Before I discuss how to help babies with reflux (GERD) sleep better, I would like to reference the 7 signs of reflux as discussed in more detail in the book Colic Solved: The Essential Guide to Infant Reflux and the Care of Your Crying, Difficult-to- Soothe Baby by Bryan Vartabedian, MD (which is a very informative, helpful book).
The presence of one or more of the following signs may suggest that your baby is suffering with GERD:
1. Spitting and vomitting
2. Constant hiccups
3. Feeding disturbances
4. Chronic irritability
5. Discomfort when lying on the back
6. Sleep disturbance
7. Chronic cough and/or congestion”
***If your baby has any of these signs, please discuss this with your pediatrician before trying to address any sleep problems. Reflux can cause night wakenings, discomfort when lying down and shortened naps.
How To Help A Baby Sleep Who Has Reflux (that is being treated)
As parents, our natural instinct is to soothe a baby who hurts. That’s exactly what we should do. But we need to pay attention to how we soothe a baby who has reflux. While a baby without tummy problems may learn to rock himself to sleep for example, a reflux baby dealing with projectile vomiting may miss out on the chance to learn how to self-soothe and fall asleep on his own! As we comfort our babies, we may inadvertently reinforce poor sleep habits. Then, even after the reflux has passed or been controlled, our babies still don’t sleep well. They must then learn, or relearn, how to put themselves to sleep without being walked, rocked, fed, put in the swing, the car seat, or ridden around the block—you know the drill.
I will give you two related sets of suggestions—one on how to deal with sleep while you and your child are still handling the worst of the reflux, and a second one on how to get him on a better sleep path once the medical part is under control or he has outgrown it. In both cases he’ll do better if you tackle bedtime first, then naps. Before the nap piece falls into place, do whatever you need to do to get him some sleep during the day, even if it means breaking my usual rules of not using the car to get him to sleep. If you are feeding him at night for medical reasons, don’t worry about changing that right away, although the night wakenings might diminish on their own as other aspects of his sleep improve. Work with the information here as well as the relevant age chapter in my book “The Sleep Lady’s Good Night, Sleep Tight” (SLGNST).
As with a colicky baby, reading reflux babies’ sleep cues can be difficult. I suspect this is because they don’t learn to differentiate their cries because pain, vomiting, hunger, and tiredness all sort of blur together for them. We then have more trouble figuring out what they’re crying about and may not respond as consistently to whatever it is they’re trying to tell us. So you have to be more diligent about watching the clock, not just your baby. Keep track of when he ate. As he gets older, you’ll want to stretch out the time between feedings as long as you can without provoking more vomiting, particularly overnight.
Also pay attention to how long he has been awake. Make sure he naps on time. The last thing he needs is an overlay of exhaustion on top of his burning esophagus. Taking him into a quiet, dim room for a while before nap or bed often helps. He may show his sleepy signals more clearly in such a setting. Also, the quiet environment may cue him that it’s time for bed.
As I mentioned, your doctor will probably recommend that you hold or seat your baby upright for about twenty to thirty minutes after he eats. Once the reflux is under control (i.e. your child is no longer in pain) try not holding him until he falls completely asleep. You don’t want him to develop an association between sleeping and being in your arms, or otherwise you’ll have to hold him to sleep all the time, including overnight, for months to come. Don’t worry if he falls asleep in your arms occasionally. Just don’t teach him that your arms are his only bed.
Allow enough time between feeding and bedtime for another activity in between. Feed him, hold him upright, and then read him a book, give him a bath and a massage. When it’s time for him to sleep, put him down drowsy but awake. Stay with him and soothe him intermittently until he is asleep. Gradually reduce your soothing as he learns to do it himself. If his crying ramps up quickly then pick him up and hold him to sleep and try again another day- especially if his reflux is newly under control and you are still concerned. I would rather you wait until you are confident that your baby is not in pain before you start sleep coaching- no matter how gentle the method.
When possible try to arrange his daytime schedule so that you are feeding him when he wakes up in the morning and when he gets up from naps, instead of before he takes naps, to avoid that holding-to-sleep association. That gives him time to digest before he lies down, a position that increases the reflux.
Some reflux babies fare better if they eat small, frequent meals. That might mean you will have to feed him overnight to an older age than you would a baby without reflux. But the night feedings can also add to his discomfort, so talk to your doctor about when you can stop them. At some point, the nighttime nursing (or bottlefeeding) ceases to be a physical requirement and starts being a sleep disrupting habit. When that happens, you need to stop those nighttime feedings gradually and gently. Some babies give up the night feeding much more easily than you might guess, in a night or two.
However, with children who had reflux, you might want a more gradual and gentler approach. I give many suggestions about night weaning in the age chapters in SLGNST.
In my own sleep practice, I have found that post-reflux babies often remain very sensitive to their environments. They react more to such stimuli as bright lights, crowds, food, and textures. You then need to be sensitive to their sensitivities! Continue to be very careful about his schedule. Watch the clock, and keep using that quiet, dimly lit room to help him calm down. Once his reflux is under control you can sleep coach for naps and nights!
Photo by valentinapowers on Flickr