#001 What is Reflux

Last updated on May 18, 2021

Baby Sam was hungry, but at a few weeks of age, he started to reject both the breast and the bottle. He would appear irritable, and his mother thought he was hungry because it had been a while since he last fed.  She would hold Sam in her arms and introduce him to either formula or breast milk.  Sam would put the nipple in his mouth, suck for a short period of time, arch his back,  turn away, and scream.   After a period of time, he would return to the nipple, suck for a short period of time, and scream again.  Feeding took forever because this is how the feeding behavior looked.

In the meantime, Sam's mother became increasingly upset.  She did not know why baby Sam was rejecting food.  She took Sam to see either the pediatrician or the family medicine physician as either of them can see children.  His mother became increasingly upset because Sam seemed to refuse to feed.

Sam's doctor thought that perhaps his symptoms were that of silent reflux.  He prescribed an acid suppressing medication.  Guess what happened?  Although in many cases I am sure that these acid suppressive medication could have at least some benefit, his symptoms did not seem to get any better. You see, acid reflux seems to be a common diagnosis these days.  However, when given acid suppressing medication, some children's feeding does not get better.  Why is that?  

This conversation will span two different episodes.  (See the end of this post for a link to the second episode.)   In addition, this podcast is part of my new free training on histamine blockers.  I will link to it here.  The free training will tell you a whole lot more than this episode can, and I highly recommend that you take it.  

Our questions about reflux are as follows.  First, what is reflux?  Second, why do we often say that children with vomiting, feeding challenges, or a lot of crying have reflux?  I am going to spend the rest of this post discussing what reflux is, and then the next episode will be about its role in these symptoms. (The link to the next post will be at the end of this article.) 

It's often said that many young children develop reflux, but reflux - in and of itself - is overly diagnosed.  Most babies and some toddlers have reflux.  Then why it is that when young children have feeding challenges, vomiting, or excessive crying, the culprit is often thought to be reflux?  It almost seems as if we are medicalizing normalcy.  Today I wanted to discuss what reflux is. 

If you look up the definition of reflux in the dictionary, you might come across the following definition:  Reflux is the flow of fluid through a tube in the opposite direction to how it is meant to go.   There is a physical reason why backwards flow can happen in babies.  

You can think of the digestive tract as one hollow tube filled with muscles.  The stomach is an enlarged portion of that hollow tube, and the stomach has a ton of muscles.  When we eat, food goes into the mouth, down another portion of this digestive tube, through a ring of muscles, and into the stomach.  For many older children and adults, the ring of muscles keeps this upper portion of the digestive tube separate from the stomach.  (One upper portion of the digestive tract is called an esophagus.)  

The stomach has strong muscles.  These muscles do what many muscles do; they contract and relax.   The stomach also produces acid.  Thanks to the action of this ring of muscle, this acid does not often wind up in the tube connecting the mouth to the stomach (i.e, in the esophagus).  If the ring of muscle cannot quite do its job, however, then as stomach muscles contract and relax, acidic stomach juice may get into this tube.   

Think of the stomach like a stomp rocket.  I'm going to tell you how to make a quick one.  Take an aluminum juice pouch; part of the packaging usually includes a straw surrounded by a plastic wrapper.   Make a small ball out of the plastic wrapper. Attach one ends of the straw to the juice pouch.  Tape it in place.  Attach the other end of the juice pouch to the small ball.   Now stomp on the juice box filled with juice.  The small ball should fly out from the other side of the straw.  In fact, if the straw is not securely fastened to the juice box or the stomp is strong enough, perhaps the straw and some juice will fly out as well.

The stomach does a similar stomping action.  The goal of this stomping is to propel food further down the digestive tract.  Its goal is not to have the food move backwards and up and out of the mouth.  However,  if the muscle connecting the stomach to the tube above it cannot properly close, stomach contents might fly up into the mouth.   

In reflux, stomach contents flow back up the tube from which they previously came. This reverse flow is known as reflux.  It is common in very young children because the muscles connecting the upper parts of the digestive tract to the stomach are not perfect.  It takes time for them to learn how to effectively close shut when the stomach is trying to stomp - or pump - food further down the digestive tract.   

Symptoms of reflux in babies include wet burps or hiccups as well as spit up.  Fluid winds up oozing out of the mouth.  This is a "normal" process.  What I find interesting is that young children's symptoms such as vomiting, failure to grow, and excess crying are often attributed to reflux.  If most babies have reflux, then why don't most babies also have  vomiting, failure to grow, and excess crying?  Perhaps there is something else going on, and we will explore that in the next episode.  

Three "legal" things:  First, either a male or a female could consider themselves to be a mother.  My job is to serve and not to judge.  Second, although I am a family physician, I am not your doctor or therapist.   Please see your and your child's doctor.  Third, the information presented here is for educational purposes only.  It does not constitute professional medical advice.