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Feeding your baby breastmilk

Gastro-oesophageal reflux disease (GORD) and feeding breastmilk/breastfeeding

Reflux during or following a feed is common in all babies, but GORD, a chronic form of reflux, is particularly prevalent in OA/TOF babies and adults. This is due to the nature of the OA repair.

Emma Sidebotham, MD FRCS in The TOF Book, says, “Repair of oesophageal atresia pulls the lower oesophagus upwards into the chest to a varying degree.

  • This shortens the length of intra-abdominal oesophagus, opens the angle of His and can stretch the hiatus in the diaphragm. These changes combine to reduce the efficacy of the lower oesophageal sphincter and increase the tendency to reflux.
  • The longer the gap at the time of the repair, the greater the risk of this happening.

The muscular wall of the normal oesophagus squeezes sequentially from top to bottom to push swallowed solids from the mouth to the stomach. This process is called peristalsis.

  • When reflux occurs into a healthy oesophagus stomach contents are rapidly pushed back into the stomach by this peristaltic wave.
  • Following repair of oesophageal atresia, the oesophagus below the anastomosis peristalses poorly. When stomach contents reflux up, they will clear much more slowly and cause more irritation.”

GORD causes stomach acid to regurgitate into the oesophagus which can lead to inflammation and pain, sometimes described as “heartburn” in adults.

Signs and symptoms observed in infants may include:

  • Frequent “spit up”, during or following a feed
  • Frequent gagging, choking, coughing, burping and/or hiccupping
  • Only taking small amounts of feed
  • Crying and irritability
  • Appearing in pain or discomfort
  • Being uncomfortable when lying flat and sleeping poorly when doing so
  • Arching back when feeding
  • Wheezing and chest infections
  • Reluctance/refusal to feed

(East Sussex Healthcare, 2013)

Some of the symptoms of GORD are similar to those of a stricture or dysmotility in OA/TOF babies, so it is important to discuss any concerns you have with your baby’s surgeon or NICU team in order to gain a clear understanding of the cause and receive appropriate treatment. If your baby does have GORD, they can still have your EBM or breastfeed, but they may require medication to help to treat it (Martin & Crabbe, 2016).

If your baby has GORD, as well as medication, the following tips may help to alleviate some of the symptoms when feeding breastmilk/breastfeeding:

  • Using positions when feeding that keep your baby’s head higher than their tummy, such as having them diagonally across your chest in a cradle hold, to prevent stomach contents from travelling back out of the stomach into the oesophagus. Avoid positions where they are lying flat, such as having them lie next to you in your bed whilst feeding.
  • Giving shorter, more frequent feeds (if your baby is agreeable), to reduce the amount of milk that they have in their tummy at one time
  • Keeping your baby upright and avoiding too much movement for 15-20 minutes following a feed to allow milk to digest. This could be achieved by leaning back with your baby on your chest for a cuddle or whilst having skin-to-skin contact
  • “Burping” your baby at the end of each feed
  • Feeding your baby in the bath when they are more calm is also a great way to enjoy time having skin-to-skin contact
  • Non-nutritive sucking can help to encourage the stomach to empty
  • Gently rolling your baby from side to side when changing them, rather than lifting their legs up higher than their stomach, can also reduce stomach contents from moving back up into the oesophagus

(La Leche League International, 2024).