The Great Debate of Normalizing Reflux

Guest post written by Mallory Millet, SLP

“Your baby is gaining weight. You simply have a laundry problem. All babies reflux. Babies have a weak esophagus.”

Reflux by definition is the regurgitation of contents from the esophagus. The esophageal sphincters’ function is to open for allowance of contents into the stomach and keep it there. For safety, they will open to rid the body of anything problematic (sickness, poison). Important here to note: spitting up is reflux. It’s all regurgitation. 

Do all babies reflux? No, they don’t. This completely negates the weak sphincter idea. If that were the case, every single baby would do it and every baby who is low tone would have a much bigger problem with it. This is not the case. And when fed correctly, babies can stop refluxing. Do most babies reflux at some point in their life? Yes. 

Reflux occurs for three reasons:

  • overfeeding/ pressure

  • air

  • allergy/ intolerance.

Most babies will experience an overfeeding or pressure on their belly in just the right spot after a feed. They may reflux or “spit- up.” But this would be an anomaly, not the norm. For these babies, don’t force that last bit in the bottle and watch how you burp. 

When babies take in air during a feed, it is called aerophagia- the swallowing of air. This air mixed with liquid in the stomach leads to reflux. The more dysfunctional or uncoordinated the feeding process, the more air intake which leads to more reflux. Signs of this during the feed include: clicking, turning head side to side, popping on and off, milk dribbling, arching back, frustration, clenched fists. These babies are having difficulty with latch, tension in the mouth and/ or in the body. Adjusting latch, position and doing oral play with them will make a big difference. 

For babies who are struggling with allergies/ intolerances, more individualized work needs to be done. Additional signs to look for are dark green/ black poops and/ or eczema. To add to the complexity of these babies, their disrupted GI system can lead to body tension. Where they may have been born without oral dysfunction, they will often develop some form of it as the reflux continues. Common recommendations include eliminating dairy. However, most babies will struggle with digesting gluten and carbohydrates over dairy and soy for breastfeeding babies, and the increased corn product ratio found in hydrolyzed formulas for formula fed babies. 

Now, let’s talk about the most common recommendations: medication and thickening. Both of these options are bandaids to what is really going on. 

Medication does not stop reflux from happening. It decreases any pain associated from the reflux. And like the thickening agents, babies often turn into silent refluxers. Silent reflux is when the symptoms are all there but nothing is coming up through the mouth or nose. The reflux travels up and stops at the esophagus, then baby swallows it back down. It’s the same amount of internal trauma and the underlying cause: dysfunction or allergy, is still not corrected. Medications have not been tested on infants and if tried, the medication label themselves state that it should not be given for more than 6 weeks. This is to allow time to figure out the root cause and have a pain reliever for baby if they need it. Medications also greatly change the GI system and its intended functions.

Thickening adds weight to the feed. So, essentially, it makes what baby needs to reflux up too heavy to do. You may find mucous in the poop, constipation, eczema, but no “reflux”. This is when the snowball effect takes place because then to aid in those side effects something else will be given. If thickening with oatmeal or rice cereals, we are now changing the gut microbiome. If a baby is not mature enough to put the food in their mouth themselves, chew and swallow, then it shouldn’t be going into their immature digestive system. Additionally, with this recommendation often comes the recommendation to stop breastfeeding and if bottle feeding, increase the flow rate or make a bigger hole in the bottle nipple. This is now changing the oral mechanism function. It can lead to oral dysfunction and tension. 

You can see how it can become very intertwined. It’s similar to a person who gets migraines. The doctor gives them something for the migraines which makes them extremely anxious. The doctor puts them on an anti-depressant. Then they begin to get acne, so the dermatologist puts them on a steroid. The steroid makes them angry and gain weight---- you can see where this is going. When originally, they were getting a migraine because they had low iron. Which was never addressed. 

On the flip side, you did all those things and feeding is going good. You don’t want to change anything. You are happy with where you are. I want you to watch for: open mouth breathing, trouble with moving to solid foods (motor or digestion related), congestion, sleep difficulty, eczema worsening. These can be related to what the original problem may have been: dysfunction and allergies. 

Important Takeaways: ounces from feed to feed should vary anywhere from 2 to .25 ounce difference. For burping, pat/ wiggle at the hips and rub hand upward on their back; don’t pat at the back.  Oral play is so important and can serve as a great tool. Learn pacing and positioning to optimize their control/ regulation. Seek individualized assessment from a specialist if struggling. Most pediatricians are not feeding specialists. 

Disclaimer: this is not medical advice. This article serves as an educational resource only. The ingredients in formulas are not inherently bad; the author is simply acknowledging that some babies will have a harder time digesting them.

Services

https://the-feeding-mom.passion.io 

Say AHH- Oral Play guide

Let’s Pop a Bottle- everything bottle feeding; new parent resource

Pre-recorded Consult: Troubleshooting- immediate solutions for feeding difficulties. 

https://www.thefeedingmom.com/book-online

Scheduling for virtual support and in-person sessions available to those living in Southeast  Louisiana area. 

Free content on all things infant feeding, oral development and craniosacral therapy on Instagram @infant.feeding.specialist 

Mallory Millet is a Speech Pathologist who specializes in pediatric feeding disorders. Her focuses include infant reflux, infant oral development and craniosacral therapy. Through her professional work, and with the lack of support during her own babies’ feeding journeys, she created, The Feeding Mom. It is here that she provides in- person and virtual support to empower parents through their feeding journeys locally and around the world. Her philosophy is: every parent deserves to love feeding their baby.  

She is a mom of three under the age of 5. She currently lives in Prairieville, Louisiana. 

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