Understanding Infant Reflux: A Guide for Parents and How Osteopathic Manual Therapy Can Help
Shauna Ironside is an osteopathic manual therapist, certified athletic therapist, athlete, and mother of three. She has a busy clinical practice in Ottawa, Canada, where she has been helping bodies of all ages and stages lead pain-free, healthy, strong, and active lives for the past twenty years. Learn more about Shauna here.
As a parent, witnessing your baby experiencing discomfort can be distressing, especially when it comes to issues like infant reflux.
Infant reflux is a common condition in which stomach contents flow back into the esophagus.
While many infants experience some degree of regurgitation, persistent or severe cases will typically require professional intervention. Any passage of gastric (stomach) contents into the esophagus is called gastroesophageal reflux (GER).
In this article, we will explore the basics of infant reflux and delve into how paediatric osteopathy can be a valuable and gentle approach to alleviate symptoms and support your baby's well-being.
This guide is not meant to diagnose your baby’s problem. It is important that your baby is feeding and digesting well, so please do not hesitate to contact your doctor or midwife if you suspect your baby has reflux.
These red flags should be acted upon immediately. Seek immediate medical help if you baby has:
persistent or worsening symptoms
isn't gaining weight
spits up forcefully (vomits)
spits up green or yellow fluid
spits up blood or a material that looks like coffee grounds
refuses feedings repeatedly
has blood in his or her stool
has difficulty breathing or other signs of illness
begins spitting up at age 6 months or older
cries for more than three hours a day and is more irritable than normal
has fewer wet diapers than usual
Reflux is not vomiting. Vomiting involves the engagement of the abdominal muscles to forcefully eject the contents of the stomach. A baby who is vomiting should be seen by their doctor immediately to determine the underlying cause and be evaluated or monitored for dehydration.
What is normal for baby: spitting up vs reflux
Some spitting up is normal for babies, breast or formula fed, in the first year of life. Their digestive systems are sensitive and immature. Their stomachs are also tiny, so overfilling in one feed can happen.
Normal spitting up is often referred to as physiological reflux or uncomplicated reflux. What exactly defines normal from more complicated reflux is not well defined.
Uncomplicated Reflux Babies
These are the babies that ooze or regurgitate a tsp or two, 1-3 times a day at most, somedays none at all. Their weight gain is great. Generally, they spit up less and less after 5-6 months of age, but it may persist until 12-14 months. They are generally unbothered by it.
Here are some numbers that may be helpful in defining uncomplicated reflux:
it usually starts before 8 weeks of age
50% of all 0-3 month olds spit up at least once a day
1-2 tsp of regurgitation is considered normal
often peaks around 3-4 months
usually decreases by 7-9 months
typically resolved by 12-16 months
Complicated Gastroesophageal Reflux Babies
Reflux can be more complicated for babies that are oozing or spitting up multiple times a day. These are the babies that need a “burp bib” around their necks all the time or changes of clothing. These are the parents that always have a “burp cloth” over their shoulder or on hand.
These babies are often fussy during or after a feed, arching their backs, squirming, scrunching their face and grunting. They may have colic. They often have other digestive troubles, like gas - their bellies can be distended like there is a little balloon inside.
They may not sleep well unless they are more upright on a parent. They may or may not tolerate being on their tummy.
Their weight gain can be either poor or good.
They may sound “snorty” or sniffly on or off the breast or bottle. They often have hiccups, cough, and/or gag (without any apparent stimulus). They may make a “click” sound at the breast or bottle during feeding. They may not want to feed or they may want to feed or suck all the time.
Silent reflux babies typically have all of the signs and symptoms of GER babies, but the regurgitation goes up the esophagus and back down, it doesn’t leave the mouth.
Figuring out the cause of infant reflux
Understanding the causes behind infant reflux is crucial for both parents and healthcare professionals in providing effective care and support. Unfortunately, this can be difficult, because reflux is often multi-faceted.
Some common causes of reflux in babies:
Underdeveloped Lower Esophageal Sphincter (LES)
The lower esophageal sphincter, a muscular ring that separates the esophagus from the stomach, is not fully developed in infants. This can lead to temporary relaxation, allowing stomach contents to flow back into the esophagus.
Immature Digestive System
The digestive system of a newborn is still in the early stages of development. As a result, the coordinated muscular contractions that propel food through the digestive tract may not function optimally, contributing to reflux episodes.
Food Allergies or Sensitivities
Some infants may experience reflux symptoms due to allergies or sensitivities to certain foods. Common culprits include cow's milk, soy, wheat, or other allergens introduced through breastfeeding or formula feeding. The health of the baby’s gut biome (microbacteria) may vary depending on whether the baby was delivered vaginally or by C-section. This biome is the primary cursor for digestion and the absorption of nutrients, vitamins and minerals. It plays a major role in immunity and countless other physiological processes. Consulting with a pediatric naturopath may be helpful for some babies with reflux to discuss how parents can help support the gut and microbiome of their baby.
Birth Strains & Body Tensions
The birthing process itself can contribute to reflux issues. Strain from in utero positions or during birth, especially if it involves the head and neck, may lead to tension or misalignments that affect the function of the digestive system and the ability to latch, suck and swallow optimally. Torticollis (tension in the neck) is commonly associated with reflux. A pediatric osteopath can assess and properly address these issues with manual therapy, cranio-sacral therapy, and home exercises.
Overfeeding or Improper Feeding Techniques
Overfeeding, mother’s oversupply, feeding too quickly, heavy letdowns, or not burping the baby properly during and/or after feeds can increase the likelihood of reflux. When the stomach is excessively full (of milk and/or air) it puts additional pressure on the LES, making it more likely for stomach contents to regurgitate. Seeing a lactation consultant can be helpful to help with any feeding issues.
Positioning During Feeding and Sleeping
The position in which an infant is fed and sleeps can influence reflux. Feeding in a lying-down position or putting a baby to sleep immediately after a feed may increase the likelihood of regurgitation. Paced bottle feeding is often recommended.
Neurological Factors
Neurological factors can also play a role in infant reflux. The communication between the brain and the digestive system may not be fully mature, impacting the coordination of muscle movements in the gastrointestinal tract.
Hiatal Hernia
While rare, some infants may be born with a hiatal hernia, a condition where a portion of the stomach protrudes into the chest cavity. This anatomical abnormality can contribute to reflux symptoms.
How osteopathy can help your baby with reflux
Osteopathy is a holistic, manual approach to treating body tensions, strains and dysfunctions. It focuses on the interconnection of the body's structure and function.
For infants with reflux, osteopathic manual therapy can offer targeted and gentle interventions to address underlying issues contributing to the discomfort.
Here are some ways in which osteopathy can help babies with reflux:
Assessment of Musculoskeletal Structure
Osteopathic manual therapists are expertly trained to assess the musculoskeletal system, including the spine, skull, and pelvis. In infants with reflux, misalignments or tension in these areas could contribute to the dysfunctions associated with reflux.
Cranio-sacral therapy
Gentle cranial osteopathic techniques can be applied to assess and address any restrictions or imbalances in the skull, facial bones and mouth. This is particularly relevant for infants, as the birthing process almost always creates tension in the cranial structures.
Balancing the Autonomic Nervous System
Osteopathy aims to restore balance to the autonomic nervous system, which plays a crucial role in regulating digestion. By addressing any dysregulation, we can positively influence the digestive process and reduce the severity of reflux symptoms.
Optimizing Diaphragmatic and Gut Function
Osteopathic techniques can help improve the function of the diaphragm and gut tube (it’s all just muscle and fascia!). The diaphragm is involved in respiration and digestion. Enhanced diaphragmatic function can contribute to better control of gastric pressure, potentially reducing reflux episodes.
Supporting Infant Feeding Practices
Shauna is lactation informed, having completed numerous courses on infant feeding with world leading lactation experts. She can provide guidance on optimal feeding positions and techniques that may help minimize reflux episodes. She will work collaboratively with other healthcare professionals, such as lactation consultants, to ensure comprehensive care for your infant.
Infant reflux can be a challenging experience for both parents and babies.
Paediatric osteopathy offers a gentle and holistic approach to addressing the underlying causes of reflux, promoting optimal health for your little one. If you have concerns about your baby's reflux, consult with their doctor or midwife first and foremost. If there are no medical concerns, consider osteopathy to help relieve pain and discomfort, tensions and restrictions, associated with the reflux.
