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Infant Reflux: The Need for a Team Approach

As a pediatric feeding therapist, I often receive referrals not to not to address gastroesophageal reflux symptoms but to address the feeding difficulties and limited intake that is occurring due to current or past reflux issues. Having an infant with reflux is exhausting, stressful, and concerning for parents. It is hard to watch their baby cry out in pain, not want to feed, and struggle with discomfort from what is supposed to be a bonding and nourishing experience. The first stop on the reflux journey is the pediatrician. The pediatrician should be consulted with when it comes to struggles with limited intake, discomfort, and limited growth when it comes to your infant. They will recommend potential diet changes for mom, perhaps a gentler formula, and will determine if the reflux case is severe enough to require medication. Please know, that even if the baby is growing and gaining weight, feeding issues can still be present. There are many underlying reasons as to why these symptoms of reflux may be occurring! This is where the team approach comes in.

infant reflux

Some potential contributors to reflux in infants: 

·        Tethered Oral Tissue (tongue, lip, or buccal ties)

·        Flow rate of bottle nipple or breastmilk

·        Vertebral Misalignment

·        Poor oral coordination and/or strength

·        Intolerance or food allergy

·        Fascial Strain (potential tension in fascia post-birth)

·        Positioning during and after feedings

What prolonged reflux infant can lead to:

·        Compensatory bolus manipulation leading to poor oral coordination/strength.

·        Oral and feeding aversion.

·        Poor weight gain/Limited Intake

·        Increased muscle tension and stress on the body

·        Continued GI issues

·        Difficulty transitioning to age-appropriate foods.

·        Heightened senses with various tastes, textures, and foods

As you can see, reflux goes beyond the pediatrician’s office. Professionals you may want to consult with may include a pediatric feeding specialist (SLP or OT), pediatric chiropractor, pediatric craniosacral therapist, and a lactation consultant. While switching formulas or changing mom’s diet may help feedings in the moment, it is important to dig deeper with a specialist to assure that there are not any further contributing factors that will affect feedings and the transition to new foods in the future. You have heard how crucial early intervention is for child development and I can assure you it is no different for feeding!

infant feeding

As a pediatric feeding therapist, I am going to explain what I typically see in referrals I receive with a history of reflux (even those that have been given medication). Most of the time, I receive referrals for feeding therapy when the child is not transitioning to solid foods. The child may gag on puree or refuse the spoon. The child may not know what to do with the food once it is in the mouth. The child may be averse to anything coming towards their mouth. All these reasons may be due to the underlying issue of reflux not being fully addressed from the onset of symptoms. When intervention begins at the onset of symptoms, the therapist can provide interventions and strategies to the family to ensure the transition to solid food is appropriately introduced. The therapist will also address any aversions and oral motor concerns. Not to mention, if a feeding therapist is consulted at the onset of reflux symptoms, helpful strategies for oral work and feeding interventions can create less stress for the parents and infant during bottle/breast feedings. It’s okay to ask for consistent and specialized support when it comes to feeding your child!

What can you expect when you meet with your pediatric feeding therapist? First and foremost, you will have briefly discussed your concerns over the phone or email. This allows for the therapist to prepare for the initial evaluation. During the initial evaluation, the pediatric feeding therapist will perform an oral motor exam. The depth of the assessment will be determined by the response towards stimulation and interventions. The feeding therapist will want to observe you feeding the infant. During this they are observing as assisting with positioning and posture, suck-swallow-breathe patterns, flow rate, observing potential issues with latch, and monitoring endurance. While discussing what was observed, the therapist will also be taking note of post-feeding positioning, behaviors, and body language from the infant. You can expect that strategies will be provided at the end of the assessment and the therapist will or will not recommend follow-up sessions based on the assessment.

Addressing feeding issues with a specialist allows you to feel supported outside of your physician’s office. It allows you to ask questions as you face challenges or simply need guidance regarding your next step in your infant’s feeding development. Specialists often work with each other so if a referral needs to be made to another discipline, you have a set of professional eyes providing you with resources to continue ensuring appropriate development for your little one.

If you have any questions regarding your child’s feeding, do not hesitate to set up a phone consultation with a local feeding therapist. We are here to help and get you and your little one headed in the right direction!

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