Restful Nights for Everyone: Understanding and Addressing GERD-Related Sleep Issues in Infants and Children

There aren’t many studies on sleep interferences in infants and children with GERD; however, this study looked at the sleep patterns of 102 infants and children aged 1 to 36 months with and without reflux. The primary outcome measures were time to settle at night, the number of nighttime wakes, and daytime sleep patterns. Compared to population norms, those with reflux had a greater prevalence of nighttime wakings and daytime sleep and a very delayed sleep onset. What was shocking is that 50% of children with reflux (compared to 13% without reflux) aged 3-12 months had nighttime wakings, and 60% of children with reflux (compared to 10% without reflux) aged 12-24 months had nighttime wakings. 

The GERD-Sleep Connection: How Reflux Disrupts Your Child's Rest

GERD symptoms may be worse when lying down because gravity cannot keep the stomach acid down. Infants don’t have a mature GI tract, meaning the digestive system doesn’t fully function properly, and their GI muscles are not fully developed. This makes it easier for milk or stomach contents to pass back into the esophagus. Some common signs that your child's sleep might be affected by GERD include frequent night wakings, arching of the back, and difficulty settling.

Creating a Sleep-Promoting Environment for Children with GERD

Luckily, there are some things you can do to help your child by creating a comforting sleeping environment. Regardless of the child’s age, ensure the room temperature is appropriate (not too hot or cold) and trial hypoallergenic bedding. 

Optimal Sleeping Positions for Infants and Older Children

As far as sleeping position goes, the age of your child matters. The American Academy of Pediatrics (AAP) recommends that infants under one year only sleep on their backs. They say that the risk of sudden infant death syndrome, or SIDS, far outweighs the benefits of sleeping on the child’s stomach. Instead, try rocking your infant until they are drowsy. This may help soothe your child while keeping them upright for a little bit before laying them down. If your child is over one, the AAP suggests having them sleep on their stomach, which is beneficial for GERD. 

Dietary and Lifestyle Modifications to Improve Sleep

If your child is old enough for a diet and not solely formula, a few food items to avoid prior to bedtime include acidic foods (oranges, tomatoes, tomato sauce), high-fat foods (fried foods, pizza, chips, fatty meats like bacon), fast-food meals, chocolate, onions, and peppers.

If your baby is young enough to be formula-fed, you can try changing or thickening the formula with the ok from your pediatrician. This article on Formula for Infants with Acid Reflux does a great job breaking down various formulas for infants with reflux. Additionally, this article on Formula Thickeners for Infants with Reflux does a great job breaking down and explaining thickeners for formula and breastmilk. So, whichever route you choose, either article can be helpful. 

Some lifestyle modifications you may want to implement are timing meals and ensuring you are not feeding your child immediately before bed. Also, avoid rigorous activity before bed and help manage your child's stress level before bed. 

When to Consult a Pediatrician for GERD Symptoms

There are many reasons that an infant or child may have frequent wakings at night, but to rule out the exact cause, I highly encourage you to reach out to your pediatrician. Your pediatrician can help provide lifestyle change guidance as well as medication options if necessary. 

1. _{Douglas P. S. (2005). Excessive crying and gastro-oesophageal reflux disease in infants: misalignment of biology and culture. Medical hypotheses, 64(5), 887–898.}
2. _{Ghaem, M., Armstrong, K. L., Trocki, O., Cleghorn, G. J., Patrick, M. K., & Shepherd, R. W. (1998). The sleep patterns of infants and young children with gastro-oesophageal reflux. Journal of paediatrics and child health, 34(2), 160–163.}
3. _{Lightdale, J. R., Gremse, D. A., & Section on Gastroenterology, Hepatology, and Nutrition (2013). Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics, 131(5), e1684–e1695.}
4. _{Pappa, A., Muschaweck, M., & Wenzl, T. G. (2023). Change of Sleep Stage during Gastroesophageal Reflux in Infants. Children (Basel, Switzerland), 10(5), 836.}