Is It Spitting Up Or Infant Reflux?

Dear Mamas,

My little boy is just 3 months old and has been quite a spitter since he was born.  Almost every feeding is followed by vomiting — and it seems like a lot comes back up!  Our pediatrician says he has infant reflux, and gave us some feeding techniques to try,  but so far it hasn’t made much of a difference.  I’ve heard there’s medicine we can give him … should we consider that?

Sarah (who smells like sour milk)

Dear Sarah,

Ah yes, Eau de Curdled Dairy, I remember it well!  According to the Mayo Clinic more than half of all babies experience infant reflux during the first months of life.  Most often this is pretty normal stuff, or what we used to just call ‘spitting up’.

It’s caused by a loose valve at the junction between the esophagus and the stomach (the lower esophageal sphincter) who’s job is to squeeze shut so food — or in this case, liquid — can only travel in one direction … down.  In many infants this valve is still immature, allowing the stomach contents to do a 180 and come back the other way.  Add to this the fact that babies younger than 9 months or so spend most of their time lying down and  get no help from gravity, and you start to see why most new moms travel with plenty of spit up cloths.

Normal reflux (sounds like what yours has) doesn’t interfere with your baby’s growth or health, and isn’t a cause for concern.  Occasionally, symptoms can be more severe, calling for medical attention.  Signs that a baby may have a more serious problem, called gastro-esophageal reflux disease, or GERD include:

  • slow or poor weight gain
  • spit up that shoots out of the mouth with enough force to cross the room
  • spit up tinged with green, dark brown, or red blood
  • discomfort or pain during feedings
  • constant hunger between feedings
  • other signs of illness, particularly wheezing or altered breathing, abnormal arching body movements, or color changes associated with feedings.

Treatment depends on what’s causing the reflux and how severe it is.  You can try to minimize normal spitting up with feeding strategies that encourage milk to stay put, like holding your babe in a sitting position during and  after feedings, frequent burping, smaller, more frequent meals, and raising the head of the crib or infant seat.

Check to see if your kiddo is gulping a lot of air while sucking, either at the breast or from a bottle that allows lots of air in. An air-filled stomach has less room for food.

In severe cases that are causing health problems, doctors may prescribe medication, but this is reserved for children who can’t get adequate nutrition without it, or are otherwise at risk.

The good news is that infant reflux is mostly a laundry problem rather than a true child health issue.  You can count on it resolving sometime between 9 and 12 months as the sphincter gets stronger and your baby spends more time upright.  It’s a rare toddler who waddles around dribbling milk and stomach contents.

In the meantime, cherish the aroma.  Now, when my husband and I are around a spitty baby we’ll often look at each other nostalgically — those were heady days …

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?


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