Reflux in infants — also called gastroesophageal reflux (GER) — refers to the effortless regurgitation or spitting up of milk after feeding. It is a very common and usually normal physiological process, caused by immaturity of the lower esophageal sphincter, the muscular valve between the stomach and esophagus.
Reflux typically peaks around 3–4 months of age and improves as the baby grows, usually resolving by 12–18 months.
When reflux becomes excessive, painful, or leads to feeding difficulties, poor weight gain, or sleep disturbances, it may be classified as gastroesophageal reflux disease (GERD).
Estimates suggest that up to 40–65% of healthy infants experience some degree of reflux in early life, while true GERD affects around 5–10%.
Reflux is not always a sign of illness — in most cases, it reflects a transient developmental stage of the digestive and neuromuscular systems.
Frequent regurgitation or spitting up of milk after feeds.
Irritability, crying, or arching of the back (especially after feeding).
Hiccups, coughing, or apparent throat discomfort.
Disturbed sleep or frequent waking.
In some cases: poor weight gain or refusal to feed.
Red flags: Persistent vomiting with bile or blood, poor growth, dehydration, respiratory distress, or lethargy warrant immediate medical assessment.
Reflux is multifactorial, involving both mechanical and functional components:
Immature lower esophageal sphincter: allowing stomach contents to flow back into the esophagus.
Feeding patterns: large or rapid feeds, swallowing air, or overfeeding may increase reflux episodes.
Postural influences: lying flat after feeding, or tightness in the diaphragm and upper abdomen.
Birth strain and mechanical restrictions: tension around the diaphragm, ribcage, or cervical region can affect breathing and swallowing coordination.
Sensory and autonomic factors: increased visceral sensitivity or dysregulation of vagal tone.
In many infants, these factors overlap with other common early-life conditions such as colic, torticollis, or oral restrictions.
Osteopathic practitioners assess reflux within the context of the baby’s whole-body function, including digestion, breathing, and postural comfort.
An osteopathic assessment may include:
Evaluating the mobility of the diaphragm, ribcage, cervical spine, and cranial base.
Gentle manual techniques to release strain patterns that may influence the esophagus, stomach, and vagus nerve.
Supporting the baby’s ability to feed, settle, and digest comfortably.
Discussion of feeding positions, burping, and post-feeding routines in collaboration with medical and lactation professionals.
The goal of osteopathic care is not to treat or “cure” reflux, but to help restore mechanical and autonomic balance, supporting the baby’s ability to regulate and adapt naturally.
Research into manual and osteopathic approaches for infant reflux is ongoing.
Some studies suggest that gentle manual therapy may help reduce regurgitation frequency, crying duration, and improve feeding comfort, but findings are variable and more high-quality research is needed.
Manual techniques are generally reported as safe when performed by qualified practitioners.
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