Reflux or possetting is common in babies but only presents a problem if it causes physical symptoms (e.g. pain, aspiration, projectile vomiting, excessive crying), poor growth, or develops into gastro-oesophageal reflux disease (GORD). Breast milk remains the preferred method of feeding: human milk is efficiently digested, whereas switching to infant formula – even a specialist formula – may only worsen reflux symptoms; breast-fed babies also take in less air when feeding, thus decreasing the incidence of regurgitation.
Several strategies may reduce the risk of vomiting or pain associated with reflux; specialist formulae should not be considered as first-line measures. As the most common cause of infant reflux is an immaturity of the oesophageal sphincter muscle, feeding and handling techniques should be adjusted to reduce the risk of ingested milk flowing back up the oesophagus. The baby should be fed at a 30–40°angle (try the cradle hold). Short, frequent feeds may be better tolerated, with the baby’s head kept above her bottom. Winding should be delayed and should be undertaken gently. It may also help for the baby to remain elevated while sleeping or resting for a few minutes after a feed, to allow the stomach contents to empty. Allowing the baby to suck on the mother’s clean finger or a pacifier after feeding helps the peristaltic action of the GI tract to digest the milk more effectively.1 Sodium and magnesium alginate preparations can be prescribed for infant GORD, but medical supervision is required. These preparations can be mixed with small quantities of expressed breast milk and given at the start of the feed.

Reference1.  Kombol P. Soothing your breastfed baby with reflux. J Hum Lactation 2009; 25:  237–238.

From: Journal of Family Health Care Bulletin. Directory of Breast-Feeding Advice. December 2009. Published with JFHC 2009; 19(6). http://www.jfhc.co.uk/images/stories/breastfeeding.pdf