Eva: (00:04)
Hey there, you’re listening to the, My Sleeping Baby podcast, which is all about baby and child sleep. I’m so excited to teach you how you can get your little ones sleeping so that you can sleep too and enjoy parenthood to its fullest. I’m Eva Klein, your resident’s sleep expert, mom of three, founder of the Sleep Bible online coaching program, and lover of all things sleep and motherhood. If you’re looking for tangible solutions for your little one sleep woes or you simply want to learn more, this podcast is for you. For more information, check out mysleepingbaby.com and you can follow me on Instagram and Facebook @mysleepingbaby.

Eva: (00:43)
Okay, Dr. Playforth I am so happy to have you here on the, my sleeping baby podcast. So why don’t you tell us all a little bit about yourself and what you do?

Dr. Playforth: (00:55)
Well, thank you so much for having me. We’ve been trying to kind of schedule this now for a few months and, uh, my having the baby derailed it a little bit,

Eva: (01:02)
But I’m so glad babies do it’s okay.

Dr. Playforth: (01:06)
Um, so yeah, I’m uh, my name is Dr. Play fourth. I’m a board certified pediatrician and a mom of now spree I’m in Northern Virginia. And I have, um, been cultivating kind of an, a social media platform with the idea of providing some evidence-based, but also nuanced information for parents, because I think a lot of the information that’s out there is very black and white. Um, and so I’ve been writing at the pediatrician mom and blogging a little bit and doing things like this.

Eva: (01:33)
Amazing. No, and I totally agree that I, I know as a mom of three myself, that when I was a new mom, it was very overwhelming trying to navigate all of this information out there that can be contradicting and overwhelming, and you don’t know what’s good information. What’s not so good information. And so having a platform, you know, by someone like you, who’s an actual pediatrician and a mom as well. I feel like that just provides moms with such value that they can’t get in, you know, just simply Googling and hoping for the best. So it’s really, really phenomenal what you provide, uh, what you provide your people. And so, you know, today I wanted to talk all about reflux because reflex is one of those really pesky annoying, but common medical conditions that we see, you know, primarily in infants, that is a very well-known sleep stealer. You know, it can really get in the way of your little one sleeping. Well. Um, so why don’t we start off by talking about like, what, what reflex is and what it isn’t and you know, what it, how it presents itself and what it can look like, you know, give us that, that overview first.  Then we can talk about how to help a baby with reflux sleep.

Dr. Playforth: (02:52)
So reflux is essentially what it sounds like. So when we, you know, a lot of women in pregnancy will have it as well. So the, the stomach acids are, are kind of coming up up to the, through the esophagus sometimes all the way into the mouth and they’re causing Harper and they’re causing pain. Um, it’s something that we see frequently in young babies, probably probably more babies than we really know. Um, but because the symptoms look so much like other things like colic, like gas, like just random fussy baby. Um, it can be very hard to distinguish what is in the reflux bucket and what is not. So a lot of things are called reflux when they’re not. And a lot of things that are reflex, you know, a lot of babies who are refluxing are actually not that uncomfortable. Um, but it’s basically, you know, what we call gastroesophageal reflux. And I like to think about it in two different ways. So gastroesophageal reflux, and then there’s gastroesophageal reflux disease. So a lot of babies are refluxing and that’s, um, physiologic, um, and it’s not necessarily a problem. It’s the point at which it starts to become a problem that we think about

Eva: (03:57)
It. So when you say refluxing you referring to like spitting up

Dr. Playforth: (04:00)
To the assets coming up, they don’t necessarily have to come out of the mouth. I mean, a lot of cases they do, but reflex is sort of its own entity where they’re not coming all the way up.

Eva: (04:11)
Right. Okay. Okay. And so then how do we know if this is a problem or if it just means that we’re doing five times as much laundry as we normally do? You know that, I mean, it might be a bit of a problem, but like medically speaking, how do we differentiate between yeah. Something that just causes more laundry versus something that, you know, would require some medical attention?

Dr. Playforth: (04:35)
I think that’s a really good question because, um, when I do like to tell parents who think that their babies are refluxing, but when the babies are out, otherwise thriving, that it, that tends to be more of a laundry problem than a medical problem. But, um, but for babies who are failing to gain weight, who are having feeding aversion, who are just extremely uncomfortable with feeding where you’re worried that that was going to then lead to a feeding aversion, those are some of the categories where we start to think, okay, maybe this is something where we need to, to think about what to do. Um, unfortunately with reflux, our options are somewhat limited. Um, and a lot of times what we end up doing is just waiting to baby stop, grow it, but that’s, that’s brutal for the parents and for the babies.

Eva: (05:23)
Yeah. Right. No, a hundred percent. So I’m curious, you know, if let’s say you have a mom or a dad, you know, in your office with a baby who they suspect might have reflux, they’re telling you like doctor Playforth. My baby, he won’t stop crying. He’s miserable, he’s irritable. Um, he’s just not a happy camper. How do you then figure out whether or not it is reflux versus colic versus gas versus something else. If you have this little baby that can’t talk, but it’s just unhappy. And, and, and all of those things can be caught, can be causing that, crying, that irritability,

Dr. Playforth: (06:02)
This is the, this is the problem with pediatrics right here in a nutshell. Right. I mean, that’s, that’s almost always the case. Um, either your babies or your patients cannot talk or they’re teenagers, and then sometimes they don’t really want to. Um, but yeah, so, so if I have a patient come in and the parents tell me this, I mean, the most important thing is to take a careful history. Um, and sometimes I find that what’s happening is parents feel lost because there are pediatricians, don’t always have time to take that careful history. Um, and, and I think that means that that’s when parents start grasping and going to social media or the internet, trying to get the information themselves, which is, I mean, hard, right? Because it’s not your job, it’s our job. But if somebody came in with this, this problem, I mean, I would want to talk more about exactly when they’re fussy, what the birth history looked like.

Dr. Playforth: (06:52)
Um, we’d look at charts and see how well they’re gaining weight. That doesn’t mean I expect them to be 50th percentile or above. They can stay at the like 10th or 12th percentile if that’s where they are, but how, how consistently they’re gaining weight rather than dropping off their own curves. Um, so we look at growth, we look at milestones, um, and we look at kind of feeding behaviors too. So yeah, it’s beautiful history. I mean, with reflux, a lot of times you can kind of tell based on the pattern of the fussiness, whether it’s something like reflux or something like colic, um, where those babies tend to be fussier later in the day.

Eva: (07:27)
Right, right, right, right. With the college versus the feeding. Right. I do find that with my clients that have happens to be with my three kids, none of them ever had severe reflux. Thank God. But I have a lot of clients with babies who have had reflux, because what ends up happening is, you know, they’re in survival though, because BB is so unbelievably unhappy. And then when they finally get it under control, they then come to me for sleep help because the reflux has been resolved. But now they have a really crappy sleeper, you know, as a result. So, so I see lots of babies with reflux and they almost always tell me that when the reflux isn’t in control, um, they start to see BB busing a lot while feeding, because I guess it’s, it’s causing that Harper like pain. Right,

Dr. Playforth: (08:14)
Exactly. Right. But the thing is sometimes, you know, they feed, okay. And then you see the symptom more as, as they, as the, the acids are coming up, which doesn’t necessarily have to be right after the feed. You know, sometimes that can happen even an hour later. Yes. And it happens more if you put them down immediately after a feed, which kind of makes sense. You know, if you just think about the physics of it, you know, gravity is going to help keep things down. And so if you have a bottle, I mean, if you just think of like a water bottle, right. If you have a bottle and you do this, things are going to be moving, uh, you know, upwards up to the top of the bottle, um right, right. Things aren’t going to stay down.

Eva: (08:55)
Yeah. Right, right, right. No, a hundred percent. That, that totally makes sense versus you’re right. Like a baby that might have colic, they’re typically not going to see those symptoms, you know, later on in the day. So, you know, how do you, I mean, let’s talk about it. Cause I know that there’s regular reflux and then there is silent reflux, which I would imagine is even harder to diagnose. So what’s the difference between the two.

Dr. Playforth: (09:18)
So, uh, with silent reflux, you know, a lot of times we’ll see symptoms like back arching something, you call Santa for sign where honestly like they, they, as they reflex, they’re almost trying to rear away from the pain. So you see them kind of doing this back arch thing. Um, and it’s not necessarily coming out. So it can be, it can take a little bit longer to diagnose because you know, you’re not having this, oh, this is a spitty baby. Um, but I think the important thing to realize here is there are babies. I mean, a lot of babies spit up and spitting up can be totally normal. There are babies spit up and maybe you have some reflux, but, but it doesn’t necessarily mean it’s a problem. Parent came in and said, look, my baby’s happy. They’re feeding. They’re, you know, maybe sleeping, maybe not. I mean, that’s a whole other thing, but, um, but you know, they’re, they’re growing well. And then they just spit up a lot, but the spit-up doesn’t seem to bother them. We call those babies happy spitters. And those that wouldn’t be a baby where I would want to change anything, but for the babies that are back arching, um, even if they’re not actually spitting up, those might be babies that actually do have some reflux going on.

Eva: (10:24)
Right, right, right. Right. Now I remember when, when my oldest was probably two, three months old, she was that happy spitter, upper that you were talking about. The one that created like five times as many as much laundry as I was used to. And you know, I’m a first time mom, I don’t know any better obviously. And there was this, um, we’ll, we’ll call this person a well-intentioned family member who had the best of intentions who saw my daughter, a Muna, you know, spitting up like crazy. And she’s going, oh my gosh, that shouldn’t be happening. This is, this is not good guys. You got to take her to the doctor immediately. And I was like, okay, I’m going to go to the doctor because I’m a first time mom and I don’t know any better. And so I took her to the doctor and my pediatrician is wonderful.

Eva: (11:10)
And you know, he kind of calms me down and he’s, you know, ways her sees that she’s fine. And he’s going, Nope, it’s really no problem. She’s gaining weight properly. Is she happy? Is she eating? Guess she’s happy. Yes. She’s eating. Yes. She has lots of, you know, wet and dirty diapers. Okay. So she spits up a ton, you know, that’s that that’s, that was it. And so, you know, I managed to catch my breath immediately, um, because yeah, it’s only a problem if it’s like an actual problem, you know, and, and simply spitting up is not a problem unless it comes along with, you’re saying either like weight gain issues, feeding issues, like nonstop irritability throughout the day. Right. Yeah, exactly.

Dr. Playforth: (11:56)
Okay.

Eva: (11:57)
So that way, if you have, so let’s say, so you decided, okay. I think that this baby, you know, most likely has some form of reflex here. What’s the next step? When all signs are pointing towards, you know, a reflux or reflux diagnosis, that is a problem. Okay.

Dr. Playforth: (12:14)
So the most important thing is actually what we call kind of environmental precautions. So, um, you know, as I said, reflux is a normal process, right? It’s physiologic, a lot of babies are regurgitating. Um, but if you’re getting to the point where now you’re starting to see those problems, the very first thing I tell parents is, you know, what are you doing around the feed itself? You know, are you feeding your baby and immediately putting them down or are you keeping them upright? Some babies don’t need to be broken, but I found so I’ve had, so I have three kids, right? Every single one of them had reflux. And, um, I haven’t ever put together a post about reflux because honestly I think I kind of have some PTSD related to it so hard. And the first two also did not gain weight. Um, and it was just so hard to like, navigate exactly that process and having pressure from family members.

Dr. Playforth: (13:07)
Cause even when you’re a pediatrician, you still get that pressure. Right. I’m sure. You know, and trying to figure out like, am I missing something? You know, I would take the kids to my pediatrician and they would say, no, you know, they’re not getting weight great. But like, things are still basically, okay. It’s just like one of the mill reflux. And he’s kind of in the middle of the night when you’re awake and you’re tired and, and thinking that’s, that’s when you know those, you kind of get into like, almost like a fixation. Um, so the first thing I do is take a step back. Let’s talk a little bit about exactly what reflux is. Let’s talk about reflux, being a normal physiologic process. Now, um, let’s talk about what you’re doing around feeding. So if you are, um, putting your baby down, what we usually say is try and keep them upright for 20 to 30 minutes after a feed.

Dr. Playforth: (13:53)
Um, we, I look into a little bit of, you know, are they breastfeeding? Are they feeding with pumped milk? Um, buy a bottle? What kind of bottles are they using? How well are they burping? Um, my current baby, so he’s three months old. Now he 100% needs a burp halfway through a feed. And then at the end of the feed, and if he doesn’t have that, I mean, you could just tell he is so uncomfortable. Yeah. Frequently as he burps some of the, some spit-up will come up with it, which makes sense. You know, again, if you have a physics, you’ve got an air bubble, you got milk on top. When that air bubble inevitably rises whatever’s on top is going to come up to yeah, of course. Um, so, you know, he’s a baby where we have learned over the past three months that, that we need to burp him.

Dr. Playforth: (14:34)
Um, and then we keep them upright for a good 20 to 30 minutes, which honestly at night is very hard. Yeah. Not everybody is as good about it. So, you know, I’m pretty particular about it, but I find that, um, for example, if we have a family member in nanny, my husband feeding them, they don’t always do as good of a job of keeping them up. Right. Right. And then we put them down and then if I start to hear that kind of sound like, you know, that they’re, they’re gulping then, um, you know, I frequently I’ll actually pick them up and just hold them up right. As well. Um, and that will help kind of with the gravity, just pulling things down. Yeah. Um, we have noticed, so he’s three months old now and we’ve noticed that the reflux in the last week has gotten substantially worse, which is normal, usually last three to four months, but it’s still very hard to see your baby that uncomfortable. And

Eva: (15:21)
I’m sure

Dr. Playforth: (15:22)
In a lot of parents will say, okay, well, or a lot of, let’s say a lot of family members will start telling mom, oh, it’s in, what are you eating? Is this something that you’re eating? And you end up with these families where the parents are so desperate to make their baby comfortable, which of course, I understand that moms are eliminating things from their diet or they’re switching formula here, you know, every few days trying to find the one that works. Um, and it’s just, it’s very frustrating. You feel very helpless, right. Suffering. And there’s like, nothing you can do about it.

Eva: (15:55)
Do you find that any of that works, you know, eliminating, I’ve heard, you know, eliminating dairy, eliminating soy and gluten, and you know, all the typical allergens, which in and of itself can take, if you, you know, weeks for led to completely rid itself out of your system, does is any of that from what you’ve seen in your patients, as well as with your own kids, is any of that ever actually help with reflux symptoms?

Dr. Playforth: (16:21)
So it’s very interesting. Um, you know, most of the time, no, but the symptom of regurgitation of reflux can also be a symptom of, of a protein intolerance. Now you will see other symptoms.

Eva: (16:39)
It’s like a milk protein that we’re talking about, which is not reflux, that’s different, but

Dr. Playforth: (16:45)
I mean, it’s causing a reflux type symptom, right. So it kinda is reflux. Right. But, uh, so milk protein is probably the most common, but you could have other proteins as well, soy egg. Um, a lot of times we’ll see blood in the poop when, when kids have that symptom, but some kids just have like the reflux type symptoms. Right. So I will say, you know, if parents are really struggling and they really want to try something, you can try eliminating for example, milk and mom’s diet, um, for, you have to have a full two weeks, um, to see if that makes a difference. Sometimes it does, sometimes it doesn’t. Um, but if you look at the algorithm from the, um, national association of kind of GI, um, physicians, um, they have like sort of a stepwise algorithm and that is actually one of their steps. Their algorithm is first. I mean, so, so your environmental precautions, um, so avoiding overfeeding, keeping them up bright, um, things like that, your second seven, they actually say to thickened feeds, which I am not a huge fat off, you know, we do it sometimes if we’re at that point, I will often kind of be talking to a GI doctor as well. Um, you know, it’s a sort of old school, a lot of old pediatricians will say, just put some rice cereal in that bottle.

Eva: (18:03)
Right. And we know that’s is that that’s a choking hazard, right?

Dr. Playforth: (18:07)
It is, it is a total lizard. And, um, you know, it can work, but that doesn’t necessarily mean it’s the best choice. It’s obviously only something you would do, um, for someone who is feeding from a bottle. So if you have somebody that’s actively breastfeeding and wants to continue to breastfeed, like we it’s our job to partly help create a situation where they can fulfill that goal if the people want to write.

Eva: (18:30)
Yeah. Yeah. My mom was told to do that with my sister. Okay. So this was a very long time ago, you know, over 30 years ago now. Um, and my mom still remembers how horrible it was because I think my sister was less than three months old was not ready. Like her body, her GI tract, like wasn’t ready to be taking down any amount of rice cereal. And it sounds like my poor sister as this little baby just screamed her brains off for like an eight hour period until that rice cereal really began to be digested. So yes. Horrible advice. Don’t, don’t do it.

Dr. Playforth: (19:13)
There are like alternative thickeners too. So, you know, you can buy ’em, there are these commercial thickeners, like Joe mix and things like that, but I wouldn’t be doing that without being under the guidance of a physician. Who’s telling you to do that. Right. Um, just because some of them can have side effects and things like that. Um, the next step is when we started thinking about, okay, should we eliminate something from the diet so that this is the way the algorithm, um, kind of progresses? So we would, if we’re thinking, okay, maybe this is a milk protein intolerance, and mom wants to continue breastfeeding. You eliminate dairy from mom’s diet. So I’ve seen people temporarily, like if they’re, if they want to switch to something else, um, and they can continue pumping and freezing the milk and, um, offer a, um, partially digested, um, kind of a protein hydroceles type formula, um, that is designed for milk protein intolerance or for general protein intolerance. Um, and they can switch to that for a few weeks as well for the babies, for whom this is the problem that can make a huge difference. It can be like night and day.

Eva: (20:19)
So for the babies that are formula fed, and let’s say they do have a milk protein allergy intolerance, whatever it is. And they switched to a dairy free formula. How long of a period does it take before? If that’s the problem, would the parent begin to see an improvement?

Dr. Playforth: (20:39)
This is the case. Um, we say, oh, it can be up to two weeks. Usually within like five. Yeah. The difference though, honestly. Right.

Eva: (20:50)
And then, and then with a breastfeeding mom, it’s going to take a little bit longer. Cause you know, she knew everything needs to exit her body, right. So that takes, it takes a little bit longer, but with a formula fed baby, you’re saying within a few days you can begin to see improvement. That’s the problem.

Dr. Playforth: (21:05)
Yeah. You may not see the maximum difference until it’s been that two week period, but you can often see some difference. Sheryl has a lot of these hydraulic formula options are quite expensive. They’re more expensive than, you know, standard commercial.

Eva: (21:18)
Yeah. They can be what like 60, $70 a can, something like that.

Dr. Playforth: (21:24)
Your pediatrician writes a letter. I have, I have had, um, insurance companies cover it no way

Eva: (21:30)
For that

Dr. Playforth: (21:31)
Many people know. But if your child really has like a diagnosed milk, protein intolerance and you, your pediatrician writes a note, sometimes it works

Eva: (21:40)
Really good to know. I mean, I’m Canadian, I work I’m in Toronto and I know that, um, whatever, we obviously have a completely different healthcare system than you guys do, but it’s considered like, do you need a prescription for that sort of thing? Because if you really, if it’s a prescription yeah. Then depending on you could have it, wouldn’t be covered. It wouldn’t be free necessarily. But if you have like an extended healthcare plan through work, um, then you might be able to get that covered. So that’s good to know because otherwise those bills can add up very, very quickly, especially if your baby’s a big eater that is going through one of those cans in less than a week. Um,

Dr. Playforth: (22:16)
The other thing that people don’t know is you often have samples of these things. And I remember we would have all these samples and people wouldn’t give them out and they would expire. So, you know, if your child, and this is sort of any kind of formula, if your child’s on formula and you’re going to like your regular pediatrician visit, ask if they have samples, there’s no shame in that. Um, you know, it’s better to use it up than to let it expire

Eva: (22:39)
No, a hundred percent. That’s a really, really good call. Um, okay. So, so let’s say, all right, you, you suspect baby has reflux. You know, you have tried offering that baby, you know, smaller feeds. So by the way, so for the formula fed babies, I think it’s just important. I want to just get this out here because there are some books out there that talk about feeding a bottle fed baby every four hours throughout the day, which entails giving that baby a very big bottle, um, so that they can last a full four hours. That’s not going to fly. If you have reflux, don’t try this at home kids. That’s not gonna, it’s not gonna go well. So this is more, that might be great advice for a non reflux baby. But if you’re a baby, if you suspect that baby has reflux feed every three hours or so, don’t, don’t try stretching them to that four hour. Mark is then they’re going to be so hungry, eat way more than they can handle. And then, and then they’re going to get another, going to be extremely uncomfortable as a result. So you offer them smaller, more frequent feeds. You’re holding them at right after, you know, they eat. Um, and you know, you’re trying to eliminate any, you know, possible allergens and there, and it’s still not in control, right. So where does medication fit into the picture of treating the reflux?

Dr. Playforth: (24:04)
So we used to have a, even when I started, so I’ve been in practice for about little over 10 years. And when I first started practicing our threshold, disturbed medications was actually very low. You know, we would be like, yeah, let’s just try and see what happens. And what we have found is that those medications are not proven to make as much of a difference as we would think. And a lot of times, you know, by the time you get the approval and you start the medication, um, you know, time is passing and your baby’s getting better. Anyway, um, you committing these babies to weeks, to sometimes even months of being on these medications, um, about, and it would be something that was probably going to get better on its own. Anyway, if you’ve tried all of this, your baby is still struggling to gain weight is still super uncomfortable.

Dr. Playforth: (24:50)
Usually this is the point in which I will refer to a pediatric gastroenterologist to kind of go through them and some monitoring. Now in this area, it can be hard to get in with somebody for a few weeks. So it can be like three, four or five weeks to get in with a gastroenterologist. So if you’re waiting for the appointment and I’m certain that this child probably has reflux, then I will sometimes start them on a medication, um, like an acid suppressing medication, right. We, I don’t like to do it for longer than four to eight weeks, which is consistent with the GI guidelines. Um, and so, you know, what we do, what I do is I started and we had four weeks, we sort of reevaluate the situation and see kind of, okay, like, are things getting better? Can we do a trial off of the medication?

Dr. Playforth: (25:35)
Sometimes kids need up to eight weeks, but we really don’t want them to be on it longer than that. We want to be doing all the other things. I think the other thing you were just saying about the frequency of feeds and stuff, you know, it’s hard, I think, as a new parent to hear that advice and then to read about feeding a baby every four hours and then also to hear, okay, you need to feed your baby on demand, right? Yes, yes, yes. And I think that, um, some of this is just going to be getting to know your baby babies can stretch out, you know, within a four or five hours, like a once in a 24 hour period overnight or something like that. And when they feed, they still might do. Okay. But then what you find is when they’re more active throughout the day, um, that they’re struggling a little more with feed. So what I’m finding with my three month old now is like, cause he moving around, right. He’s kicking he’s squirming rolling. And all those things are compressing the stomach. So if he starts doing that stuff right after feed, I’m going to see more, I’m spitting up and often more discomfort. Yeah. Um, but for, for babies who, uh, are naturally struggling even at night or not necessarily extending their, their period between feeds then, um, then you know, swollen refer for competes is the right advice. The baby hasn’t read the book.

Eva: (26:52)
Right, right. No, a hundred, a hundred percent. I’ll tell you, I’ll tell you how I kind of look at how to rectify the, you know, feed your baby every X number of hours versus feed your baby on demand. Right. So this is how I see it. So the whole idea behind feeding a baby on demand is you feed the baby when they’re hungry, right. Like no different than like I eat when I’m hungry. You eat when you’re hungry. You know, I think we, humans should all for the most part, be eating on demand. Right. Um, but, and so normally when you have a baby, I think the idea behind the four hour feeding schedule for a bottle fed baby, not for a breastfed one, that’s going to be a recipe for low milk supply and, you know, and, and breastfeeding struggles. But I think the idea behind trying to get a baby to go, you know, four hour stretches is that if your baby can take down X number of ounces in that feed, then they might not be hungry until that four hour mark, because you know what we do want to avoid reflux or no reflux is you want to avoid a baby who is snacking all day long.

Eva: (28:04)
Right. So that can also be a problem for many other reasons. And I would imagine it would probably exacerbate reflux as well, if they’re constantly eating and they, and their body just never has a break, right. To be able to actually digest that food. So, so the whole idea here is that yes, for feeding the baby when they’re hungry, not when they, as opposed to allowing them to snack all day long. And then it means that they won’t be able to actually take down a proper feed now for a baby with reflux, um, that proper feed might need to be a little bit smaller than a baby without reflux, because we need to take into account the fact that, you know, their tummy is extra sensitive. So I think that you can still feed a baby on demand more frequently because it just means that their feeds are going to be shorter or smaller.

Eva: (28:58)
And then it means they’re going to be hungry a little bit earlier than say a baby that is eating bigger feeds with longer chunks of time. So what you’re not doing is you’re not looking at your hungry baby and it’s been three hours since they last ate and you’re going, Nope, you need to wait an hour. Like, that’s not the idea here. As I said, like, don’t try this at home kids. You don’t want to be doing that. But I think the idea is that for a non reflux baby, if that eight ounce bottle that they take, first thing, take down first thing in the morning. Um, if they’re able to do that, then they likely will be able to last, you know, close to four hours. And, um, my son was able to do that. I breastfed him for the first few months and then transitioned him to bottles afterwards.

Eva: (29:45)
And he was able to get himself down to a four hour feeding schedule. But I did look at it as though I was feeding him on demands because he wasn’t hungry by the three hour mark. Yeah. Yeah. So that’s how I think. Cause I, I totally get that. This can be so unbelievably confusing and, and the ideas can sound like they contradict one another. So I’m glad that you brought that up. Cause I wanted to just sort of take the opportunity to sort of clarify how those pieces of advice do actually come together and don’t contradict one another. Does that make that makes sense?

Dr. Playforth: (30:18)
I think the way you’re describing it as really is helpful. Um, and like you said, for a breastfeeding baby that the situation’s a little bit different, right? Because you’re trying to do everything you can to, to, um, optimize supply and feeding and breast milk is usually, I mean, there’s more to it than just the feeding, right? There’s more to it than the volume that they’re taking in and that comfort and things like that. The skin to skin wool that for a refluxy baby who is otherwise uncomfortable, some of those other measures are still very important. I mean, that’s good, especially for your baby. That’s just really not feeling great. Um, now on the topic of grazing the old day, what I have sometimes found with reflux babies is that they have a, almost a desire to feed more. Um, and that’s actually because when they swallow the milk, it’s neutralizing and pushing down some of that asset. Right. So they can like temporarily actually feel better. Right.

Eva: (31:16)
Do they feel worse, God or words? Is it one of those? Is it kind of the equivalent of eating like that big pizza at 10 o’clock at night? And you’re like, this is so good. And then at 1:00 AM, you’re like, this is so bad. Like, is it that kind of idea?

Dr. Playforth: (31:32)
And that’s, so that’s part of why you also kind of want to keep an eye on that and make sure that that’s not what’s happening. Yeah. I’m seeing that a lot with my current baby he’s he’s wanting to do more grazing and then the other thing is,

Eva: (31:44)
And hold them off. You have to tell them, no, I’m telling you, bud, you’re going to regret this. You’re going to regret this

Dr. Playforth: (31:50)
And you end up then holding them all day too, because they’re your third. And you have other children that you have. It’s just, it’s very, very challenging because you know, you’re trying to do all the right things. But I think the other thing that’s confusing about it then is do you have a baby that’s sort of a little on the fuzzy side to begin with and they’re grazing all day long and then they’re fussy. You’re you don’t know, is this the time for the feed or is this just like random things

Eva: (32:18)
And are they tired? Are you tired? Are you hungry? You know, I just fed you an hour ago, but you only, you know, nurse for three minutes or fed an ounce and a half or do I do I know, I agree. And so I do find that, you know, if, if, if you’re breastfeeding, um, you know, to try and limit feeding like less than every two hours, because you know, at least this way, um, if it’s been at least that two hour period, um, you’re setting the baby up to be able to take down a bigger feed and then naturally not be hungry for at least another two hours. And the same thing would apply to a bottle fed baby, um, ballpark, like the three hour window and I’m using the word I want to emphasize, like, I, these are babies here, not robots. Right?

Eva: (33:06)
I’m sure you would agree with me on that. And so when I’m saying, you know, two hour, two to two and a half hours for breastfed babies and three hours to maybe four hours for bottle fed babies, this is like, I’m putting like an ish next to it, like two ish hours, you know, in other words, we’re, it’s a baby, not a robot. Don’t, don’t think of this in like exact, you know, this is a guideline it’s like a loose guideline to kind of guide you so that if you know that your baby you’re breastfed baby ate an hour ago and they’re fussy right now, chances are, they’re not hungry again. They might actually be tired. Right? That’s a really common misconception that I find is that people mistake, um, tired signs for hungry signs. And then what ends up and then, you know, what ends up happening is they think the baby’s hungry again.

Eva: (33:56)
So they feed the baby again, baby will take down like half an ounce or a nurse for like two minutes and then fall asleep because they were actually tired. But then what happens is that that little snack that they had before the nap basically ruined their appetite for like the next feed. So it can, it can perpetuate that snacking cycle. So that’s why I like giving people these loose guidelines to, you know, try to maneuver their day around so that they’re not setting themselves up for like a Grazer, a snacker throughout the day that can yeah. Cause those problems.

Dr. Playforth: (34:30)
And of course the other thing in the scenario you’re describing is so they, even if they just take a half ounce, you’re like, okay, I got to keep them upright. So I’m going to hold them for 20 minutes and I’m not putting them down or creating any kind of like sleep routine or anything else like that. Um, and so you’re sort of setting yourself up for more challenges a little bit later.

Eva: (34:51)
Yes, yes, yes, yes. It’s funny. Cause I know a little while ago you met, you know, when we were initially talking about keeping baby upright after the feed, um, a lot of parents will ask me, you know, do, does is my sleep Bible program going to help their baby with reflux, you know, there, and then they’ll mention in the same context that the baby needs a bottle or needs a breast to fall asleep. And I’ll say 100000% it’s going to help because you’re actually able to kill two birds with one stone here because a part of the solution is going to involve breaking that food sleep association so they can learn how to fall asleep by themselves and connect their sleep cycles and sleep like a champ. You’re also going to help your kids reflex because now it means that you’re able to, by moving that feed earlier on, they’re not conking out while eating and then waking up an hour later screaming because they’re uncomfortable from not having gotten burped properly and being able to digest that food properly. So it really is like you get to have your cake and eat it too by, by addressing, you know, how they’re falling asleep and eliminating that pre bedtime little snack that they fall asleep on. This step can REALLY help a baby with reflux sleep.

Dr. Playforth: (36:02)
And we should also talk a little bit about safety, um, with upright and inclined positions, right? So, um, you know, there’s a lot of products that are marketed to help your refluxy baby, um, w that, uh, provide a way to incline your, their sleep surface or their bassinet, their crib, whatever it is either by putting things underneath the feet or underneath the mattress or underneath the baby, those things are safe. Um, and if you think about, again, the physics of it, like if, if, if they’re in that inclined position, what they actually do, the chin kind of falls down because they don’t have a good amount of like muscle control and that chin falling down can close off the airway. So if there can be a set up for a bad situation, so we do not recommend those inclined sleep surfaces, um, you know, you keep them fully upright and then you put them down flat on a surface that doesn’t have anything else in there.

Eva: (36:56)
Right, right, right. Right. And do you ever have parents that say to you, but if my baby is on his back and he needs to spit up, like, is that going to be dangerous that, you know, he doesn’t know how to roll yet, you know, do they have to worry about, you know, choking? How do you respond to that question?

Dr. Playforth: (37:13)
So we do have reflexes that are designed to protect us from choking in that situation. Um, there are some babies, um, especially babies with kind of floppy airways and things that struggle a little bit more with that. Um, and they they’re going to have other symptoms, um, like the breathing issues and things, um, that might kind of cue you into that being what’s going on. Um, but, uh, you know, they should have re flex reflexes designed to protect them from choking if they’re refluxing up, you know, to kind of

Eva: (37:45)
Right. So they can like turn their head to the side, you know, for example, and that it’s not, it’s not really a concern okay.

Dr. Playforth: (37:52)
Itself, you know, a cop itself is a way to kind of protect your airway.

Eva: (37:56)
Right, right, right, right. No, that, that makes sense. Um, and I’m curious, you know, have you ever had, I know there are these homeopathic remedies that are, you know, that claim that they help with reflux. I don’t know if you’ve have any patients that have ever tried them, what you’ve seen anecdotally, or if there is any actual clinical data about those interventions.

Dr. Playforth: (38:18)
I get asked about things like probiotics, uh, asked about things like gripe, water, and gas drops. Those are the, probably the three most common things that I get asked about. And, and they’re usually, um, something that where people are asking about, I have a generically fussy baby, and they’re gassy and maybe a little refluxy and can try these things. Um, there’s no data that supports that, um, gripe, water or gas drops are helpful. Probiotics are a little bit different. So there’s a little bit of data. Um, a couple of studies that show that, um, crying duration in a colicky baby can be decreased significantly with the use of a certain type of probiotic. Um, but that wouldn’t be something that would help with the reflux. Yeah. Unfortunately, babies are not so, so black and white. Right. So baby, that has one problem often has another. Yeah. If I love my reflux babies that are frequently quite gassy as well, cause they’re crying a lot and swollen a lot of air or, you know, they’re swallowing air as they feed because part of their reflux is that they also have like a tongue tie or something else going on. Um, and so unfortunately these things are not black and white. Um, yeah. I have concerns about a lot of those products. Cause they’re not well-regulated and because the data is pretty equivocal, I don’t tend to recommend them.

Eva: (39:40)
Right. So it’s probably just a placebo, if that

Dr. Playforth: (39:43)
Yeah. Or maybe may, you know, I, if I have a patient that comes in and says, you know, I use gripe water and I swear by it, it totally helps my child. Well, I’m not going to tell you to stop something that’s helpful. And maybe it’s true that there’s a subset of babies for whom one of those things is helpful and we’re not able to study it well, because we don’t know how to kind of define the criteria to know like what kind of baby would that be more helpful for you? Things are, are hard to study. Um, there’s we don’t have great, a great way to, to put babies in the reflex bucket without having say colic or without having anything else going on.

Eva: (40:18)
Yeah. No, I think this has been so unbelievably helpful. Um, so you know, those of you, so to kind of summarize those of you who have a baby that you suspect might have reflux, you know, you go to the pediatric, you go to your pediatrician, you’ll likely be looking at, you know, smaller, to slightly more frequent feeds called baby upright. Um, and then from there possibly explore eliminating foods like dairy, for example, which, you know, could be causing an issue. Um, and then after you’ve explored those options and they haven’t really done much, then it might be a matter of going back and, um, experiment and experimenting with medication to see if it works. It’s interesting. Cause I do have a few friends who swear by, um, their reflux medication that their babies are on. Like they, they say like Eva, I’m telling you. And a lot of clients will tell me that, um, before the medication BB was miserable as anything.

Eva: (41:18)
And then the medication was like a godsend. And then what might happen is like a few weeks later being able will start getting really, really cranky again. And it’s just a reflection of the fact that the dose has to be up for baby gaining weight. Um, so they’ll think like, oh my God, is the medication not working? It’s like, no, your baby gained two pounds. So, so you need to just, you know, up at, so it does obviously have its place, but it’s not what we want to, we don’t want to immediately start just, you know, medicating something that might be able to get resolved just with, you know, environmental nonmedical interventions.

Dr. Playforth: (41:54)
This is what’s hard. And this was something I learned as a reflux parent and not as a reflex PDF or as a pediatrician. Um, there are things like that, that work, right. And, and unfortunately, sometimes when pediatricians are taught about things like this, they are taught in a very black and white way. Oh, never use medication. Like it only works in a tiny subset of babies. I will tell you for some babies, it is very clear to me clinically that it makes a difference for my own babies for the first two. It made a huge difference. And then with this one, it didn’t, and the dialogue between the pediatrician and the parent on this needs to be very open. Right. So anyone who’s thinking about it in a very black and white way, oh, I will never prescribe medication. Cause it never works. Like that’s just not the way life is. That’s just not parenting or babies are you need to be able to have that kind of open dialogue. Um, because you’re absolutely right. Medication does have its place. Maybe gets a little bit of an unfair rap because we’re trying to over-correct for a tendency many years ago to get to like,

Eva: (42:56)
Overmedicate like to just, yeah. Throw, throw pills at well, not pills for babies, but you get what I mean, you know, throw medication for absolutely everything that didn’t necessarily need medication. And I feel like a lot of us, you know, as, as kids growing up can a lot of us even have, you know, those anecdotes like, oh yeah, I had this or I had it that’s and rather than just treating it with, you know, this or, or this sort of environmental change, my doctor just gave me medicine that I didn’t really need and have these side effects. And so, yeah, I think that there is a lot of over-correct and that’s probably doing here, but we don’t want to over-correct too far to the opposite end of the spectrum that, you know, your baby ends up being like miserable for months at a time that it could have been, you know, resolved with this medication. So, no, I think that this, I love your approach, that it is intrinsically holistic, right? It’s not pro medication or anti-medication like, it looks at all these different interventions as potential tools that you can use to potentially treats whatever it is, whatever, you know, level of, uh, of reflux your little one might be, might be actually diagnosed with. So,

Dr. Playforth: (44:11)
Uh, parents would reflect see babies. Also there there’s some, I think a lot of those moms have a lot of guilt, you know, I can’t get my baby comfortable and sometimes you see this sort of uptick in postpartum, depression and postpartum. Um, and you know, recognizing that if the right thing for your baby is to stop nursing and to switch to a hypoallergenic formula, um, to kind of help the whole family that is holistic. It’s like part of our approach needs to be making sure that the health of the entire family is off.

Eva: (44:41)
Yes. Yeah, no, I, I totally, totally agree. As someone who has, you know, breastfed and bottle fed, all three of my kids like to varying degrees, my oldest, you know, was breastfed for three weeks and it just wasn’t happening. And I switched her over to formula. She’s now 10. I promise you guys, if you look at her, you’ll never know. You’ll never know that she was on the formula three weeks on,

Dr. Playforth: (45:08)
Right. This will not be the decision that makes or breaks whether your child is.

Eva: (45:12)
Yeah. I saw a really funny meme, you know, talking about there’s one moms talking about how, you know, her oldest was breastfed for like three years and her youngest was breastfed for like two weeks. And she was like, and they both still pick their nose and their boogers and eat French fries off the floor. You’re all gonna get. And you know, and I, and I love breastfeeding. I’m talking about someone, you know, and I support tons of breastfeeding families, but you know, I think it is important to recognize big picture. They’re all gonna land up in that same, the same spot, you know, picking their nose, eating French fries off the floor. That’s all good. Yeah,

Dr. Playforth: (45:48)
Exactly. You just have to find what works for your baby and you as a,

Eva: (45:51)
I totally agree. Amazing doctor Palyforth fourth where it came to anyone find you, you know, if they want, they want more of you in their life.

Dr. Playforth: (46:01)
I am at the pediatrician mom. Um, and I write about all sorts of parenting things, both from my perspective as a pediatrician.

Eva: (46:09)
They’re amazing. Fantastic. So I will link to that in the show notes. Thank you again, Dr. [inaudible]. Thank you everyone for listening in and you all have a wonderful day.

Eva: (46:24)
Thanks guys for listening. Have a great day. Thank you so much for listening. If you enjoyed this episode, please subscribe, leave a review and share this episode with a friend who can benefit from it. I also love hearing from my listeners. So feel free to DM me on Instagram @mysleepingbaby, or send me an email at eva@mysleepingbaby.com until next time have a wonderful restful nights.