Reflux, also described as "heartburn", is when stomach contents leaks back up the oesophagus (food pipe). Young babies are particularly susceptible to this, although it is distinct from just "spitting up". It can cause discomfort in patients of all ages, and can be difficult to diagnose when stomach contents does not reach the mouth.
Anatomy of Reflux
Stomach contents is kept within the stomach by a sphincter. Adults might find that when they drink a lot of fluids and not so many solids, such as having meal replacement shakes, their reflux is worse. Liquids can travel more readily back through the sphincter. This is one reason why infant reflux tends to improve as solids are introduced, or thicker formula is prescribed. Babies also spend a lot of time laying down, meaning gravity is not working in their favour. Supported sitting, especially after a feed, can help to reduce episodes of reflux.
In addition to the sphincter, the diaphragm helps to form the "anti-reflux barrier". The diaphragm is a muscle that runs like a parachute along the bottom of the rib cage. It has holes within itself to allow vessels to pass through, and it is through the largest hole that the oesophagus passes through. When the diaphragm is working well, it helps to seal the top of the stomach. Adult or infant issues with the diaphragm can play a role in reflux symptoms.
Silent Reflux in Babies
As mentioned above, diagnosis can be delayed when symptoms are less clear. In silent reflux, the stomach contents begins to travel back up the oesophagus, but is not expelled from the mouth. This still causes the discomfort of acid burning the food pipe, but does not give away the main clue you might be looking for. However, some symptoms can point clearly to reflux.
One common reaction to the discomfort is for a baby to arch their back (pictured above). Coupled with crying, this might be difficult to spot, but you might find that when you're looking for it, it becomes more obvious. Discomfort may be lessened by holding baby in an upright position, either sitting or otherwise.
Osteopaths are qualified to help with some digestive issues. For both adults and infants, an osteopath may first look at the function of the diaphragm. If it is tight, direct techniques and stretches might help to improve function.
There are also things you can do as a parent to help reduce your baby's symptoms. Feeding in a more upright position might help, but keeping baby upright after feeding allows time for the meal to move down. You may also benefit from speaking to your GP or health visitor. GPs can prescribe medication to help manage symptoms, although this may cause some constipation. These professionals can help to monitor baby's weight to ensure that they aren't losing too much food to their reflux. They may also recommend changes to the milk your baby is consuming, or they might want to do further testing in case there is an underlying food intolerance.