By: Anthony Porto, MD, MPH, FAAP
All babies
spit up—and it often seems like everything they just ate comes right back up!
So, how do you know if your spitty baby's symptoms are normal or part of a larger problem?
Spitting up: what's normal & what's not
To help you sort it all out, here are answers to common questions about infant digestion and how gastroesophageal reflux (GER) is different than gastroesophageal reflux disease (GERD).What are the differences between GER & GERD?
Without getting too technical, spit-up
(also called reflux, gastroesophageal reflux or GER) is the movement of stomach contents into the esophagus, and sometimes through the mouth and nose.
When reflux is associated with other symptoms, or if it lasts beyond infancy, it is considered a disease known as gastroesophageal reflux disease or GERD.
GER in infants is not considered a disease (so it does not include a "D"). In fact, it is considered normal. These infants are known as "happy spitters" because they are not cranky and do not appear to be in much pain when spitting up. Your baby may actually feel better after a good spit-up.
Other symptoms of GER include mild feeding problems, such as occasional prolonged feeds or interrupted feeds.
When does baby reflux peak?
GER usually begins at about 2 to 3 weeks of age and peaks between 4 to 5 months old. For most babies born full-term, symptoms go away by the time they are 9 to 12 months old; GER disappears as upper digestive tract function matures. Normal development—including improved head control and being able to sit up, as well as the
introduction of solid food—also helps improve GER symptoms.
What are the causes of GER?
Babies may spit up if their stomach is full or their position is changed abruptly, especially after a feeding. The stomach contents—food mixed with stomach acid—press against the valve at the top of the stomach. This is called the
lower esophageal sphincter. This ring of muscle normally relaxes to let food pass from the esophagus into the stomach. Then tightens again to keep the food there.
When it is not fully developed or opens at the wrong time, the stomach contents move back or "reflux" into the esophagus. (See
Why Babies Spit Up for more information.)
In older children, diet can play more of a role. Large meals and highly acidic or spicy meals can lead to increased GER symptoms. So can carbonated or caffeinated beverages. GER is also more common in children with overweight or obesity.
How do I know if my child has GERD?
Unlike GER, GERD is associated with complications from acid reflux. Contact your pediatrician if your child shows any of the following signs or symptoms:
Refusal to feed
Crying and/or arching their back during feeds (like they seem to be in pain)
Blood or greenish color in the spit-up
Increase in frequency or intensity of the spit-up (if it is forceful, for example)
Belly is swollen or distended or feels hard
Respiratory symptoms—including wheezing and coughing
Also be sure to let your pediatrician know if you notice that your baby doesn't seem to be gaining weight or is having fewer wet and dirty diapers; These may be signs that not enough of what they eat is staying down.
How will my pediatrician evaluate my baby for GER?
The AAP believes it is important for all pediatric health care providers to be able to properly identify and treat children with reflux symptoms and to tell GER apart from more worrisome disorders. This can avoid unnecessary treatments and costs.
Your child's pediatrician will review your child's symptoms and feeding patterns. They will also assess their growth by plotting their weight and height on a
growth chart. This information will help them determine whether your child is a "happy spitter" or has symptoms of GERD.
How is GER or GERD treated in babies and children?
We wish we had a "quick fix" for babies who spit up. The truth is that for a good many spitty babies, it is mostly a matter of time. Lifestyle changes—including feeding and/or position changes—are recommended as first-line therapy for both GER and GERD.
If GERD is severe, treatment may include medication or surgery. Medications can reduce or neutralize stomach acid to treat symptoms. The surgery to correct reflux is called
fundoplication.
Treatment options for infants
Burping your baby at natural pauses in feeding in an upright position. Gently support their head with your hand.
Consider keeping your baby in an upright position for the first half-hour or so after feeding. Always closely supervise your baby during this time.
Consider smaller and more frequent feedings. Just be sure your baby is taking in enough to stay hydrated and keep up typical growth and development.
If your bottle-fed baby spits up unusually often, your pediatrician may recommend thickening their formula with a very small amount of baby cereal.
Never add solids to the bottle unless your pediatrician advises it. See
Oatmeal: The Safer Alternative for Infants & Children Who Need Thicker Food for more information on this line of treatment.
Since milk allergy can cause symptoms similar to GER or GERD, your pediatrician might suggest trying a dairy-free diet if you’re breastfeeding. For formula-fed babies, they may recommend switching to a special formula. These formulas either have proteins broken down into very small parts (extensively hydrolyzed formulas) or are made from amino acids.
- Regardless of whether your baby's symptoms warrant watchful waiting or medical treatment, the AAP does have simple feeding suggestions that can help. See
Remedies for Spitty Babies for more treatment tips.
Treatment options for older children
Avoid fried and fatty foods. They slow down the rate of the stomach emptying and promote reflux.
Peppermint,
caffeine and certain
asthma medications can make the lower esophageal sphincter relax; this can allow stomach contents to reflux back into the esophagus. Some experts believe that tomato-based products have a similar effect.
If any food seems to produce reflux or heartburn, keep it out of the diet for a week or two. Then, reintroduce it. If symptoms return, avoid that food until your pediatrician recommends adding it back into the diet.
When might my pediatrician refer my child to a pediatric gastroenterologist?
Your pediatrician may refer your child to see a
pediatric gastroenterologist, a pediatrician who has specialized training in problems of the gastrointestinal tract—including GERD—for a variety of reasons. These include:
A pediatric gastroenterologist will review your child's history, examine them and review their diet history and growth charts. Sometimes, it can be helpful for a pediatric gastroenterologist to observe your child being fed or self-feeding.
Based on the visit, the doctor will decide whether your child may benefit from additional testing or from the addition of or a change in medications.
More information
About Dr. Porto
Anthony Porto, MD, MPH, FAAP is a board-certified pediatrician and board-certified pediatric gastroenterologist. He is an Associate Professor of Pediatrics and Associate Chief of Pediatric Gastroenterology at Yale University and Medical Director, Pediatrics, at Greenwich Hospital in Greenwich, CT. He is also the medical director of the Yale Pediatric Celiac Program. Within the American Academy of Pediatrics, Dr. Porto is a member of the Section on Gastroenterology, Hepatology and Nutrition. He is also a member of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition's Public Education Committee, a pediatric expert on nutrition for The Bump's Real Answers, and is the co-author of
The Pediatrician's Guide to Feeding Babies and Toddlers. Follow him on Instagram
@Pediatriciansguide. |