Reflux in Infants

Does my baby have infantile reflux? What is making my baby irritable not feed properly or have sleep difficulties? As a parent you speak to other parents of new-borns, your parents, friends and everyone has a diagnosis and an opinion to what is causing what in your baby. Babies cannot talk but they can cry, and they make us listen. You resort to reading as much as you can on the internet but when you start reading about colic, reflux, sleep and breastfeeding difficulties the signs and symptoms often cross over. How do we know what is causing what? What is normal?

Stillpoint Osteopaths can help you decipher the myriad of symptoms and signs you notice with your baby. With a thorough history and examination, they can advise you on the main areas of concern, how to manage them and refer you when needed.

A common presentation at Stillpoint Osteopaths is where parents notice that their baby spills up some of their stomach contents referred to as reflux or gastroesophageal reflux (GER). There are varying severities of reflux and in most cases, there is no need for concern. If your baby is gaining weight well and reaching their milestones, further investigations may not be needed. There is a condition called gastroesophageal reflux disease (GERD) which is more complex and requires further investigations.

The signs and symptoms of reflux are many and varied and every baby can express it slightly differently. Be aware that just because your baby may have some of what is described below it does not mean they have infantile reflux. Your baby may have some of the below but have other explanations for the presentation.

How Much and What does it looks like:

Parents can describe spilling or posseting where baby brings up small or what appears to be large amounts of their stomach content. This can just be into their mouth onto their clothes or even have some force behind it referred to as projectile. Projectile vomiting should always be checked by your GP to rule out any underlying concerns that rarely but occasionally can be associated with this.

Parents notice that baby appears to gag and choke at times.

It can sometimes seem curdled often described as partially digested, or it can look like unchanged breast milk, sometimes it can appear to have mucous in it or be slightly coloured. Rarely, parents mention some blood spots or streaks. Any blood or discolouration it is advisable to have this checked by your GP.

It can be normal for babies to occasionally posset after feeding so don’t assume that all posseting is an issue for your baby.

Feeding Disruption:

Parents comment that it can impact breastfeeding or bottle feeding. They describe baby pulling on and off the breast or bottle, they seem to be hungry want to feed but don’t settle to feed well. Baby can get frustrated trying to feed. May only take small amounts or cry during the feeding process. Be aware that it is normal for babies to fuss with feeding from time to time and it does not mean that every baby that does this has infantile reflux. Refusal to eat can also be associated and if this persist and or weight gain is becoming a problem your baby should be evaluated.

Sleeping:

Parents comment that they catnap. That it can be difficult getting them to settle for a sleep. That baby doesn’t seem to sleep more than 20-30 minutes stints during the day. Can wake often at night. Parents comment that they hear them regurgitate and that this seems to wake them when sleeping. Some describe that baby only seems to sleep elevated on parents and wakes when they are laid down flat. Other babies with infantile reflux sleep perfectly fine day and night.

Weight gain:

In most cases of infant reflux, babies gain weight well and meet their milestones. In other cases, it can affect their weight gain. If your baby is not gaining weight well, then an assessment would be advised.

Discomfort:

Parents describe baby being irritable, hard to settle but at other times distractible and happy. Others mention constant crying or grizzling. Baby arching back, curling themselves up, passing lots of wind, lots hiccupping and difficulties burping. In isolation each of these observations can be normal for a baby however when part of a bigger presentation can be associated with infant reflux. Some parents notice the spilling, but baby seems very happy an unaffected by it.

Tummy Time

Parents comment that baby doesn’t enjoy tummy time either on their tummy or on their back.

Silent Reflux

Well we have also all heard this term discussed. Tricky because baby doesn’t spill so it often takes a little more effort to figure it out. Parents may mention some of the signs and symptoms listed above but baby doesn’t bring up their stomach contents in the same way.

With silent reflux parents will comment on an acid like smell to their breath, their cry can sound hoarse, they seem to have a snuffley nose or cough regularly. Parents are aware of gagging and choking at times, along with some of what has been described above.

Causes:

What causes Infantile reflux? It is normal for some of our stomach content to rise into our lower esophagus several times a day both in adults and babies. Most studies talk about an immaturity of infants esophagus and an immaturity of their lower gastroesophageal sphincters. Studies also show that the incidence of infantile reflux reduces considerably by the age of one so the more they grow the less it happens. So, let’s look at this a little further. In a baby their esophagus is shorter, they are lying down a lot of the time and they are predominately on a liquid diet. All of this adds up to more chance of spilling.

So how does this help us and why do some babies never have any spilling and others have so much if all babies have this immaturity? As an osteopath I understand that development and growth help infantile reflux. However, when your baby is really struggling, I also must ask myself what else could be happening that is aggravating this situation for your baby. Could there be some differences in what your baby has been through to get into this world compared to other babies and could this be affecting the way their body is functioning.

Osteopathic work is gentle and can help balance and ease tensions in the muscles and tissues of your babies’ body. This in turn may create some changes that allow your baby to feel more comfortable.