Some babies are big pukers. They routinely cover their parents’ shirts, trousers, necks, faces and any other available surface with the uniquely unpleasant curdled and sour liquid that is baby sick. Some babies are such prolific pukers that their parents and grandparents wonder how they can possibly gain weight since they are not keeping down any breast milk or formula at all. When the parents of these babies drag themselves into the paediatrician’s office, baby and parents alike in stained and discoloured clothing, everyone involved wants to do something to fix the problem.
One of the solutions usually suggested is to keep the baby upright after he or she eats. Positioning the baby upright is thought to aid gravity to keep that milk in the baby’s stomach, easing the pressure or preventing it from squirting back out. Some parents follow a baby version of the adult recommendation to prop up the head of the bed, and they tilt the cot or even buy a special wedge to help keep the baby in a more upright position while sleeping. Much effort goes into finding ways to keep the baby tilted upright (in addition to all the clothes-washing and carpet-cleaning).
Unfortunately for the parents of pukers, and for anybody else unfortunate enough to hold one of these little time bombs, the evidence tells us that positioning a baby upright does not ease their reflux. Two systematic reviews (one of them done by Aaron himself!), studies that look for and compile every single study related to a particular question, both conclude that positioning does not help reflux in children under two. Five studies examined whether upright positioning decreases reflux in babies, using a very sensitive probe that is actually placed in the baby’s oesophagus to measure changes in acidity and provide a very precise measure of whether or not any reflux is taking place, even if the baby does not vomit. Elevating the head of the bed or positioning the baby upright after meals did not have any significant effect on the reflux of the babies studied. Positioning the baby at 60° elevation in an infant seat was actually found to increase reflux compared to positioning the baby in a prone position on his or her back.
The best solution of all for reflux is the passage of time, as most babies grow out of their reflux as they get older and the sphincter around their oesophagus gets tighter. Until then, you may want to think about a laundry service.