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Children's Health

The Hypertonic Baby



Please explain hypertonicity in babies, specifically the arching of the back and thrusting the head back when being held or nursed. How is it neurological and is it a common fleeting thing with babies? Thanks in advance.


Arching back, especially during feeds, is a normal reaction to reflux of stomach contents into the esophagus. The stomach contents are acidic, and the arching is thought to result either from discomfort or the sensation of feeds distending the esophagus. Arching is not really hyper tonicity-it is a normal response to a particular stimulus. Hyper tonicity is an elevated resting tone, or an exaggerated tone in response to stimulus.

There are a few techniques to try and minimize the reflux would be to feed the infant slowly (a few ounces over 15 to 20 minutes) with frequent burping, holding the infant somewhat upright during and following feeds to have gravity help avoid the reflux, avoiding the use of infant seats after feeds, since bending at the waist can increase the pressure in the stomach and increase reflux, and as a last resort, a medication or thickened feeds may be prescribed. This is determined by the severity of the symptoms, and whether the infant is thriving or not.

Reflux almost always resolves spontaneously by six months of age, when the sphincter closing the stomach from the esophagus becomes stronger.

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Response by:

Caroline Mueller, MD
Assistant Professor
College of Medicine
University of Cincinnati