updated, November 12, 2023 – To help newborns and infants with reflux, we need to first understand what reflux is and then find comfort techniques. Reflux is a backward flow of the contents of the stomach into the esophagus that causes heartburn. Our team of night nannies presents advice to help here, with 6 Easy Tips to Help Your Reflux Baby.
Keep baby elevated
Burp frequently
Small feeds
Try paced feeding
Coleif drops
Wear your Baby
Reflux is one of the most common conditions newborns face and is often caused by the esophageal sphincter valve not being fully developed. This causes milk to come back up the esophagus through the throat and causes baby to spit up and vomit. Reflux can be upsetting, alarming, and painful to our babies! When the contents of the stomach come back up, it is usually mixed with some stomach acid, which creates a burning sensation.
While the only true remedy for reflux is time, there are some techniques to help keep your baby comfortable during and after feeding.
6 Easy Tips to Help Your Reflux Baby:
1. Keep your baby elevated while feeding. Whether breastfeeding or bottle feeding, use a position that keeps baby’s head higher than their stomach. Gravity helps hold contents in the belly, and reduces the amount of spit up. Also, be sure not to place your baby in a spot where they can easily slide down because this could put pressure on the belly and force contents back up.
2. Burp frequently during feeding. As you might have guessed, burping helps keep air out of the belly so try to minimize those air bubbles. Air or gas can force milk back up the esophagus, causing pain and discomfort.
3. Have smaller and more frequent feedings. When baby is too full, the full tummy can put pressure on the sphincter valve forcing baby to spit up. This can lead to pain and possibly choking, so slow, smaller feeding sessions are recommended.
If you’re breastfeeding, La Leche League recommends trying to have baby nurse at one breast only at each feeding. This avoids two strong milk ejections, therefore reducing overfeeding and excess swallowing of air. Also, leading sources in breastfeeding including LLL and KellyMom agree that in general spicy foods do not contribute to infant reflux.
4. Pace Feed. For bottle fed babies, conventional thinking tells parents to keep the bottle nipple full of milk or formula. This way air doesn’t get into the nipple and then into your newborn or infants tummy. However, the technique of paced feeding has shown to be more effective in minimizing reflux and pain. As Jordan Stubblefield, CLC and owner of Let Mommy Sleep Central New Jersey says, It’s not so much air intake as it is pacing the baby! Pace feeding helps to not overfeed by allowing baby to take breaks when they want, and following babies cues.
Here’s how to pace-feed:
Keep baby in a slightly reclined position so that the bottle isn’t pouring down and your baby can control the flow of milk/formula.
Let baby pull the nipple into his mouth. Once latched, keep the bottle just above horizontal.
Continue feeding this way. This allows baby to control the flow of milk better without taking in air. This also helps your baby to feed at their own pace, which keeps them more comfortable.
5. Try Coleif drops. Some babies have reflux not only due to immature sphincter valves, but because they have trouble digesting lactose in milk. This can lead to bloating, gas, discomfort, and a lot of crying. Coleif is a natural lactase enzyme that helps to break down lactose in an infant’s breast milk or milk-based formula. (not sponsored, just like the product!)
6. Wear Your Baby! Carrying baby in an upright carrier helps gravity do its job by minimizing the amount of liquid flowing upwards. Less liquid = less pain. Baby wearing also reduces muscle tension in baby as they can completely relax when being snugly carried by you.
this is an artist’s rendering, it doesn’t show safe sleep
Is Reflux More Common in Preemies and Twins?
The only cure for reflux is time, as newborns and infant systems may need a few months to fully develop. Because twins are often born prematurely they have a higher risk of experiencing GERD or reflux. Additonally, preemies who have spent time in the NICU may have other issues compounding digestive challenges.
For more tips on keeping baby comfortable check out 10 Ways to Calm a Fussy Baby. You can also ask our team of night nurses and postpartum doulas any questions on Instagram!
Update, February 14, 2022 – As of February 8th, the CDC and AAP have expanded infant, toddler and early childhood development milestones. See the new guidance here.
Infant speech milestones and communication progress varies from child to child, but there are general guidelines parents can use to gauge their own baby’s development. In this blog, Baby Talk: Infant & Toddler Speech Milestones, parents can find a quick guide of communication milestones for babies age newborn to 18 months old.
As always, you know your child best so if you ever feel that baby isn’t reaching their milestones on time or that there’s something wrong, don’t hesitate to contact your pediatrician. For a full breakdown of milestones, this chart from the American Academy of Pediatric Dentistry is very helpful!
Birth to 5 Months Old
Cooing, vocal sighs and vowel sounds such as “ahhh”
Laughter, crying (obviously!) and fussing sounds
6 -11 Months Old
Begins gesturing or using actions to try to communicate
Babbles without meaning (to us, not to baby!) and attempts to say mama and dada
12- 17 months Old
Understands how to label objects and people. Mom is actually “Mama” or Dad is actually “Dada”
Repeats simple words
Has a vocabulary of 4-6 words
Can respond non verbally
By 18 Months Old
Is adding more sounds, like animal sounds, to their repertoire
Is adding more vocabulary words
Pointing and gesturing, is able to communicate answers to simple questions like “Are you hungry?”
Again, there is a wide range of typical behavior in babies and toddlers. For example, sometimes newborns with older siblings reach milestones later than their peers because the older kids “speak” for their younger sibling. In other cases the child may start communicating earlier than expected because they are exposed to older family members or peers modeling speech to them all day! And of course twins and higher order multiples may even develop their own language which becomes part of their everyday communication.
Either way we hope this info is helpful and if you have more questions, you can visit our Parent Resource Center for evidence-based support.
Since the Back to Sleep campaign began in 1994, it has become widely known that babies sleeping on their backs instead of their bellies helps reduce the risk of Sudden Infant Death Syndrome (SIDS). ABC’s of Safe Sleep is an easy way to remember how to help newborns and infants sleep safely.
An example of what a safe sleep environment looks like can be seen here on the National Institute of Health’s website. A good summary however is to also remember the ABC’s of Safe Sleep: Alone, Back, Crib. Let’s break down each of the ABC’s:
Alone
It’s recommended that baby share a room but not a bed with parents for the first year of life.
No toys, pillows, blankets, crib bumpers or other loose items should be in baby’s crib.
Once baby is rolling over or taking off their swaddle blanket, it’s time to remove the swaddle blanket, or exchange it for a sleep suit that will keep baby warm.
Back
Put baby to sleep on their back, also called the supine position, for sleep.
If baby falls asleep in a carseat or stroller, it’s okay to stay there for short stretches. Place the carseat in an area where you can observe, or ideally put baby in the crib.
Crib
The terms “crib” and “bassinet” are regulated terms meaning that in order for a product to use those terms they must meet strict safety standards. Baby should not sleep in products called infant swings, beds, sleepers, napper or couch.
A crib with a flat, firm mattress should be used
Use a properly fitted sheet on the mattress.
And one last tip -as NationwideChildrens.org reminds us the “S” in ABC’S can stand for smoking…newborns “exposed to smoking, either while in the womb or after birth, have a higher risk of SIDS than infants who have not been exposed.”
Getting Baby on a Schedule and Sleeping Through the Night is a step by step plan to allow your baby or twins to sleep through the night. This can be used once your pediatrician agrees it’s appropriate. This is the exact sleep plan our newborn care providers and night nurses (RN/LPN) use to help all the parents who ask, How can I get my baby on a schedule? and How do we start to sleep train?
We understand there are many ways to care for your infant and don’t advocate for any parenting style. But we do want to provide concrete sleep training answers. Our infant sleep plans were written by Registered Nurses and Night Nannies using the guidance of our Medical Advisory Board.
The 4 month well-check at the pediatrician’s office is a great time to discuss your baby’s readiness to sleep through the night, because:
this time is when full-term babies are typically taking 4-6 ounces of milk/formula per feed, so their tummies are getting big enough to allow them to take larger feeds, fewer times through the day (meaning longer stretches of sleep between feeds at night)
Getting Baby on a Schedule and Sleeping Through the Night: 4 Steps
Get pediatrician’s okay that baby is able to sleep 8 or more hours without needing to feed
Give consistent daytime feeding of 4 larger feeding sessions during the day of 6-7 oz per feed, plus a dreamfeed of 2-3 oz = 28oz. This is usually enough to fill baby’s belly to sleep through the night. But again, the decision really depends on your own baby.
Wean overnight feeds while increasing daytime feeds.
implement formal sleep training using the Slingshot Method (below)
Once the pediatrician’s blessing is given that baby is able to sleep long stretches without feeds, you can use this plan.
Consolidating Feeds During the Day to Help Baby Sleep Through the Night
The most crucial first step to getting on schedule and getting babies sleeping restfully through the night is ensuring they’re taking larger, consistent feeds during the day. This means giving 4 consistent feeding sessions (milk every 4 hours) with one last “dreamfeed” around 10:00p.
With 4 feeding sessions of 6-7 ounces plus a final dreamfeed, we’re giving enough calories to get through the night. In other words, if baby is getting 28 ounces in a day up to and including a 10p feed, we can expect this is enough calories to sleep long stretches at night. (Getting baby to actually sleep without waking takes some teaching which we will discuss below). We’re not taking away ounces at night, we are simply “repositioning” them to be taken in during the day. Eating larger meals at predictable times means baby will also anticipate rest at predictable times. This is the natural transition to night and day instead of the 24 hour schedule of eating a bit, sleeping a bit, eating a bit, sleeping a bit.
So how exactly do we consolidate feeds and transition baby to a 4 hour feeding schedule?
Upon waking in the morning, give as much milk as he wants at feeding time.
For the next feed, hold off for as close to the 4 hour mark as possible. THIS WILL BE A GRADUAL PROCESS and may take 1-2 weeks. We of course do not want baby to get to a state of frenzied hunger so it is absolutely okay if you can only hold off feeds for 3 hours and 15 minutes on these first tries. You will not see a perfect 4 hour schedule emerge on the first day. It will take 5-7 days of consistently working toward 4 hour feedings, before you see a 4 hour feeding schedule. You’ll see he’s able to go longer and longer stretches with each feed until after several days, he’ll be doing the larger 6/7 ounce feeds every 4 hours.
While you are transitioning to feed only during the day, baby will still wake up during the night. This is because the full transition time will take several days and we have not yet addressed formal sleep training. During this time you are still doing your normal overnight feeds but gradually giving less and less overnight. Don’t worry though, these ounces are being taken in during the day.
To wean overnight simply give ½ ounce less in his bottle over the course of 2-3 nights. It’s okay to use a pacifier to help baby go to sleep during this time.
Once we know baby does not physically need milk overnight, we can address…
Sleeping Through the Night
One of the key components of a child sleeping through the night is learning to fall asleep for the night at their bedtime of 7:00/8p on their own. Putting baby down awake but drowsy at bedtime means that he already has the tools to put himself back to sleep if he has a middle of the night waking.
A key component to helping baby get ready for bed and in the “drowsy but awake” state is to instill an average of a 30 minute wind-down routine. It doesn’t matter what the wind down is; just that it is the same 2-3 quiet things before bed every night so he can switch gears and can physically and mentally wind down for sleep. Baby cannot fall asleep using anything outside of his control; he must control how *he* gets himself to sleep. In other words, no pacifier, no falling asleep while feeding and no rocking to sleep. These 3 things are controlled by parent and not baby so baby can’t find out how he gets himself to sleep.
When baby wakes for a bottle during the first wake up window, we find the more formal sleep training technique of the Slingshot Method is helpful. Slingshot -where a parent stays in the room while baby learns to go back to sleep- can be the least jarring method of sleep training. You may choose another method though and that’s fine!
How to do the Slingshot Method of Sleep Training
During the first few nights, stay next to the crib and reassure with your voice and touch. You can try patting or singing, but try not to pick baby up when he fusses. You are showing that you are there to comfort and support, but baby is the only person who truly knows how to get to sleep. It is okay to sleep in the room during the first nights.
During the next few nights, sit (sleep) a little further across the room and just soothe with your voice. If he continues to fuss, you can get up and reassure with touch but try to wait a bit longer in between each time. During the next few nights, sit even further away from the crib near the doorway and soothe with your voice. The next few nights you should be in the doorway or even into the hall. The object is to slowly and gradually do this so that it is a gradual change for your baby.
Employ Slingshot for night waking as well. We define a night waking as any wake time between 10p – 5:30a.m Once he is able to fall asleep independently at 7:00, he will also be able to soothe back to sleep during the night wakings. If baby wakes for the day rested and happy at 6:00a, then you know that that is his natural wake up time.
Consistency is Key
The most important thing to remember in helping a baby sleep through the night is consistency. If you are sure, and the pediatrician agrees, that baby is able to sleep through the night without waking to feed, the only way sleep training works is to see it through. For example, if baby cries for 10 minutes and you give a bottle, they learned that crying for 10 minutes = bottle.
Getting Baby on a Schedule and Sleeping Through the Night: Twins and Schedules for Older Babies
Twins sharing the same room should be kept together for sleep training since they will need to learn to sleep through each other’s wake ups.
To help with this transition from dependent to independent sleep, you can make the atmosphere as comfortable as possible by incorporating dark blinds and shades and a small nightlight in the room. Calm activities during the afternoon will also help pave the way for a calm bedtime. Below is a sample schedule for a 4-6 month old, based on an average 7:00 awake-for-the-day time. If baby wakes at 6, simply adjust back 1 hour.
There will be 3 “blocks” of 4 hours. The last block includes only a short nap since it is close to bedtime.
Nap #3 in the late afternoon will disappear in month 7. You will see the nap become shorter and less reliable for about 3-4 weeks until the lap nap eventually drops altogether.
Each block begins with milk and the last block ends with milk. So feeding times are at: 7am, 11:00am, 3pm and 6:30pm. There will obviously be some adjustment time where the schedule is not perfect. This transition time it will likely last 5-7 days.
Sample Schedule for a 4-6 Month Old
7:00 wake up, change
7:15 or 7:30 5/6 oz. milk
8:30 solids: grain or grain + fruit
9:30 wind down
10:00 nap
– 4 hour cycle repeats upon waking up –
11:30 5/6 oz. milk
12:30 solids: grain or grain + veg (when lunch is introduced)
12:00 – 1:00 activity
1:00 – 1:30 wind down for nap
1:30 – 3:30 nap
– 4 hour cycle repeats again upon waking from nap, but with a third short nap*-
3:30 5/6 oz. milk
3:30 – 4:30 quiet play, try to stay around home and stick to calm activities
4:30 – 5ish nap
5:30 dinner of solids (This is appropriate whenever you want to begin the addition of an evening meal. We’re only including it so you can see what it looks like to have a 3 meal per day schedule)
6:15 – 7:00 5/6 oz. milk, bed
Last thing… the Dreamfeed
10pm Dreamfeed as the last feed of the night and baby does not have to be fully awake for this. It is just a small 2-3 ounce feed to “top baby off” for the night. You don’t have to wake baby, simply hold the bottle to their lips and they’ll instinctually take in what is needed. When finished, there’s no need to burp but you may opt to do a quick diaper change at this time.
The above is only a sample schedule. It might not work for you and that’s okay!
Did you read all this and feel like you want someone to help talk it through? You can schedule a sleep consult here!
Vaccine notifications pouring in from our Night Nurses & Nannies, January 2021
As the pandemic emergency is officially over on May 11, 2023, this post is no longer being updated. We are keeping it up as an archived post for those interested in how the company handled COVID19.
COVID19 and Newborn Care Best Practices for our Night Nurses and Postpartum Caregivers working in the family home have been updated as the coronavirus pandemic evolves. Vaccinations are now widely available and covid19 testing easily accessible, so we’re able to service more families while still remaining vigilant with safety. Below is a breakdown of our COVID19 safety and ongoing best practices:
Updated, Nov 20 2021 – Yes, we are all vaccinated including the booster. We understand some folks have big feelings about the vaccine however, as an evidence-based newborn and postpartum care company we’re following the advice of the CDC, The American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine (SMFM) and the AAP.
Updated, Jan 11 2021 – Our Nurses and Newborn Care Providers are now receiving the 2nd round of the Pfizer and Moderna vaccines. We still wear masks because it’s possible for a vaccinated individual to transmit the virus. We also want to protect those in the household too young to receive immunization or those who are immune-compromised.
Update – Dec 1, 2020 We’ve prided ourselves on using the highest vetting and safety practices possible since we began in 2010. As a company dedicated to evidence-based care, we lean on the recommendations of the CDC, the American Academy of Pediatrics (AAP) and other primary sources. Specifically we follow the AAP statement that vaccines are “ethical, necessary and just” to protect vulnerable populations. Too young to receive vaccines themselves, newborns and infants are considered vulnerable.
COVID19 and Newborn Care Best Practices
Coronavirus has caused us to examine and refine our practices even further. Here is an overview of current Let Mommy Sleep practices:
What we always do:
Wash Hands – Caregivers wash hands upon arrival into the family home and continue handwashing and sanitizing through the night and before and after all contact with baby.
Remove Shoes – upon arrival into your home.
Masking – Masks are required unless the family and caregiver mutually agree that they are comfortable without masks.
Vaccinate – We follow evidence-based science. We remain updated on all vaccinations to minimize the risk of illnesses to which newborns are vulnerable. These include influenza, pertussis (MMR), TDaP and COVID.
Continuing Ed – Provide free continuing education to all staff. This ensures we’re following the most recent safety, health and care guidelines.
Err on the side of caution – Staff is kept home at any sign of illness, even if symptoms might be “just allergies.”
What can we do together to minimize exposure?
Please leave sanitizing wipes or other household cleaners out for our team to use periodically through the night. While we can’t always practice social distancing when caring for babies, we can wear masks, handwash and clean, clean, clean!
We can’t wait to see you again and remain thankful and privileged to be in your homes. If you’d like to learn more about us and our practices, please visit this page.
