It is not just heartburn, but very often severe chronic heartburn which leaves you and your baby exhausted. Acid infant reflux, where the baby is vomiting up their milk, is relatively easy for a doctor to diagnose as the baby often fails to put on weight. This is an immediate worry and many parents and professionals recognise that there is a problem early on.

However, with silent reflux, where the content of the stomach is coming back up the oesophagus and into the mouth but not being vomited up, it is much harder to know why a baby is in pain and not sleeping. The heartburn is likely to be more severe as the acid liquid continues to run up and down the gullet and only when the baby is in an upright position with gravity working in her favour does the content of the stomach settle down.

Along with the severe medical heartburn there can be other side effects. Problems with breathing can occur and should be taken very seriously, as well as sore throats, sore gullets, raw sinuses and generally runny noses. All these are due to the regurgitation of liquid.

It is important to get medical advice for your baby for various reasons:

• To check that it is silent reflux causing the heartburn and not some other underlying cause.
• To receive support and advice from a professional to help with your worry over having a baby regularly in severe pain.
• To get advice on medication and feeding which can help to diminish your baby’s symptoms, leaving the baby with less heartburn and you and your baby with more precious sleep.
• To gain reassurance that your baby will grow out of silent reflux probably by her first birthday (or if very severe) by her second birthday and be fully well.

It is one of the most underestimated child care difficulties. It is very ill understood in the general population as well as by many professionals in the field. Many people think it is just a fancy name for a bit of wind or a form of colic but it is very distinct from either of these and its life as a problem for your baby is considerably longer.

Baby heartburn also needs medical checking and treatment or at the very least a carefully managed feeding routine different to other babies. Less food more often is the general guideline, though it can be very hard to tell when a silent reflux baby is hungry or just craving something to sooth their throat and oesophagus which is raw from the regurgitation of liquid in their stomach.

Severe medical baby heartburn is a very good way of describing you baby’s condition to people. Heartburn is something that many people can understand and have experience of or know someone who suffers from it and it gives them a gage as to just how painful this is for your child and just how difficult for the baby and the rest of the household to sleep as a result.

One of the difficulties for mothers with babies who have silent reflux is that there is no visible problem. Many people therefore have advice they think is helpful regarding baby routines and ways of dealing with constantly crying babies. If they can understand just how painful the problem is, then they are more likely to stop offering kind but misplaced advice and be willing to help by sometimes holding the baby while you sleep.

Baby heartburn means that sleep becomes something rare and very important for you, your baby and the rest of your household; especially if there are other young children in the house. Take any help offered and although you may well want to be the one holding your baby when she is in pain, it is important that you stay well for the long haul. Say yes to help and get some sleep whenever you can.

Perhaps your child wakes every two hours, or sometimes even several times an hour? Is your child in a twilight zone where he seems to want to sleep but can’t? The cry is one of pain. You know it’s not wind: he has winded really well. You know it is not colic: his little legs are not kicking up and down towards his tummy. Yet you know that he is in terrible pain somehow.

It is possible that your’s is one of a number of babies with acid reflux. Acid reflux comes in two main forms. There is the spit up, vomiting type which is usually recognised very quickly as there is a visible and physical sign of the baby’s pain and a recovery after the child has vomited up. Often there is an obvious problem as the baby is not putting on enough weight as a lot of the milk is coming up again and not staying down to be digested. You as a parent or a professional will have picked this up and probably diagnosed acid reflux.

With it come some of the worries, mainly if there is an associated breathing problem, but most of the worries are manageable with sensible feeding. Some relatively mild medication available through your doctor or paediatrician will help, as will the knowledge that it will come to an end as your child grows out of it.

There is, however, another type of acid reflux which is often diagnosed much later. It is called silent baby reflux. The baby regurgitates the milk in the same way as the babies with acid reflux but it does not vomit. The regurgitated milk runs up the oesophagus and back, or sometimes it runs up into the mouth and gets swallowed back down the throat. Babies with this type of silent reflux are often in more pain as the acidy liquid is running up and down their delicate gullets and causing very severe heartburn.

As well as this, the oesophagus and throat and often sinuses can become very raw and give constant pain in your baby’s life. This can mean that unlike acid reflux babies, who are fussy and really difficult to feed as feeding is associated with pain and vomiting, they often crave milk even when they are not hungry just to soothe their sore throat and the rawness they are feeling all the way down through their chest.

If you are a parent of a silent reflux baby it is important to get some help. This means both medical help and help in the home, especially if you have other young children. You will need sleep.

Be aware that you are in for the long haul. There is nothing very serious to worry about if your baby has average reflux as he will grow out of it somewhere between one and two years of age and by about ten months of age it will be diminishing enough for him to learn to sleep through the pain if it comes in the night. However, although it is a short term problem for you and your child, it is a long haul with a baby who might be up anywhere between three and eight times a night. Say yes to help, in fact seek it out so that you can get a nights sleep on a regular basis. The happier you are and the less tired that you are the more able you are to help your baby and to have fun with him and any other children during the day. This is really important with reflux babies. You need to enjoy the times of laughter when your baby is out of pain as much as possible.

There are ways of feeding and weaning which are as important as any medication which your paediatrician might prescribe. Little and often is good advice and more solids as soon as possible with as little acidic food as possible, especially near bedtime.

You may feel overwhelmed from lack of sleep and powerlessness to keep your baby out of pain, but you will be fine and so will your baby. Just stay focused on your own knowledge of your baby and what works for you both and for your whole family.

When you feed your baby, food travels from the mouth to the esophagus and then down into the stomach. At the opening of the stomach is what is known as a sphincter muscle. This muscle opens and closes during eating and also when the baby needs to burp. If the ring does not close properly, food can come back up and either lodge in the esophagus or come up into the throat and mouth. This gives the burning sensation that grownups often describe as heartburn. Unfortunately, your baby cannot tell you that’s what it feels like.

Figuring out what is wrong with your baby isn’t easy. He or she may cry more than normal and they may drool or have a hard time swallowing the formula. Many parents notice that something is wrong when the baby starts to act differently after eating or sleeping. Eating obviously aggravates the condition as the sphincter muscle is being put to work. Sleeping is also a problem for gerd infants as lying down allows the food to come back up easily. Your baby may wake up crying or not sleep like normal infants. This is a warning sign that something is going on.

If you think your baby has acid reflux, immediately make an appointment with your paediatrician. If you don’t get this treated, the esophagus may become damaged. Your doctor will most likely diagnose this from what you are describing. If at all possible, you need to write down when the baby seems to be in the most pain and what he or she was doing right before that. Was he eating or sleeping? How often does this occur after a meal? Being able to answer questions like that will give your paediatrician a better idea of what to look for. With some gerd infants, other tests will be needed so don’t be surprised if your doctor orders some.

If your doctor does suspect that your baby has gastro-esophageal reflux, he may recommend that you start by making some lifestyle changes. First he will suggest smaller feedings more frequently as overfeeding the baby can make symptoms worse. The baby will need to be burped frequently, even mid-feeding, and you will need to keep him or her upright for a minimum of 30 minutes after a bottle. Don’t put your baby in the car seat after eating either as it tends to scrunch their little body up which causes they symptoms to appear. Some doctors recommend that you add rice cereal or oatmeal to formula, but that can lead to gas or other digestive issues. Only do this if your paediatrician recommends it.

With gerd infants, clothing needs to be kept loose around the abdomen. It is also a good idea to raise the top of the crib mattress to keep your baby at an angle while sleeping. Only use a wedge that fits the crib properly. Most cribs will allow you to raise and lower the mattress as your child grows. Set the bottom of the crib at the lowest setting and the top of the crib at a higher one. This will keep your baby propped up and safe at the same time. An added benefit is that ears will drain better so your baby will be less susceptible to an ear infection.

For gerd infants with severe cases, your paediatrician may give you a prescription medication. Many are available to choose from so he may even give you a combination of two or more. Be sure to use these just as he directs to help your baby as much as possible. We don’t want to see our little ones suffer and this will help to avoid pain for your baby.

This condition is very common and it has been estimated that one in every five babies has colic. Baby colic symptoms often appear in the first few weeks of life and continue until the baby is around four months old. This is not caused by anything the parent has done, but the cause is often unknown. Baby colic symptoms include uncontrollable crying, a red face, gas, legs drawn up and an arched back. This is not a serious condition and your newborn is not in pain although he or she may appear to be. The biggest problem seen with colic is stress and anxiety within the home. This affects the siblings and parents more than it does the baby.

Symptoms often appear in the late afternoon or early evening, just as you are getting home from work and trying to prepare dinner. There are many things you can do when baby colic symptoms appear. First you can move around with the baby. Babies love to have contact with you so this appears to help. As it is a busy time in most households, you may also wish to use a sling or front carrier so baby can stay close while you get household chores taken care of. Run the dishwasher or vacuum cleaner if you can as this often helps to control the crying. If possible, give the baby something to suck on as this may provide relief. You may also want to give your infant a bath as this can be very soothing.

If you are feeling stressed out over the baby, be sure to take some time for yourself. Ask for help. This may be from your spouse, friends, neighbors or grandparents. Continuous crying can be very nerve wracking and there is nothing wrong with asking for assistance. You and your baby will both feel better if you do this. Others will be more than willing to chip in and help, especially if they have dealt with baby colic symptoms before.

There are times when baby colic symptoms may require immediate medical attention. If your infant has a high-pitched cry that is very weak, this is not a sign of colic. Cries associated with colic are strong and normal-pitched. When you pick your child up, if they feel like a rag doll, immediately seek out a doctor as this is not normal either. A fever over 100.4F in babies under three months and over 102.2 in three to six month old infants means you need to be seen by a professional. Seizures, green vomit and bloody stools are also warning signs. If you have any concerns, don’t hesitate to make a trip to a doctor or hospital. It is always better to be safe than sorry when it comes to your precious little one.

Symptoms that you may notice in reflux infants include spitting up, vomiting, irritability, coughing and a refusal to eat. These by themselves are not something to worry about as all babies have moods at times. It is when you are noticing a combination of symptoms that you may need to be concerned. Also, if your child seems to become more irritable after eating or napping, you may have an infant with reflux. Eating obviously will bring on symptoms. Laying down allows the contents of the stomach to come up easier so that is why you may notice irritability more after napping.

Reflux is a direct result of the action of the sphincter muscle. This muscle is what connects your stomach to your oesophagus. When you eat, the muscle opens and closes. For babies with reflux, this muscle also opens when burping. If the muscle opens at other times, food may be released and you will see the symptoms mentioned above.

Reflux infants will often outgrow this condition without help. There are some times though that you must seek immediate medical help. If your baby is projectile vomiting, get him to a doctor, especially if he or she is under eight weeks old. Excessive amounts of vomit, vomit that looks like coffee grounds or blood, or vomit that is green or yellow is not normal and means you need to get to a doctor. If your little one appears to be having trouble breathing after throwing up, race to the nearest emergency room. This is very serious. If at any time your baby refuses food for extended periods and doesn’t seem to be growing, you will also want to get him in to be seen.

Your doctor may recommend a number of things for reflux infants. He or she will tell you to avoid tobacco smoke as this will irritate the condition. Also, he may recommend smaller, more frequent feedings and suggest you burp the baby more frequently. Changing your baby before a feeding can help and you must keep the baby upright for at least half an hour after he or she eats. This will give the food time to digest in the stomach so it will not come back up.

Sometime medications will be needed to control the reflux. H2 blockers are drugs that prevent or block stomach acid production. You may know them more commonly as Pepcid or Zantac. Proton pump inhibitors, in contrast, reduce acid secretion and stop acid right at its source. Prokinetic agents are used to help close the sphincter muscle while also speeding up the emptying of the stomach. Your doctor may prescribe one or more of these medications. Be sure to use them as directed so your baby can obtain the maximum relief.

Although this is very different to baby acid reflux, I thought it was worth considering baby colic relief here.

Symptoms of baby colic.

Colic is an acute abdominal pain with intense spasmodic cramping. The baby will be in acute pain and distress, crying and usually pulling his/her little legs up so that the knees seem to meet the stomach in an attempt to stop the pain. This is often the easiest way for first time mothers to tell if her baby has colic, as early on the cause of each cry is not easy to distinguish. However, the pulling up of the little legs is a consistent visible symptom.

Most babies grow out of colic at around three months old. It is very rare for colic to continue past six months. If it does, it is much more likely to be baby acid reflux and might need medical treatment and management and you should seek medical help.

Causes of baby colic.

There is no single consistent cause for colic which experts can agree upon. There appear to be multiple contributing factors and which one or which combination affects a baby is different in every case. These factors include:

1. Babies’ digestive systems are not yet mature enough to do the job they are being asked to do; ie digest milk. The muscles in the intestines have not yet developed a rhythm for taking food through their system.

2. Newborns lack the bacteria (probiotics) which develop in babies over six months which aid digestion.

3. If the baby is breastfed by the mother then certain foods which the mother eats can affect her milk and upset the baby. Peas, beans, cauliflower, spices and alcohol are probably most well known for leaving trace elements in the breast milk which can cause gaseous bloating in the infant.

4. Babies often swallow air when feeding or when crying which increases bloating and pain. This can be even more common with bottle fed babies.

5. Newborns have an immature nervous system. This means they can easily get sensory overload from sights, noise, visitors or just being awake too long. This may well add to the likelihood of colic.

6. Anxiety in a parent can also transmit to the baby and again this can lead to the baby feeling anxious and for some babies this can also lead to tension in the intestinal tract and therefore lead to colic.

Treatments for baby colic relief.

1.  Companionship for the main carer.

Ironically, calming your own anxiety is the best form of treatment.

Sleeplessness and general worry about your baby’s health and about your own capacity to parent the baby well can leave you feeling frustrated, guilty, exhausted, inadequate and isolated. One of the best ways to help calm yourself and therefore calm your baby is to find others who are experiencing the same thing and know that you are not alone.

Most areas where extended families have dispersed will have a charity centre, local play area or medical centre for mothers of very newborn babies to meet and exchange thoughts.

Often the effort to get out of the door is so immense that it doesn’t seem worth it, but the right kind of companionship can help calm you and give you confidence. This will have an immediate good affect on your baby.

2.  Gripe water

There are many different types of gripe water on the market, depending where you live. A homemade remedy of very very weak cooled fennel tea can be effective. All of them aim at dispersing the bubbles which form in the tummy and as the milk is going down through the baby’s intestinal tract.

There are many other remedies available in different countries. Just check carefully that the treatment is registered properly and check with your doctor. Another advantage of finding other mothers is that they may be one step ahead and have useful advice. Ask your doctor before giving your child any medication or herbal remedy.

3. Winding for baby colic relief

This is the most important thing. No amount of winding will stop a colicky child being colicky, but you can at least minimise it by ensuring that you have winded your baby fully before putting him/her back to sleep. This sounds obvious, but in the depth of a winter’s night I know just how tempting it can be not to hang on for the last bit of wind that you can feel your baby still twitching to release!

Even laying a reflux baby down to change him/her can trigger the pain. Parents need to think about how to help them sleep. In the past a baby reflux wedge might have been suggested, but the US FDA has safety concerns about these (see the link at the bottom of the page).

The moment the baby does not have gravity on his/her side keeping the liquid down in its tummy then the milk is likely to flow up through the unclosed sphincter muscle at the top of the stomach and create the heartburn. You will be able to hear the liquid flowing the wrong way and you will certainly hear the scream or sometimes a rather sad whimper from your child.

Every baby differs. Some have acid reflux very mildly, some very severely. Some grow out of it in months when they start sitting, some not until two years, but the majority of babies with this particular problem have a major diminishment in pain by ten months old. If your baby is little that may seem like an eternity of a creaking back with a baby over your shoulder for most of the night, but hang in there. It may seem like forever away but the time will come and you will survive it knowing that the pain will go and your baby will be ok and so will you. If you really are not coping then get help quickly.

Sleep your baby at an angle day and night.

Make sure your baby’s cot is propped up at an angle, at least 30%. You can the head put higher still when they are little and not yet wriggling in their sleep. Get his/her head as high above the stomach as you can.

You could go the equipment based way, but there are now concerns about the safety of infant sleep positioners and SIDS (Sudden Infant Death Syndrome).

A good answer is books under the head end legs of the cot. There is no expense and you get the same result.

Get the baby’s head up; in his/her cot, in the pushchair, in the pram, on the floor, on the changing mat, in your bed, out in the park on the grass. Whatever it takes just do it. It is the single most effective solution and less pain for even a short period can help in the long run.  It will allow you to have moments of fun with your baby and your baby with you. Every fun minute out of pain is a bonus for the whole family. Whatever it takes – head up as high as is safe.

Consider the size of cot.

Once your baby starts moving in his/her sleep then the narrower and shorter the cot the better. If he/she can’t wriggle upside down off the angle then more sleep is likely to happen. If he/she can’t slip down off the angle lower and lower then more sleep is likely. It may be that the pram is a better place to sleep propped up. If your baby sleeps in your bed then make sure he is propped up high on pillows and can’t roll off; although this solution can make for problems later when trying to differentiate between pain and habit in waking patterns. A small space of the baby’s own to sleep is the best solution, not least as you may be able to sleep through some of the lesser whimpers before the scream comes if the baby is not right next to you. Every minute of sleep makes a difference. This is a long haul. Do not feel guilty about a bit of sleeping space for you, your partner, your baby and any other children.

As the baby gets bigger and starts to sit up and can fall out of prams etc then you need to make sure the solution meets the other safety needs of a growing child.

Head up at least 30% is the principle to aim for at all times.

US FDA Information about Infant Sleep Positioners September 2010

Silent reflux in babies

This is when the baby does not vomit or spit up, but swallows the regurgitated liquid, sometimes choking on it first. You will start to know if this is happening as you spend time with your baby after a feed, while he/she is sleeping, when the baby is laid down without the help of gravity to keep the liquid in the stomach. However, for a professional who might see the baby for ten minutes, without the description of vomiting and seeing the weight loss it is much harder to diagnose that your baby has acid reflux.

Confusion of symptoms

Silent reflux in babies is less messy but very confusing as often silent reflux babies want more and more food and put on weight, as they comfort eat to try and soothe the pain. Most diagnoses are dependent on the symptoms of raw throats from vomiting, hiccups, lots of vomiting itself and weight loss. You may need to be persistent if your medical help has not had experience with silent reflux babies. Keep a diary or remember to describe when your baby is crying in pain, how long after food, when upright or lying down. Remember to listen to see if you can hear the liquid flowing up his food pipe and into his mouth. You can usually hear the liquid and certainly the swallowing and sometimes the choking on the now acidic liquid which he/she has regurgitated. A permanently runny nose and bad breath are also very common signs.

Pain

Is a baby crying because it is in pain, hungry, tired, frightened or bored? Most people who care for a baby learn quickly to differentiate between these things. If the baby is your first child, it may well be harder to know which cry is which. It is therefore possible to feel that something is wrong, but not be confident enough to say that there is a problem. Lots of small babies don’t sleep well. Lots of small babies cry in the night. Lots of babies cry when they are put down. However, if you are worried and aware that by six weeks your baby is still not settling at all well, flaying little arms around and you can hear the liquid coming up, then be confident and consider the possibility that your baby has silent reflux.

Diagnosis

For the reasons given above, babies with of silent reflux tend to get diagnosed much later than ordinary reflux babies who vomit and fail to put on weight. However the reflux is not less painful for your baby. The lack of sleep and worry is no less devastating to you and your family. If it helps find a close member of the family or friend who is experienced with babies recently and ask them to do a night with the baby for you in your home. See if they can settle him or her or if they too realise the baby can only sleep comfortably when help upright on a shoulder or on a lap on a chair. Another experienced person’s confirmation that the baby is in discomfort or pain, not just lacking in routine can help.

Your baby needs the right medication and the right management of reflux to help the pain. Acid reflux is a long haul. Be assertive with your doctor, confident in your capacity to tell when your baby is in pain and wise in asking someone for help to hold your baby while you get some sleep. You are looking not at days or weeks up eight times a night and no respite in the day, but months. It helps to have a diagnosis and treatment. But remember your baby WILL grow out of it.

Infant silent reflux is hard to diagnose. You will have to help the professionals with your 24 hour experience of your baby. Management of silent reflux babies as well as getting the right treatment is very important. My email course is written to give you tips on sleeping, eating, finding treatment and explaining to the outside world what the difficulties are for your baby in pain and for you and the rest of your family. Acid reflux affects everyone in the household.

If you think your baby has acid reflux it is a good idea to go to your doctor and get some help. It is best if you can get referred to a specialist. It can help a lot over the next year of your baby’s life to feel that there is someone who understands this medical condition and is there to help. Do make sure that you are happy with the doctor and if necessary explain how bad the pain and the sleeping can be for you and your family. The worst thing you can do is pretend it’s nothing at all. Help the people who are there to help you. They need to understand fully what it is like for the baby and what it is like for you. Acid reflux requires symptom- based diagnosis. The doctor needs you to describe the symptoms fully and accurately to be able to help. Think about it before you leave home and write down the information you think is important. Here are some things to think about for infant reflux treatment.

Gaviscon

This is most commonly given. The active ingredients of Gaviscon are not absorbed into the bloodstream but react with the content of the stomach to form a gel. This makes the content thicker and less likely to be regurgitated back up the food pipe. There is, however, a side effect with babies of all ages and that is constipation. In itself it can increase the problem of reflux. Do talk to your doctor (or preferably paediatrician) as it may be better to use another kind of medication if your baby has relatively severe reflux.

Ranitidine (Zantac)

The stomach produces acid as a natural part of its digestive process. Ranitidine works by blocking the cells of the stomach lining from producing this acid. As it is often this acid flowing back into the oesophagus, the food pipe, which causes the pain (known as heartburn) then a reduction in stomach acid can help diminish your baby’s pain.

Domperidone (Motilium)

Domperidone’s actions effectively speed up the passage of food through the stomach into the intestine, which can help to prevent vomiting and bloating. It also prevents food from flowing the wrong way through the stomach and so diminishes the reflux, the regurgitation of the stomach content back up into the mouth. However, your baby needs to be heavy enough to have this as it cannot be given to small babies, so it will probably not be given until six months or even later depending on the size of your baby.

Omeprazole (Losec)

This is sometimes known as the “Royal” drug for heartburn. It cannot be given until your baby is heavy enough, probably six months or even older if your baby is small.  It does not always work for all children. Each child reacts differently to different medication. Omeprazole works as a proton pump inhibitor. Like Ranitidine it reduces the production of stomach acid. A baby should not be given both omeprazole and ranitidine at the same time. As with Ranitidine, it helps prevent acid in the food pipe and mouth, which helps prevent heartburn and also allows a raw oesophagus to heal if there has been bad reflux for a period of time.

Over the counter medicine

Painkillers for babies cannot be used very often as the heartburn is a long term problem. If desperate for some sleep it can be used, as long as you follow the instructions carefully and have consulted your doctor. However, the liquid itself can trigger heartburn so may counteract its usefulness.

Infacol, gripe water and weak fennel tea can all help with general baby tummy troubles, wind and colic. Anything that you find helpful to diminish other baby tummy ache is helpful in the early stages. Once the baby is older than three months you will probably find that other baby tummy aches settle down and you are left to deal with a single pain problem, the reflux.

Lifestyle and management of the problem is easily as important as the medication for your baby.

NONE of the above medication should be given without professional medical advice from a doctor or preferably a paediatrician. It is also important to tell your doctor the effect that the medication is having so they can find the most effective one or combination for your child.

Acid reflux is when your baby has an underdeveloped digestive tract. This is, of course true of all babies to some degree for the first nine months of their lives, but about 20% of babies have a particular problem. As a mother, I want to help you understand baby reflux symptoms. The intestine muscles are not developed enough and cannot pull hard enough to take the milk down through their system. The sphincter muscle at the bottom of the oesophagus and the top of the stomach responds and closes in conjunction with the pull of the intestines taking the food down through the system and out as waste. If the intestines are not pulling enough then the sphincter at the top of the stomach does not close and anything in the stomach is free to go back up into the mouth. Of course liquid is most likely to do this, more than solid food and therefore with babies who can only have a liquid diet of milk it is very difficult to stop the return flow. Gravity is the most effective way, which is why the baby will be so much happier upright on your shoulder or propped upright on your lap.

The stomach’s content is acidic.  When the milk in the baby’s stomach flows back, the lower oesophageal sphincter (the muscular ring at the lower end of the oesophagus going from mouth to stomach) doesn’t close and therefore it causes heartburn.

What are the symptoms?

A painful or burning sensation floods across the upper abdomen or with babies more normally across their chest. The acid content of the stomach may also come back up into the babies mouth causing a burning or sour taste. This can cause choking on the liquid or often makes the baby sick. Many reflux babies are very difficult to feed as so much of the milk they take is vomited back up once the reflux begins and this is usually very shortly after a feed. Both these things can be frightening to watch and can cause not only pain for the baby but considerable alarm for the parent. Not all acid reflux babies are difficult to feed or sick up their milk. Many just have the heartburn and although with these babies there is less worry about weight loss, they are often diagnosed later, as the symptoms are more subtle. It is no less painful to the baby and no easier to help them to sleep whatever the visible physical consequence of acid reflux.

What to call it in public?

Almost nobody has ever heard of acid reflux in a baby. Or if they have, they think of it as colic, or normal baby tummy troubles, or a bit of spitting up. Very rarely do they associate it with constant pain day and night or screams of agony every time the baby lies down. They certainly don’t imagine it as a powerful enough problem to impact on a whole family and overwhelm even a calm and sensible mother with no sleep, worry and even despair at times. The powerlessness you feel to help the tiny creature in your arms who is your responsibility is unbearable but at times combined with waves of desire just to put your hands over your ears; and all at a time when the usual post-new born hormones are operating as well.

GERD is another common phrase used by experts and on the internet, which stands for gastroesophageal reflux disease. I can guarantee no one has heard of this, unless they suffer from it as an adult. If so their sympathy and understanding is likely to be genuine as they too have felt the pain at night. I could never get my tongue around pronouncing it, but it does at least sound as if you have a real problem to deal with and not a bit of baby tummy ache once in a while.

Heartburn is probably the most accurate and compelling name. Everybody knows what heartburn is. Everybody knows how painful it is, how enormous the impact on sleep, how impossible to resolve and the delicate balance around times to eat. It can help you hugely if the words you use can be identified by other people. They can understand and then you feel understood. Heartburn is a very good phrase to use.