Reflux in Babies: How Osteopathy Can Provide Relief and Improve Digestion

Does your baby:

• Bring up milk?

• Vomit shortly after feeding and/or a few hours after?

• Cough or choke during feeding?

• Get frequent hiccups?

• Become irritable during or after feeding?

• Refuse to drink milk?

• Gain weight very slowly or not gain enough weight?

• Cry and/or not settle down while feeding?

• Make a face like they do not like the taste in their mouth?

• Have a white coating at the back of their tongue?

If you answered yes to any of these questions, your baby might be experiencing reflux.

What exactly is reflux?

Reflux is a common condition in infants where the stomach contents flow back into the esophagus (the tubular organ of the digestive system that connects the throat and stomach).
Reflux happens when the lower esophageal sphincter, the muscle between the esophagus and the stomach, is not fully developed in babies. As a result, food and digestive acids can easily come back up, causing discomfort and symptoms such as those mentioned above.

“Reflux is very common. It affects nearly half (at least 4 out of 10) of babies younger than 1 year.”

— NICE, 2019

Several factors can contribute to reflux in infants, however, the most common causes of reflux in babies are:

1. Immature Digestive System

2. Overfeeding

3. Tongue-tie

4. Positioning

5. Allergies or Intolerances

Despite reflux being very common and mostly not a serious condition, it can still be unpleasant. Therefore, it is important to treat it as soon as we notice its symptoms to minimise discomfort and prevent the development of more severe and long-lasting conditions, such as Gastroesophageal reflux disease (GERD) or a baby`s failure to thrive.

Conventional Treatments for Reflux:
Quite often, a GP or pediatrician may want to prescribe medication that reduces your baby's stomach acid production, such as Omeprazole or Gaviscon. This type of treatment is mainly offered to breastfed babies. However, as I have observed in my practice, it often results in constipation, causing additional discomfort for the baby. Consequently, parents often discontinue the medication shortly after starting it.

Another reason for the limited effectiveness of medication is that babies may regurgitate milk containing the medication, preventing it from working properly in the stomach.
For bottle-fed babies receiving formula or expressed milk, thickening powders may be offered to help the feed stay in the stomach.

I want to clarify that I am not against using medication when necessary. However, medications used to treat reflux in babies and adults, such as Proton Pump Inhibitors (PPIs) and H2 Receptor Antagonists (H2RAs), have been found to be harmful if taken long-term.
The Royal Children's Hospital in Melbourne stated in their "Managing Infants with Reflux" guidelines:

"The use of PPIs and H2RAs to manage infants with reflux has increased. These medications have been shown to have no benefit in improving symptoms in infant reflux. In contrast, studies have shown that PPIs and H2RAs can cause harm, including:

- 3.6 times more likely to develop acute inflammation of the stomach and intestines (gastroenteritis)

- 6.4 times more likely to develop community-acquired pneumonia

- 1.6 times more likely to have a fracture (with a higher dose, starting earlier (under 6 months old), and a longer duration all individually linked to increased fracture risk)

- 5.24 times more likely to contract Clostridium difficile infection in the colon

- Vitamin B12 deficiency, low magnesium levels, and high stomach acid production after stopping the medication.

Therefore, the prescription of PPIs and H2RAs is only indicated in infants with GERD, which only a small percentage of infants have."

How Can Osteopathy Help with Reflux?

With reflux being a very common complaint among parents, I encounter babies affected by it in my practice every day. However, reflux is rarely my final diagnosis, as it often serves as a symptom of other underlying issues. It is therefore crucial to identify the root cause of all your baby’s symptoms and rule out any red flags.

As an osteopath, I treat the body as a whole, looking for specific relationships unique to each baby. When treating reflux, you may see me working around your baby's diaphragm, as this is where we are most likely to observe the main physiological dysfunction that leads to reflux. This is due to the unique anatomical configuration at the point where your esophagus joins your stomach - the gastroesophageal junction (GEJ). Here, the diaphragmatic sphincter (DS) and lower esophageal sphincter (LES) work together to create "the antireflux barriers" in our body (to better visualise this, please refer to the picture above).
You can read a detailed explanation here, but to explain this mechanism simply the DS and LES must continuously work together to maintain the correct pressure between the stomach and esophagus, reducing the likelihood of a backflow of stomach content (reflux). However, this relationship can be easily disrupted by the diaphragm's proximity to the LES. The diaphragm, like other skeletal muscles in our body, can tense up, which can cause a disturbance to it’s regular movement between the abdomen and chest cavities. For example in babies, frequent hiccups (which is an involuntary spasm of the Diaphragm) can further complicate maintaining the pressure at the GEJ, leading to reflux.

Using visceral osteopathic techniques and diaphragm release techniques can help ease some of this tension in patients suffering from digestive disorders. Combining these with individually tailored guidance for your baby, including feeding adjustments, burping techniques, proper positioning, and exercises yields the best results in treating baby patients in my practice.

If you have any questions, please do not hesitate to contact me.

References:

• About this information: Information for the public: Gastro-oesophageal reflux disease in children and young people: Diagnosis and management: Guidance (no date) NICE. Available at: https://www.nice.org.uk/guidance/ng1/ifp/chapter/About-this-information (Accessed: 25 June 2024).

• Carreiro, J.E. (2009) An osteopathic approach to children: The perfect companion to pediatric manual medicine by carreiro. Edinburgh Scotland: Churchill Livingstone.

• da Silva FC;Vieira LS;Santos LV;Gaudreault N;Cruvinel-Júnior RH;Santos GM; (2023) Effectiveness of visceral fascial therapy targeting visceral dysfunctions outcome: Systematic review of Randomized Controlled Trials, BMC complementary medicine and therapies. Available at: https://pubmed.ncbi.nlm.nih.gov/37525195/ (Accessed: 25 June 2024).

• Eguaras, N. et al. (2019) Effects of osteopathic visceral treatment in patients with gastroesophageal reflux: A randomized controlled trial, Journal of clinical medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832476/#B23-jcm-08-01738 (Accessed: 25 June 2024).

• GP Information Managing infants with reflux (no date) The Royal Children`s Hospital in Melbourne . Available at: https://www.rch.org.au/uploadedFiles/Main/Content/hsru/Clinician_Information%20for%20GPs_Public.pdf (Accessed: 25 June 2024).

• Mittal, R.K. and Goyal, R.K. (2006) Sphincter mechanisms at the lower end of the esophagus, Nature News. Available at: https://www.nature.com/gimo/contents/pt1/full/gimo14.html (Accessed: 25 June 2024).

• NHS choices. Available at: https://www.nhs.uk/conditions/reflux-in-babies/ (Accessed: 25 June 2024).

• (Picture) The Functional Gut Health Clinic by Bella Lindemann. Available at: https://bellalindemann.com/blog/causes-of-acid-reflux-natural-treatment.

• The diaphragm (no date) TeachMeAnatomy. Available at: https://teachmeanatomy.info/thorax/muscles/diaphragm/ (Accessed: 25 June 2024).