Gastro-oesophageal reflux refers to involuntary passage of gastric contents into the oesophagus. It is one of the most common causes of gastrointestinal symptoms among infants. At birth, neuromuscular activity and lower oesophageal sphincter peristalsis are underdeveloped resulting in frequent retrograde spilling of gastric contents. Several factors such as liquid milk-based diet, position of baby lying down, immaturity of gastro-oesophageal junction, shorter distance and lack of angle between top of stomach (gastric fundus) and oesophagus can exacerbate reflux. As infants are unable to verbalize their symptoms, sign of irritability together with back arching is thought to indicate a gastrointestinal discomfort. Other conditions with a similar presentation are; cow’s milk protein allergy, constipation and infection.
The physiological immaturity of gastro oesophageal junction is often temporarily and improves without any medical intervention. It’s been found that over medicalisation and attempted treatment without clinical benefits could lead to adverse consequence. It is clear that caring for new born with reflux can be very tiring especially when there is lack of guidance, hence it is essential to reassure and support parents through that time and offer some tools that help manage their baby’s condition.
Preterm infants have higher risk of reflux due to immaturity of the lower oesophageal sphincter and presence of indwelling gastric tube which increases reflux frequency. In that case medical opinion should be sought after if there is a presence of respiratory symptoms, weight loss, inadequate weight gain, failure to thrive.
There is some evidence for the use of feed thickeners on reducing regurgitation, but FDA currently discourages the use in infants born before 37 weeks of gestation. A rough guide is to add one tablespoon of cereal to every ounce of formula or breast milk.
The first line of reflux treatment involves holding baby in upright position for 20-30mins after feed and frequent winding. Second line of management involves putting baby on cow’s milk protein free diet for 2-4 weeks. It can be achieved either by using hydrolysed formula or exclusion of milk from maternal diet and potentially allergenic substances (e.g., Nuts, eggs, chocolate). If this fail osteopathy is of benefit in the condition’s management.
From an osteopathic perspective, torsion within the ribcage can create tension in the central tendon of diaphragm affecting gastro-oesophageal junction contributing to indigestion. By using some of the osteopathic techniques we aim to mobilise the neck to free up trapped/irritated nerve, thoracic spine, ribs and easing diaphragm tension. Other techniques include mobilising of the stomach and gently entice stomach downwards to stretch its ligamentous attachment to diaphragm and spleen allowing more freedom of movement.
An Osteopath also focuses on several other factors and treat accordingly. One hypothesis focuses around the role of Vagus nerve/Cranial nerve 10 as well as phrenic nerve, which supplies diaphragm. Gut is connected to brain via vagus nerve which regulates the digestive system and control lower oesophageal sphincter tone. If there is a birth strain creating head and upper neck tension it can cause compression on the vagus and phrenic nerve. Furthermore, thoracic spine, diaphragm and intestinal tension as well as irritation can result from caesarean birth, as infant don’t have the advantage of ‘elastic recoil’ following a vaginal delivery to unlock “cranial bones”.
Osteopathic work focuses on a gentle ease of any strain patterns within cranial bones, tissues around neck, thoracic spine, ribcage, diaphragm and abdomen to help with any compression or torsion resulting from birth.