Why Does My Baby Have Reflux? 5 Causes of Infant Reflux You May Not Have Considered

If your baby is frequently spitting up, arching, coughing, gulping, pulling away from the breast or bottle, or seems uncomfortable after feeding, you may have been told that they have infant reflux.

Reflux is incredibly common in babies. But one of the most important questions I ask is:

What is causing your baby’s reflux?

Reflux is just a symptom. It describes milk or stomach contents coming back up into the esophagus, but it doesn't necessarily tell us why it is happening.

For some babies, reflux is primarily related to the immaturity of their digestive system and improves with time. For others, feeding mechanics, milk flow, oral function, food allergies, or a combination of factors may be contributing to their symptoms.

As a chiropractor and International Board Certified Lactation Consultant (IBCLC) working with infants in Danville and Livermore, California, I take a comprehensive approach to babies experiencing feeding difficulties and reflux symptoms.

Here are five factors I commonly consider when evaluating a baby with reflux.

1. Tongue Tie and Restricted Tongue Function

A tongue tie occurs when the tissue underneath the tongue, called the lingual frenulum, restricts the tongue's movement or function.

But simply looking underneath a baby's tongue isn't enough to determine whether the frenulum is actually affecting feeding.

The more important question is:

How is the tongue functioning?

During feeding, the tongue needs to move in a coordinated way to create suction, maintain a deep latch, control milk flow, and efficiently transfer milk.

When tongue mobility or function is restricted, some babies may compensate by using their jaw, lips, cheeks, or other muscles differently during feeding.

Parents may notice:

• Clicking or leaking milk while feeding

• Difficulty maintaining a deep latch

• Frequent unlatching

• Painful breastfeeding

• Long or inefficient feeds

• Poor milk transfer

• Excessive air intake

• Gassiness

• Hiccups

• Arching or discomfort after feeds

• Reflux-like symptoms

Importantly, not every baby with a visible frenulum needs a tongue-tie release.

A functional tongue-tie evaluation should assess much more than appearance. I evaluate tongue range of motion, suck strength and coordination, oral reflexes, feeding mechanics, and how the tongue, mouth, jaw, and body are functioning together.

For families looking for a tongue tie evaluation in Danville or Livermore, identifying whether oral restriction is actually affecting function can help determine the most appropriate next step.

2. Oversupply or a Fast Milk Letdown

Sometimes the problem isn't that a baby isn't getting enough milk.

They're getting too much milk too quickly.

Parents with an abundant milk supply or forceful letdown may notice their baby:

• Coughing or choking at the breast

• Gulping rapidly

• Pulling on and off

• Clicking

• Becoming frustrated during letdown

• Spitting up large amounts

• Swallowing significant amounts of air

• Appearing gassy or uncomfortable

• Feeding for very short periods

When milk enters the baby's mouth faster than they can comfortably coordinate sucking, swallowing, and breathing, feeding can become stressful and disorganized.

Some babies compensate surprisingly well, while others struggle significantly with the flow.

This is one reason why a lactation assessment can be helpful for a baby with reflux. Instead of simply looking at whether the baby is gaining weight, we can observe an actual feeding and assess milk flow, positioning, latch, swallowing, milk transfer, and your baby's response to your letdown.

Changes to feeding position, breast management, or feeding patterns may help when oversupply or fast letdown is contributing to symptoms.

3. Bottle Flow Rate and Bottle Type

Bottle feeding isn't always as simple as choosing a bottle labeled "newborn."

Nipple flow rates are not standardized between bottle brands. A "slow flow" nipple from one company may flow very differently from a slow-flow nipple from another.

If milk flows too quickly, your baby may have difficulty controlling it.

You may see:

• Gulping

• Coughing

• Milk leaking from the sides of the mouth

• Clicking

• Pulling away from the bottle

• Very fast feeds

• Increased spit-up

• Increased air intake

• Fussiness during or after feeding

Bottle shape matters too.

A nipple that is marketed as looking like a breast doesn't necessarily encourage a breastfeeding-like latch or support optimal oral mechanics for every baby.

During a bottle-feeding assessment, I look at much more than how many ounces your baby drinks. We can evaluate your baby's latch on the bottle, lip and cheek seal, tongue function, suck-swallow-breathe coordination, feeding position, nipple flow rate, and how efficiently your baby manages the milk.

Sometimes something as simple as changing the nipple flow, bottle, feeding position, or pacing technique can make a significant difference.

4. Food Allergies

For some babies, gastrointestinal symptoms may be related to a food allergy, such as cow's milk protein allergy.

Depending on the baby, parents may notice reflux alongside other symptoms such as:

• Blood or mucus in the stool

• Diarrhea or abnormal stools

• Significant fussiness

• Skin rashes or hives

• Eczema

• Vomiting

• Feeding discomfort

• Poor growth

Food allergies are different from feeding-mechanics problems, and requires furth evaluation. Dr. Kara has additional training in infant food allergies and can help you along this journey. This is also why I don't assume every baby's reflux has the same cause.

A baby who is clicking and swallowing air during every feed needs a different evaluation than a baby who has reflux accompanied by hives or blood in their stool.

And sometimes more than one issue can be occurring at the same time.

5. Poor Oral Function or a Weak/Uncoordinated Suck

A baby does not need to have a tongue tie to have difficulty using their tongue effectively.

Some babies have reduced tongue strength, poor coordination, difficulty cupping the tongue, decreased tongue elevation or lateralization, or an immature or disorganized suck pattern.

The suck-swallow-breathe sequence is an incredibly coordinated process.

If your baby has difficulty creating and maintaining suction, they may repeatedly lose their seal while feeding. This can contribute to clicking, leaking, inefficient milk transfer, and increased air intake.

During a functional oral assessment, I evaluate areas such as:

• Tongue range of motion

• Tongue elevation

• Tongue lateralization

• Tongue cupping

• Suck strength

• Suck coordination

• Oral reflexes

• Lip and cheek function

• Jaw movement

• Ability to maintain suction

We then look at those findings in the context of an actual breast or bottle feeding.

The goal isn't simply to label a baby with a "weak suck." It's to determine where feeding is breaking down and what we can do to support better function.

Reflux Isn't Always Just a Stomach Problem

One of the biggest takeaways I want parents to understand is that reflux symptoms don't occur in isolation.

Feeding involves the tongue, jaw, lips, cheeks, neck, nervous system, digestive system, milk supply, milk flow, positioning, and the baby's ability to coordinate sucking, swallowing, and breathing.

That's why two babies with "reflux" may need completely different approaches.

One baby may be struggling with a fast maternal letdown.

Another may be overwhelmed by a bottle nipple that's flowing too quickly.

Another may have poor tongue function and repeatedly lose suction during feeds.

Another may have symptoms that warrant medical evaluation for a food allergy or gastrointestinal condition.

And some babies may have several contributing factors at once.

Getting Help for Baby Reflux in Danville & Livermore

If your baby has reflux and feeding just doesn't seem right, a comprehensive feeding and oral-function assessment may help uncover factors contributing to their symptoms.

At The Well Chiropractic & Lactation Support, I work with families in Danville, Livermore, and throughout the East Bay to evaluate the whole feeding picture.

Depending on your baby's needs, an assessment may include:

• Breastfeeding or bottle-feeding observation

• Functional oral assessment

• Tongue range of motion and function

• Suck strength and coordination

• Oral reflex assessment

• Evaluation for signs of tongue restriction

• Milk transfer and weighted feeding when appropriate

• Bottle and nipple-flow assessment

• Assessment of body tension and movement

• Individualized recommendations and home exercises when appropriate

As both a Doctor of Chiropractic and IBCLC, my goal is to look beyond the symptom and assess how your baby's mouth, tongue, feeding mechanics, and body are functioning together.

If your baby is struggling with reflux, clicking, painful breastfeeding, bottle feeding, excessive gas, poor latch, or suspected tongue tie, you can schedule an infant feeding, lactation, or pediatric chiropractic evaluation in Danville or Livermore, CA.

Reflux can also be associated with medical conditions that require evaluation and treatment by your child's pediatric or medical provider. Feeding and chiropractic care do not replace appropriate medical evaluation, particularly for persistent vomiting, poor weight gain, blood in the stool or vomit, dehydration, breathing difficulties, allergic reactions, or other concerning symptoms.