Spit-up – also called reflux, gastroesophageal reflux or GER – is the movement of stomach contents into the oesophagus, and sometimes through the mouth and nose. — Raisin7036/Dreamstime/TNS
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?
Without getting too technical, spit-up – also called reflux, gastroesophageal reflux or GER – is the movement of stomach contents into the oesophagus, 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. 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.
GER usually begins at about two to three weeks of age and peaks between four to five months old.
For most babies born full-term, symptoms go away by the time they are nine 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.
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 called the lower oesophageal sphincter.
This ring of muscle normally relaxes to let food pass from the oesophagus into the stomach and 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 oesophagus.
Treating GER
Unlike GER, GERD is associated with complications from acid reflux.
Signs that it’s time to contact your child’s paediatrician include a refusal to feed, crying and/or arching their back during feeds like they seem to be in pain, blood or greenish colour in the spit-up, increased frequency or intensity of the spit-up, a swollen belly, and respiratory symptoms.
Also be sure to let your paediatrician 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.
The American Academy of Pediatrics (AAP) believes it is important for all paediatric 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 paediatrician 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.
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 neutralise stomach acid to treat symptoms.
Burping babies
Non-medicinal ways to stave off GER include burping at natural pauses in feeding in an upright position, keeping the baby upright for half an hour after feeding, and smaller more frequent feedings.
If your bottle-fed baby spits up unusually often, your paediatrician may recommend thickening their formula with a very small amount of baby cereal. Never add solids to the bottle unless your paediatrician advises it.
Since milk allergies can cause symptoms similar to GER or GERD, your paediatrician 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 or are made from amino acids.
Your paediatrician may refer your child to see a paediatric gastroenterologist, a paediatrician who has specialised training in problems of the gastrointestinal tract – including GERD – for a variety of reasons.
These include poor weight gain, feeding problems and a lack of response to medical therapy.
A paediatric gastroenterologist will review your child’s history, examine them and review their diet history and growth charts.
Sometimes, it can be helpful for a paediatric 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. – American Academy of Pediatrics/Tribune News Service
Dr Anthony Porto is a board-certified paediatrician and board-certified paediatric 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 Gastroentero-logy, Hepatology and Nutrition. He is also the vice-chair of the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition’s Public Education Committee and is the co-author of The Pediatrician’s Guide to Feeding Babies and Toddlers.
