“Increased muscle tension…” I see a lot of little patients whose parents have heard this diagnosis regarding their baby. However, some of them do not need to see a physical therapist to begin with; but rather a gastroenterologist, a speech therapist, a neurologist…
Why? Because this supposed “increased muscle tension” may not be the problem at all. It may simply be a defensive reaction to something that the baby cannot cope with. The real “issue” behind the problem could be irritation of the esophagus resulting from the reflux of stomach acid.
LET’S START FROM THE BEGINNING: SPITTING UP
A baby spitting up is not an unusual sight. Indeed, infants “just do it” — and usually continue this until around 6 to 8 months of age. In most cases, it is not the symptom of an abnormality; but rather the result of physical immaturity. The baby’s digestive system is not yet developed enough, and it cannot completely prevent the reflux of gastric contents back up the gastrointestinal tract. It is as if the digestive system is not fully closed, leaving a “gap” for the stomach contents to come up through again.
If your child does NOT experience an unpleasant burning sensation in such case, you could consider it luck (if you’ve ever had heartburn, you know what I’m talking about).
Conversely, if refluxing food content causes discomfort during feeding, the child has the right to react with tension. Don’t you go stiff when you accidentally hit a wall with your bare toe? 😉 Exactly! I think this is a pretty good analogy… 😉
BUT MY BABY DOESN’T SPIT UP!
That is actually a worse scenario! Really! The pH of the esophagus is at 5-6 while the pH of the stomach is at 1-2.
If the acidic content of the stomach travels back so far that it spills completely out, then, apart from the fact that you’ll have much more laundry to do, your child won’t be showing any significant signs of discomfort.
If, on the other hand, the contents reflux only slightly, and, instead of coming out, they REMAIN in the esophagus, it may cause irritation of the mucous membrane, burning, and pain. If that’s the case, should you be surprised that your baby
Great… I was just born, it felt so comfortable and cozy in Mom’s belly. And now what? All this open space around me! I don’t know how to control my body, I don’t know its boundaries… and now this? Something is burning inside me… I don’t know exactly where… but it hurts… I’m not feeling that great, do something about it! Waaaa!!!
Come on, I told you I feel bad!!! It hurts and burns and it doesn’t stop!!!
Ha! Get that… Physiommomy says that the torso should provide stability, right? That I should tighten my tummy, right? Well, I don’t think she has ever felt anything like this! Tell her to toss all of her good advice into the garbage. Whenever I try to tighten my tummy, it hurts even more! But you know what? I want my body to be stable!!! So if I can’t tighten my belly, I’ll tighten my shoulders instead! Smart, huh? Wow! You see? When I tighten them, the pain doesn’t get worse! GENIUS!!!
- STIFFENS THE LEGS AND WON’T LIFT THEM ABOVE THE GROUND?
Ouch, it burns, it hurts!!! Well, I can’t lift up my legs. But they are soooo cool! Mommy kisses my feet all the time! All in all, I’d like to take a closer look at them too. But, no way! I’ve tried lifting my legs before and it started to hurt again. I’m not going to risk it again, thank you very much…
Hmm, it hurts less now, but I’m afraid it will start again. You never know what might happen. So I have to be ready!
Now I’ve had enough! How long will it take? It hurts during the day and it hurts at night! Argh!!! 😕
- WANTS TO BE HELD AND CARRIED ALL THE TIME?
Phew, what a relief.
- AND MANY OTHER REACTIONS…
HOW CAN I TELL IF THE STOMACH CONTENT IS RECEDING? WHAT ABOUT HIDDEN REFLUX?
If you notice that your baby spits up for a prolonged period of time and it flows out, then it is much easier to recognize the problem. If, on the other hand, the food content moves up the esophagus only slightly, you may not associate the symptoms with reflux in the first place.
THE SYMPTOMS THAT SHOULD TURN ON A WARNING LIGHT ARE:
- excessive, prolonged spitting up; or seeing your baby chew on something in his or her mouth even if feeding has not happened recently,
- visible swallowing,
- frequent coughing despite lack of infection,
- burping which continues a few hours after being fed,
- nervousness, irritability, trouble sleeping, or discomfort when lying down; or the baby calms down when taken into your arms or is put into a different, elevated position,
- choking on food even at night — despite being fed much earlier,
- strongly expressed aversion to certain activities that may worsen unpleasant symptoms — like lying on the tummy or playing with the feet, and
- lack of appetite, problems with breastfeeding; or, conversely an excessive appetite to alleviate unpleasant effects.
WHAT CAN BE HELPFUL?
One approach which can bring relief to your toddler is changing positions.
Of course, every child is different — and parents who struggle with this problem have often tested all possible positioning — but the following may be helpful:
- Carry the baby upright for about 30 minutes after feeding, and then place the baby on his or her left side or on the tummy (DON’T LEAVE THE BABY SLEEPING IN THIS POSITION!). Research confirms that there is less reflux when children lie on their tummies or on their left sides.
- It is recommended that infants should be put down to sleep lying on their backs; and on a hard, flat surface (despite the fact that lying on the tummy seems to be the most advantageous). Remember: Due to the risk of Sudden Infant Death Syndrome it is not recommended that one should leave a baby sleeping on his or her tummy.
- Other research suggests that placing a baby on his or her right side speeds up digestion; so it may be useful to try the following regimen: After feeding, hold the baby upright for 30 minutes; then lay the child down for 30-40 minutes on his or her right side (repeat this on the left side); ending with sleep while lying flat on the back.
- Allow the baby to burp not only after, but also during feeding.
REFLUX — WHAT YOU NEED TO KNOW
- Reflux may be caused by abrupt food intake or the “gulping” of air during feeding (like when you start nursing a restless, crying baby who shows symptoms of significant hunger).
- Reflux worsens when the infant eats too much food all at once. Therefore, more frequent, less abundant feedings are recommended.
- If you put your baby down too quickly after feeding, reflux may get worse.
- Breastfed babies spit up milk less frequently than those fed with formula.
- To prevent reflux, you should AVOID using car seats and other equipment which cause the child to lie with his or her neck bent and the chin touching the chest. In a car seat, bent legs also increase pressure inside the abdomen.
TO SUM UP:
Reflux may affect your baby’s development — both its pace and its quality.
This does not mean the situation will go on forever. Most children successfully catch up with their peers as soon as the unpleasant symptoms go away. 😉 The “delay” in development does not result from physical irregularities. It is, rather, a consequence diminished experiences caused by the distressed child’s inability to FREELY explore the surrounding world.
Should we go see a physiotherapist? Yes and no. There is certainly no point in providing physical therapy if the ACTUAL CAUSE of the problem has not been dealt with. If it is irritation, discomfort, and pain, these are the first things to get rid of. Otherwise, even the best therapy won’t bring fully fruitful results.
Of course, there are instances when consulting a physiotherapist can help a lot — like when the baby has developed strong compensating and coping habits.
Such babies will likely not need ongoing therapy. Often, I just draw the parents’ attention to the seemingly small details such as everyday care, carrying, lifting, and playing together. Little changes can bring about a really good effect. 😉
Remember, we’re dealing with CAUSES first! “Treating” symptoms, even if necessary, will be a lot easier then. 😉
Certainly, when your child faces such difficulties it is always best to stay calm and composed. I know it can be really hard — especially when you constantly hear questions such as: Your little one is not sitting yet? Why isn’t your baby rolling over by now?
In such cases you might find it helpful to answer the following question: “Does the time when one starts walking significantly determine a person’s life later on? Do we ask professional athletes: “Hey, how old were you when you took your first steps?” 😉 I don’t think so. 😉 Let’s stick to that. 😉
By the way, I am very curious about your experiences. Please share what you found helpful in this post!
You may also be interested in:
After dealing with problems like reflux, you and your baby deserve some fun time together! Check out my e-book on Fun Playtime ideas to develop an easy and meaningful play routine with your child.
Sources:
Tolia V, Calhoun J, Kuhns L, et al. Randomized, prospective double-blind trial of metoclopramide and placebo for gastroesophageal reflux in infants. J Pediatr. 1989;115(1):141–5
Bellissant E, Duhamel JF, Guillot M, et al. The triangular test to assess the efficacy of metoclopramide in gastroesophageal reflux. Clin Pharmacol Ther. 1997;61(3):377–84.
Lau Moon Lin M, Robinson PD, Flank J, et al. The Safety of Metoclopramide in Children: A Systematic Review and Meta-Analysis. Drug Saf. 2016;39(7):675–87.
Rocha CM, Barbosa MM. QT interval prolongation associated with the oral use of domperidone in an infant. Pediatr Cardiol. 2005;26(5):720–3
Ngoenmak T, Treepongkaruna S, Buddharaksa Y, et al. Effects of Domperidone on QT Interval in Children with Gastroesophageal Reflux Disease. Pediatr Neonatol.
Cohen RC, O’Loughlin EV, Davidson GP, et al. Cisapride in the control of symptoms in infants with gastroesophageal reflux: A randomized, double-blind, placebo-controlled trial. J Pediatr. 1999;134(3):287–92.
Corvaglia L, Ferlini M, Rotatori R, et al. Starch thickening of human milk is ineffective in reducing the gastroesophageal reflux in preterm infants: a crossover study using intraluminal impedance. J Pediatr. 2006;148(2):265–8
