How to wean a baby with reflux or tummy troubles

If you’re a parent of a baby who has struggled with reflux or tummy troubles, you’re probably wondering how to navigate the next milestone of weaning. It’s common for parents who have struggled with the challenges associated with reflux or tummy troubles to worry as they approach this milestone, so in this blog, we’ll discuss;

1. Should you wean your baby with reflux or tummy troubles ‘early’?
2. Are there foods you must avoid, or should you approach weaning differently?
3. When to seek more support

When to wean your baby who has reflux or tummy troubles?

A common question from parents with babies who have reflux is, “Should I start weaning early?” in fact, some health professionals may even suggest this approach to parents.  The basis of this recommendation is grounded in the theory that introducing solids may increase the viscosity (thickness) of your baby’s stomach contents, thus helping to manage reflux symptoms.  However, the guidelines and evidence available for this group of babies are minimal.   It’s essential for a parent with a baby who has reflux to know that there is no robust scientific data to suggest that early weaning, e.g., from four months/ 17 weeks, will improve your baby’s symptoms.  Starting solids cannot be promised as a ‘magic bullet’ to help resolve all baby’s reflux symptoms, and in practice, the reality is that for some babies, starting early can create additional stress for parents and may worsen reflux symptoms.   For this group of babies, I’d recommend the following considerations when deciding when to start solids:

1. Is your baby showing developmental signs of readiness for solids, e.g. able to hold their head up, maintain an upright seated position, swallow food (and not just thrust it out of their mouth) and coordinate picking things up and bringing it their mouth?
2. Have you optimised reflux management of their milk feeds, for example 
   1. Check the frequency and volumes of feeds 
   2. Explored paced bottle feeding for those fed via a bottle
   3. Sought breastfeeding support, as factors like latch, let down, and oversupply can impact reflux symptoms
   4. Discussed options such as thickeners with your GP
   5. Ruled out other diagnoses, e.g. cow’s milk allergy
      
      
3. Have you trialled an evidence-based probiotic, like Limosilactobacillus reuteri DSM 17938, for babies with tummy troubles such as colic?

If unsure, seek support from a healthcare professional who can assess your child individually and advise.  While starting before six months of age can be supportive for some babies, it’s so essential that each baby’s needs and readiness are considered individually.

Should you avoid certain foods when weaning a baby with reflux or tummy troubles?

When starting weaning for a baby with reflux, parents’ next most common question is, should I avoid anything?  Again, despite what weaning forums or ‘experts’ tout, the evidence base in this area is limited, and I always encourage parents to focus on their baby and their symptoms.   It can be easy to restrict a baby’s diet to limited foods quickly based on symptoms, but this can also impact their weaning progression and health.  Many parents are told to introduce one new food every three days, and whilst in a minimal % of cases, a more systematic and restricted approach is justified, there are consequences associated with this approach.   Each baby’s history and factors, such as its gut microbiome, are unique, so it’s vital to focus on your baby.

When it comes to foods, some babies may struggle with foods well known to be more accurate, e.g. tomatoes, fruits but equally, there can be other factors around meals which impact a baby’s reflux symptoms, for example, the fat content of a meal (which slows gastric/tummy emptying.  When it comes to tummy troubles, your baby may also experience symptoms such as more wind or changes to their poo. Many of these changes are expected due to the extra work and adaptation your baby’s gut makes as they progress from milk only to solids.  Foods high in certain fibre types may ferment in the bowel, causing extra wind, for example, beans or broccoli.  If you’re struggling with reflux or tummy troubles during weaning, keeping a food and symptom diary can be a helpful way to observe any correlation between foods, meals and your baby’s symptoms.    

When should you seek more support for reflux and tummy troubles?

As a parent, knowing when to seek extra support for your baby’s symptoms can be challenging, especially when factors like regurgitation and changes to poo are common in young babies.  The bottom line is that if you’re worried about your child’s symptoms and/or things are not improving, seeking support and reassurance from a health professional is essential.  You should also seek support if your baby is experiencing;

• Any signs of food allergy, e.g., reflux or tummy troubles, may persist despite treatment and are often alongside other signs of food allergy, e.g., skin changes, blood in stools, or excess mucus in stools.
• Your baby is losing weight or falling through centile lines on their growth chart.
• You are worried your baby’s diet is very restricted
• You are struggling with feelings such as anxiety or depression related to your baby’s symptoms.