From birth until about 6 months of age, infants may regurgitate a small amount of milk. Between 5 and 10 ml of milk can flow during feeding, when roasting or after breastfeeding or bottle feeding.
These regurgitations are considered normal by doctors and more than 40% of babies will have these symptoms without affecting their growth and general condition. Mild vomiting and are often seen in babies who regurgitate daily.
There are many causes of mild regurgitation and vomiting:
- vigorous and rapid sucking and swallowing at the breast or bottle
- a powerful and constant milk ejection reflex at the breast during feeding
- esophageal sphincter immaturity
- the baby (taking into account his age) breastfed too often between feedings or too long during feeding.
- Too much milk offered in the bottle and beyond baby's needs.
Despite the perfectly normal concerns of parents, in the casewhere regurgitation does not interfere with growth and the baby does not suffer from significant discomfort or persistent crying doctors judge that there is no need to consult for medication.
However, it is important to pay attention to infants who, at each feed, regurgitate large quantities of milk over several days. It is then advisable to weigh the baby to monitor its growth and to consult in case of doubt. Some CLSCs provide self-service baby scales for parents.
Jet vomiting is the forceful release of stomach contents. A large amount of milk can be squirted very far in front of baby. Repeated projectile vomiting coupled with poor growth often indicates a serious condition. The fluid loss caused by persistent vomiting can cause baby to become dehydrated. When the vomiting contains blood, if the fever is present and the baby's general condition deteriorates, it becomes an emergency and requires consultation with a doctor. Persistent projectile vomiting can be caused by various obstructive or pathological diseases such as;
- Pyloric stenosis or bowel obstruction
- Gastroenteritis, food allergy or medication
Gastroesophageal reflux disease (GERD)
Reflux is the rising of the milk contained in the stomach towardsthe esophagus. The milk present in the esophagus may possibly be swallowed or come out in the form of mild regurgitation. These regurgitations, which are considered normal, occur during drinking or a little after and do not cause discomfort. Gastroesophageal reflux disease (GERD) occurs most of the time between feedings. It is accompanied by moderate to severe discomfort. Backflow of acidic stomach contents predisposes to irritation of the esophagus (esophagitis) and is often the cause of significant infant crying.
Esophageal sphincter immaturity or abnormal functioning are the most frequently cited causes of GERD. In addition, the position on the baby's back tends to aggravate reflux because it facilitates the return of milk from the stomach to the esophagus.
Since the "Sleep on your back" campaign to prevent sudden infant death syndrome (SIDS) we observe that the majority of babies during periods of wakefulness spend a lot of time on back and not enough on the stomach, this situation can be a predisposing factor to GERD.
In order to reduce GERD and before consulting for treatment with medication, certain recommendations must be considered;
- Avoid overfeeding baby
- When feeding, pause several times, placing baby vertically against the parent's shoulder
- Hold baby upright for a few minutes after feeding
- When awake place baby on his stomach for a fewminutes
- Raising baby during sleep by placing a pillow under the mattress at the head of the bed
Pediatric medicine uses medication for persistent or severe cases of GERD. Some babies will gradually get relief from their symptoms and crying after taking the medicine. However, for a good number of babies little change is observed by the parents. Following this observation, the recommendation of doctors in general is to stop taking medication and wait for the reflux to gradually disappear on its own when introducing solid foods or towards age one year.
In order to be able to explain the causes of regurgitation, vomiting and GERD it is useful to look at the development of the digestive system during the fetal period. A knowledge of the anatomy of the baby's body also facilitates assessment and treatment in osteopathy.
During the formation of the digestive system the organs of the fetus such as; the esophagus, stomach, intestines and liver undergo several rotations before taking their final places in the baby's body. The nerves, the blood vessels and the supporting structures will undergo the same displacements since they are close to the viscera. The vagus nerve is the main nerve plexus that allows the functioning of the sphincters and the peristalsis of the organs. During the rotational movements of the organs of the constraints can havecaused tension on the path of the nerve and cause imbalances in its functioning. The osteopath who specializes in pediatrics must have clinical experience and in-depth knowledge to act competently with infants. During the assessment, the osteopath pays particular attention to examining the baby's body to identify areas of stress and tension. During the treatment, he carries out delicate manipulations which in many cases will already bring some relief to the baby.
“My long clinical experience as an osteopath specializing in babies has led me to always take the time, when meeting with parents, to fully understand the he alth condition that is particular to their child”.
“I elaborate with them on the dynamics of periods of sleep and wakefulness and drinking, on the moments of discomfort and crying related to the problems for which they consult me. The information thus collected as well as the overall assessment of the baby will allow me to apply the best treatment and provide parents with appropriate and specific advice for their child. In addition, my breastfeeding and bottle-feeding skills are very useful in understanding and solving the problems of regurgitation, vomiting and GERD”.
“Following the treatment, I believe it is essential to educate the parents by providing them with recommendations and indicating exercises for positioning the baby during his waking periods. These exercises are simple and easy and help to promote the rapid reduction of baby's he alth problems while reducing the number of visits required in osteopathy. In general 2 to 3 treatments are necessary to treat the problems of regurgitation, vomiting and GERD”.