", informs the gastro-pediatrician .
Good to know: carob tends to accelerate transit, while rice or corn starch has the opposite effect, it constipates, according to the feedback of some parents, but never demonstrated by clinical studies.
Which milk to choose? Blédilait AR (Blédina), Biostime AR (Polive), Célia AR (Lactalis), Gallia AR (Gallia), Guigoz AR (Nestlé), Modilac AR (Sodilac), Nidal AR (Nestlé), Novalac AR + (Novalac), Nutriben AR (Nutriben), Picot AR (Lactalis)…
Are anti-reflux milks effective?
There is no anti-reflux milk! "Anti-regurgitation milks make it possible to limit the number of these by 60 to 75%", specifies Dr. Bellaïche.
The starch-based ones are liquid in the bottle. They thicken in the stomach. Those made with carob flour thicken directly in the bottle. They therefore require a suitable pacifier.
Their price is higher than a classic infant milk.
Read alsoGERD: what if it was an allergy to cow's milk proteins?
Replacing conventional milk with goat's milk or thickened milk may not did not give satisfactory results, as did burping breaks and waiting 20 to 30 minutes after meals before putting the baby to bed. “When these lifestyle and dietary maneuvers have failed, protein hydrolysates are then offered,” explains the gastro-paediatrician. We do a two to four week empirical trial with these milk substitutes to see if the reflux is not due to a cow's milk protein allergy, because there is no biological test to detect it. »
The child is then seen again one month later to see if there has been any improvement. Normally, we must do an elimination diet – reintroduction. That is to say, the infant must, again, be fed with standard milk to see if he regurgitates again. This proposal is never well accepted by mothers. “That is why, sometimes, the child is left under hydrolyzate if the result on regurgitation is spectacular”, reassures Dr. Bellaïche.
Which milk to choose? Alfaré (Nestlé), Allernova (Novalac), Aptamil HA (Milupa), Galliagène progress (Gallia), Novalac Riz, Nutramigen (Mead Johnson), Pepti-Junior (Nutricia), Pregestimil (Mead Johnson), Prégomine (Milupa)…
Prepare the bottle properly for a baby who regurgitates
It is also important to take a few precautions when preparing the bottle:
Read alsoChoosing the right bottle teat
Teats often have several flow rates: 1, 2, 3. It is important to give the bottle with the teat oriented to speed 1 so that the milk does not flow too quickly. Silicone teats are also less flexible than rubber ones, which also reduces the amount of milk flowing at one time.
Also think about 'anti-regurgitation' teats that allow air to circulate freely in the bottle.
Which brands make it? Avent, Dodie, Le Biberon Français, MAM, Nuk, Tigex, Tommy Tippee…
A special bib for regurgitation
Regurgitation often causes small irritations in the folds of baby's neck. To limit this inconvenience, Bib'up offers a 'second skin bib'. It is equipped with a silicone neck that fits baby's morphology and prevents regurgitation from passing through. (On sale at Aubert, Bébé9, Berceau Magique, La Redoute from 6.50 euros.)
GERD and dietary diversification: how to do it?
“Dietary diversification is offered to infants between the ages of 4 months and 6 months,” says Dr. Lalau Keraly.
Before the age of 4 months, there is a risk of increasing allergic manifestations but also deficiencies in iron, calcium, essential fatty acids, the daily consumption of milk then no longer being sufficient.
The latter starts, preferably, at midday, with a few spoonfuls of mashed vegetables or fruit compote. "If the food is given mixed in the bottle, it weighs it down and there is less regurgitation," says Dr. Bellaïche.
GERD in children: should certain foods be avoided?
“Orange juice, due to its acidity, promotes gastroesophageal reflux, informs Dr. Lalau Keraly. It is therefore to be avoided. In general, it is only introduced into the child's diet around the age of one, and it is not essential!
Source 1: "Influence of breast versus formula milk on physiological gastroesophageal reflux in healthy newborn infant", H.J. Heacock et al, Journal Pediatric Gastroenterology Nutrition 1992.
Read alsoAuthor: Véronique BertrandOur experts: Dr Jean Lalau Keraly, pediatrician; Dr Marc Bellaïche, gastro-paediatrician, Robert Debré Hospital, Paris; Laure Mathis, osteopath. Article published on
