What is baby reflux? A question I am asked so often. Let me explain what I mean by baby reflux, the different types and what I believe are the most common issues that cause or contribute to it.
Up to 70% of babies regurgitate some stomach contents into their mouth up to 6 times daily. It is a normal occurrence, generally starting before baby is 8 weeks old and can be due to the frequency and size of 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 stomach is only the size of their fist and their weight can triple in the first year of life. This growth requires constant feeding and can understandably put the stomach valve under a little pressure! So, for most babies this is completely normal, they are not distressed and do not need treatment.
The most obvious symptom of baby reflux is spitting up. This happens when the contents of the stomach pass into the oesophagus (food tube). This may then be swallowed back down (as in silent reflux), pass into the mouth (regurgitation) or be ejected from the mouth (vomiting). There are different levels of reflux ranging from a mild positional reflux to a severe acid reflux.
In my experience however, Baby Reflux is usually a symptom of another condition. And identifying and treating the cause or causes should be the first step.
So, what can cause Baby Reflux?
There are many causes of Baby Reflux. Some are direct causes and others are contributory. Finding the main cause will help direct the treatment options.
- The most common cause of reflux is a Cow’s Milk Protein Allergy (CMPA). It is estimated that up to 40% of babies with moderate to severe reflux disease have a CMPA. Many parents travel quite a way down the treatment road before a primary diagnosis of CMPA is even looked at. In my opinion, the sooner a baby is diagnosed with a CMPA, the better the outcome for baby. Babies who have a CMPA can also be the group who have reflux symptoms for longer, even with treatment for the allergy. Some babies will be diagnosed early as the allergy is obvious. These tend to be the IgE milk allergy babies. However, there are a large number of babies who have a non-IgE milk allergy and this type of allergy can be missed as it is not as obvious and therefore more difficult to diagnose.
- The next most common cause is a tongue tie. This is a condition where a baby swallows too much air with the feed, be they bottle or breast fed, as a result of reduced movement of the tongue preventing baby having a good latch on the breast or bottle teat. All the air in your baby’s tummy can push the feed out and mimic reflux. Until the tongue tie is resolved, the symptoms will continue. Any baby with a suspected tongue tie should see a Tongue Tie Practitioner for a full oral and feeding assessment to determine the impact of the tongue tie on feeding. We also treat these babies physically pre and post tongue tie release to ensure optimum use of the tongue following release. The tongue tie release changes the structure, the physical work changes the function.
- The type of delivery a baby has is so important, as its the length of labour and if an induction was required. If labour is very long or very quick, if baby is in a breech or in a face to the stars position, if a forceps or vacuum was required, or if baby was born by caesarean section, are all reasons why baby may have a musculoskeletal imbalance that may affect their suck, swallow, breathe mechanism or their digestive system. Osteopathy can help these babies by returning them to midline.
- Torticollis can sometimes be a contributory factor of baby reflux. This is a condition where the neck muscles on one side are tighter and therefore shorter than the other side. This results in baby tilting and/or turning their head to one side predominantly. The main causes of Torticollis are:
An instrumental delivery – Forceps or Vacuum
A long labour where the baby is caught in an uncomfortable position for quite a long time.
In these cases, the sternomastoid muscle (the muscle that extends from the jaw to the collarbone and breastbone) is overstretched. But this head tilt can put pressure on some of the nerves that are involved with sucking, swallowing and the digestive system.
- Having a good functioning gut microbiome is essential for health and wellbeing, and that’s particularly true in a new-born infant. However, they are starting from scratch and so, small things can have a big effect on their gut health.
- The type of delivery
- How they are fed
Addressing this gut issue can often lead to a more settled baby who is less distressed by wind.
- Aerophagia is the medical term for swallowing air. It is completely normal and is the reason why we burp babies. However, in a new-born baby who swallows too much air, it can cause a problem because their stomachs are so small that if air is taking up valuable space it will be pushed out as the stomach contracts. This will then cause the regurgitation of stomach contents which over time, leads to reflux symptoms. Baby will also need to move the air they do not burp up through their digestive systems. This too can cause considerable distress for your little one.
- Laryngomalacia is a condition that is present at birth. During development, the supporting structures of the larynx do not develop fully. This results in floppy tissue above the vocal cords encroaching on the airway causing a stridor, or noisy breathing. The stridor associated with laryngomalacia is high pitched and more obvious when baby is breathing in, particularly during feeding and sleeping. Feeding issues are a common in babies with laryngomalacia as they have difficulty coordinating their breathing and feeding.
So as you can see there are many reasons a newborn baby can have reflux symptoms and be digestively upset. Very often there can be more than one cause. But identifying and treating the cause or causes will go a long way towards relieving your baby’s distress. You can then reassess your baby and if necessary, start treatment specifically for any remaining reflux symptoms.
Frank Kelleher, Paediatric Osteopath at Cork Children’s Clinic.
Frank Kelleher is one of the most experienced Paediatric Osteopaths in the country. Over the last 20 years Frank has helped over 15,000 families with some of the most common issues that can challenge babies and children.
Frank provides what every parent is looking for – information and reassurance. From digestive conditions in new-born babies to ear infections, glue ear or constipation in toddlers, he treats the most common issues affecting newborn babies and children and gives parents information to help solve their little one’s distress.
In 2021 Frank started a podcast to provide parents with professional practical information about many different issues including tongue tie, sleep, colic and flat head to name a few. You can find The Happy Baby Podcast wherever you listen to your podcasts.
Frank has also created 2 online courses. Baby Reflux – A New Approach is specifically for parents of a reflux baby. Your Newborn Baby is for new or expectant parents. Both are available to buy on his website.