Preemies can have a variety of problems with feeding and growing. There is almost nothing as frustrating as spending an hour coaxing a 2-ounce bottle into your preemie, only to have them spit up more than you thought they ate, 5 minutes later. Aside from losing valuable calories while spitting up, reflux can make your preemie extremely fussy, and can contribute to future problems with eating.

Most of the time, reflux in preemies is pretty obvious, but any baby can have reflux without actually spitting up much, or at all. This is sometimes called “silent reflux”. In babies with silent reflux, symptoms include:

  • arching and acting uncomfortable while feeding
  • stopping frequently during feeds to fuss and cry, then acting like they are starving a short time later
  • wet sounding burps and swallowing sounds after feeding is over (like milk is coming part way back up, and then being swallowed without being spit out)
  • unexplained hoarseness.

Managing your baby’s pain and discomfort from reflux, and keeping your baby’s feeds in their stomach where they belong can go a long way towards keeping both you and your baby happier. If you’re having trouble managing your preemie’s reflux, here are a few things to consider.

  • Check those medication dosages. Your preemie is growing and changing constantly, and their medication doses come in very small volumes. If it seems like the medications are “no longer working” take your baby in to get weighed and have their dosages recalculated. When our 31 weeker was first home from the hospital, we adjusted her zantac dose at least once every month, to keep up with her weight gain, and keep her comfortable. Also check with your doctor about whether your baby is getting the highest safe dose for their weight. Usually, medications have a dose range, and most doctors will start you out with a dose somewhere near the lower end of the range. Even if they haven’t grown, a higher dose of their reflux medication might still be safe.
  • Ask about other medications that might help. Not all babies respond the same to every medicine, and sometimes, a combination of an acid reducer and a medication that makes food move faster through the digestive track (like reglan) can be helpful. Ask your doctor if there are any other medications you can try.
  • Think outside the box (or crib…). Our preemies did much better with their reflux when they slept sitting up in a swing. If we put them flat in a crib, they would wake up screaming, covered in vomit within half an hour. In a swing, our 31 weeker would sleep for comfortably 12 hours straight! Ask your doctor if sleeping in this position is safe for your preemie, and if so, give it a shot. If you don’t have a swing, think about buying a wedge to prop your baby up in their crib, or ask your pediatrician for other idea for sleep positioning.
  • Try eliminating dairy products. Sometimes babies with food allergies or intolerances can spit up a lot, and have other symptoms that mimic reflux. If you’re feeding your preemie breasmilk, take a look and see if anything in your diet could be causing a problem. If you’re feeding your baby a milk-based formula, ask your pediatrician about making a switch to a hydrolyzed formula to see if it makes a difference. If you try either of these methods, be patient! It can take two weeks or more for you to see a change, because babies with dairy intolerances can have painful ulcerations in their GI tract that take some time to heal. Also realize that soy formula is probably not the best choice if you suspect a milk allergy in your baby, because a high percentage of babies with milk allergies are also sensitive to soy. Lactose free formula is probably useless here too. If your baby has a problem with milk, it is most likely a problem with milk protein, not the sugar, lactose.
  • Above all, be patient. Reflux can cause painful irritation in the esophagus that will need time to heal. Any mehod you try might take a week or two to make a real difference!