What is Reflux?
Reflux is a condition where the contents of the stomach pass into the oesophagus. This may then be swallowed back down (as in silent reflux), pass into the mouth (regurgitation) or be ejected from the mouth (vomiting).
Up to 70% of babies regurgitate some stomach contents into their mouth at least once daily. It is a normal occurrence and can be due to the frequency and size of a baby’s feeds putting the valve (sphincter) at the entrance to the stomach under pressure. This results in some stomach contents passing into the oesophagus or mouth. Remember a baby’s weight can triple in the first year of life and this growth requires constant feeding!
Reflux becomes an issue however when there are associated symptoms that cause distress. This is then called Gastro Oesophageal Reflux Disease (GORD)
Causes of GORD.
There are 2 main causes of GORD.
- An under developed Lower Oesophageal Sphincter (valve)
- A Cow’s Milk Protein Allergy (CMPA)
The Lower Oesophageal Sphincter.
This sphincter or valve is located at the base of the oesophagus at the entrance to the stomach and its purpose is to keep the contents of the stomach where they belong. In some babies this valve can be underdeveloped at birth, particularly if baby is a little premature. This can result in reflux. As baby grows the valve will continue to develop and strengthen and by the time baby is 12 months old the valve will, in most cases, be much more effective.
Cow’s Milk Protein Allergy
It is estimated that up to 40% of babies with moderate/severe reflux disease have a Cow’s Milk Protein Allergy. Many parents travel quite a way down the treatment road before a primary diagnosis of CMPA is even looked at. In our opinion, the sooner a CMPA is diagnosed the better the outcome for baby. The longer baby is exposed to an allergen, the more compromised their digestive and immune systems may become. We see babies at the clinic who have struggled for months with a poorly managed reflux, secondary to an undiagnosed CMPA. Once weaning starts the symptoms of reflux may become worse due to the overload of Cow’s Milk Protein (CMP) in their system. These babies need the assistance of a Paediatric Dietician at this stage as they may very likely have developed other allergies too. However, with careful management these babies can also be helped. Very often, CMPA can also be seen in siblings. If one child has had reflux secondary to CMPA, it increases the possibility of subsequent children having reflux too. However once you have understood and managed reflux with a previous child, you will recognise the signs and symptoms earlier and in many cases the diagnosis is expedited and the management plan can be put in place sooner.
Types of Reflux
With this type of reflux baby spits up after a feed but is not very distressed by it. It can generally be resolved by keeping baby in an upright position during and after feeds.
With this type of Reflux, the contents of the stomach are brought up but then swallowed back down. As a result, it can take a little longer to get a diagnosis, unless of course you know what other signs to look out for!
Acid Reflux is the most distressing type of Reflux. The stomach contents that are regurgitated contain stomach acid and burns the oesophagus causing inflammation and pain. Think about what Heartburn feel like yourself, that’s what it feels like for baby.
Reflux Secondary to CMPA
Very often Reflux can be secondary to a Cow’s Milk Protein Allergy. The severity of the Reflux depends on the severity of the allergy. This type of Reflux is also difficult to diagnose.
Symptoms of Reflux
General Signs and Symptoms of most cases of Reflux.
- Crying and irritability for longer than 3 hours a day. This can be at any time of the day or night.
- Regurgitation or vomiting of milk and/or clear fluid.
- Arching when feeding or after feeding.
- Wheezing on an ongoing basis.
- A noticeable breath change where baby inhales and makes a gasping type of sound.
- Nasal congestion.
- Hiccoughs after most feeds.
Signs and Symptoms specific to Silent Reflux.
- Baby is continually swallowing and appears hungry when they’re not.
- There is very little spitting up of feeds.
- Baby cries excessively.
- Baby seems to be in constant motion.
- Baby is very dependent on the upright position. Any change to a more vertical position will not be tolerated well.
- Baby tends to comfort feed to reduce the symptoms.
- White milk can be observed coating the tongue.
- Silent Reflux babies tend to like soothers!
Signs and Symptoms specific to Acid Reflux.
- Baby cries excessively. The cry is high pitched and baby can often cry for up to 6 hours a day.
- Baby sweats excessively.
- Baby often refuses feeds. Baby may take the first part of the feed but once winded, will then refuse the remainder of the feed for up to 40 minutes after. They tend to graze on small amounts.
- There is very little relief from upright positioning.
- Baby is often in constant motion, using the motion to relieve the pain.
- Baby has chronic nasal congestion.
- Baby has chronic Milk Wheeze.
- Baby has a cough.
- Baby is likely to refuse a soother!
It’s important to remember that baby will not have all these symptoms. This is a guide to help you recognise the general symptoms of reflux so that you can give your Health Practitioner as much information as possible.
Reflux is a condition that can vary from a mild version to a very severe version. If you have a baby with a severe Reflux, do not be discouraged if someone gives you the simple solution that worked in 2 hours for their Reflux baby and it doesn’t work for your little one! Every Reflux baby is different and every day can also be different. Keep to the plan and have it reviewed often.
For information o the treatment options, see Infant Reflux Treatment Explained
How can Cranial Osteopathy help a baby with Reflux?
Cranial Osteopathy, in a very gentle way, encourages the body’s tissues to release any tension and increases tissue flexibility. Reflux in my opinion challenges a number of key areas that support digestion. Firstly, the intestinal tract can become bloated and retain gas for longer periods. Secondly, the arching and extending associated with reflux can tension the breathing diaphragm as the baby is trying to ease their discomfort. Thirdly, as arching of the back persists, the neck musculature can also tension. Treatment applied to these key areas allows a gentle releasing of tension and lengthening of these tissues. This creates a more comfortable feeding process for the baby and eases the tissues supporting digestion.
Reflux Survival Strategies.
Infant Reflux is a condition we see every day at the clinic. What our years of experience has shown us is that there are many different levels of Reflux and no one solution that works for all babies. Some babies have a positional reflux, where keeping the baby propped up can alleviate the symptoms. Other babies have a mild acid reflux where a change of formula and perhaps an antacid will be the answer. And then there are the babies with severe acid reflux! This is a completely different story. Caring for these babies causes a significant amount of stress. Treatment can include formula changes, medication and constant revisions, sometimes with very little success! Every day can be a challenge. With this in mind we have listed a few tips for these parents specifically.
- Don’t expect to have all the answers at the beginning as it’s a really steep learning curve.
- There are no right or wrong answers for babies with reflux, as what works for one baby may not work on another. Take advice from your medical practitioner and ask as many questions as you need to understand your baby’s condition. It really is trial and error until you find something that works for your baby.
- Accept you are doing your best and focus on what’s going right rather than what you feel is going wrong.
- Believe in yourself and trust your instincts. Reflux is a medical condition; it’s not in your head!
- You can drive yourself crazy trying to figure out why one day is better or worse than another! The simple fact is that reflux can be cyclic and some days may just be worse than others for reasons you may never know.
- Look after yourself and accept any offers of help. Please ask for help if you need it. Talk to someone – talking to someone can often relieve the strain and often helps you to see what you can do about the problem.
- Many parents have reported that reflux can flare up when a baby is stressed or sick. Hot weather, teething, over-tiredness all can affect baby. However, knowing this can help as any changes make more sense.
- Recognise that there will be times when you’re more able to cope, and more positive, while other times you will feel quite low and overwhelmed. This is normal. Take each day as it comes and just maybe it helps to know that things will get better, no matter how hard it is right now. Remember though, that if feel you’re not coping, please ask for help and seek medical guidance. Your baby needs you to be well too.
Frank Kelleher Osteopath