From birth until the age of about 6 months, infants can regurgitate small amounts of milk. Between 5 ml and 10 ml can come out during a feeding, when burping or after being breastfed or bottle-fed. Doctors consider these regurgitations as normal. Over 40% of babies suffer from regurgitations that do not affect their growth and their general state. Mild and occasional vomiting is often seen in babies who spit up daily.
The causes of regurgitations and mild vomiting are many
- Vigorous suction and swallowing when drinking;
- The baby is breastfed too often in between the feedings or drinks for too long during the feeding.
- Too much milk is available in the bottle, beyond the baby’s needs.
- Constant and powerful ejection reflex during breastfeeding;
- Immaturity of the oesophagus sphincter;
- Premature birth and low muscle tone (hypotonia);
- No or only few periods during which the baby is placed on his belly.
Despite the concerns of parents, if the baby is growing normally and does not cry or suffer from discomfort there is no need to see a doctor.
However, it is important to keep an eye on a baby who vomits a lot of milk, every time he drinks, for several days. Some clinics allow you to weigh your baby for free.
Projectile vomiting manifests itself through a violent expulsion of the content of the stomach. A large amount of milk could be projected away from the baby. Repeated projectile vomiting coupled with insufficient growth often indicates a serious condition. The liquid loss caused by the vomiting can result in dehydration. When the baby vomits blood, if he has fever and if his general condition deteriorates, it becomes an emergency and requires consulting a doctor.
Projectile vomiting can be linked to various diseases and pathological conditions such as:
- Pyloric stenosis or intestinal obstruction
- Acute gastroenteritis
- A pathology of the central nervous system
- A tumour
Gastroesophageal reflux disease (GERD)
The gastroesophageal reflux is the rise of the milk contained in the stomach into the oesophagus. Milk can remain in the oesophagus or come out as mild regurgitation or vomiting. Regurgitation considered normal happen during or shortly after drinking. Gastroesophageal reflux disease (GERD) appears most of the time between feedings. It causes medium to severe discomfort and more or less intense crying. The reflux of acid from the stomach into the oesophagus predisposes to irritation (esophagitis) and is responsible for crying and discomfort
Immaturity or abnormal functions of the oesophagus sphincter (LES) is the most frequent cause cited in GERD. Furthermore, a baby lying on the back is more vulnerable because it promotes the rising of milk. Since the ‘”Back to sleep” campaign developed by the Canadian Paediatric Society in 1991, to prevent sudden death syndrome, babies spend most on their time on their back and not enough on their belly when they are awake.
To reduce GERD and before seeking medical advice, some recommendations should be considered:
- Avoid overfeeding your baby. While feeding, burp your baby several times by placing your baby on your shoulder;
- Hold your baby in a vertical position for a few minutes after feeding;
- When your baby is awake before the feedings, place him on his tummy for a few minutes;
- Raise your baby during his sleep by placing a pillow under the mattress on top of the bed.
Paediatricians use medication for persistent or severe cases of GERD. Zantax and Prevacid are prescribed to reduce GERD. Some babies will be relieved of their discomfort and stop crying with this medication. However, despite the use of medication for several weeks, for many babies, parents and physicians observe very little changes in their health conditions. The general recommendation is to wait for the reflux to disappear progressively when parents will introduce solid foods or around their first birthday.
The approach of osteopathic treatments
To explain the causes of regurgitation, vomiting and reflux disease (GERD), it is useful to understand the development of the digestive system during the foetal period. Knowing about the baby’s anatomy facilitates the understanding of the assessment and treatment in osteopathy.
During the formation of the digestive system, several organs of the foetus such as the oesophagus, stomach, intestines and liver undergo rotations before taking their final places in the body. Nerves, blood vessels, support structures, ligaments and fascia will undergo the same displacements as they are around organs. The valgus nerve is the main plexus nerve that allows the operations and movement of sphincters and peristalsis organs. It connects to each of the organs of the digestive system. During the rotational movements of the latter, constraints can cause pressure on the nerve and cause imbalances.
The valgus nerve has another very important path, which is located at the base of the skull and in the neck of the baby. At the time of delivery, obstetric manipulations may have caused tension on that nerve. The chest, lungs, diaphragm may have been under stress and cause tension locally or on the organs of the digestive system.
Evaluation and osteopathic treatment
Just as traditional medicine, the osteopath specializing in paediatrics has clinical experience and skills to act with the baby. The osteopath may be exposed to complex health problems that require knowledge of several aspects of infant development.
My clinical experience as a specialized osteopath brings me to understand the specific health condition of the baby during the meeting with the parents.
I ask about the periods of sleep, awakening, feeding, and the moments of discomfort and crying associated with problems for which they consult me, referred by their doctor or nurse. The information gathered as well as the overall assessment of the baby will allow me to apply the best treatment and to provide parents with appropriate advice specific to their child. In addition, my experience in relation to breastfeeding or bottle-feeding will be very useful for problems of regurgitation, vomiting and reflux.
During the evaluation, the osteopath is examining the baby's body to identify areas of stress, tension and blockage. During the treatment, the osteopath uses appropriate manipulations that do not constrain the baby. In many cases, these manipulations are enough to bring him some relief. During treatment, all body parts that presented tensions such as nerves, ligaments, fascia, organs and musculoskeletal structures are treated.
After the treatment, I think it is important to teach exercises to parents and give them tips on how to place their baby.
Exercises are simple and easy and contribute to reduce your baby’s health problems faster and reduce the number of consultations.
These exercises also improve the general development of the baby and promote better sleep dynamics. In general, 2 to 3 treatments (of one hour each) are enough to address problems of regurgitations, vomiting and reflux (GERD).