It's common for infants to spit up after a meal. That little spit is called gastroesaphogeal reflux or GER. But frequent vomiting associated with discomfort and difficulty feeding or weight loss may be caused by something more serious known as GERD (gastroesophageal reflux disease). Both GER and GERD can cause the upward movement of stomach content, including acid, into the esophagus and sometimes into or out of the mouth. Oftentimes, that vomiting is repetitive. The differences between the two conditions are marked by the severity and by the lasting effects.
Older children also can have GERD.
Infant reflux generally isn't a cause for concern. It's very unusual for the stomach contents to have enough acid to irritate the throat or esophagus and to cause signs and symptoms.
When to see a doctor
See your baby's doctor if your baby:
- • Isn't gaining weight
- • Consistently spits up forcefully, causing stomach contents to shoot out of his or her mouth (projectile vomiting)
- • Spits up green or yellow fluid
- • Spits up blood or a material that looks like coffee grounds
- • Refuses food
- • Has blood in his or her stool
- • Has difficulty breathing or a chronic cough
- • Begins spitting up at age 6 months or older
- • Is unusually irritable after eating
In infants, the ring of muscle between the esophagus and the stomach — the lower esophageal sphincter (LES) — is not yet fully mature. That allows stomach contents to flow backward. Eventually, the LES will open only when your baby swallows and will remain tightly closed at other times, keeping stomach contents where they belong.
The factors that contribute to infant reflux are common in babies and often can't be avoided. These factors include:
- • Babies lying flat most of the time
- • An almost completely liquid diet
- • Babies being born prematurely
How and when to feed your baby
Give more frequent feeding
Your baby may be more likely to have reflux and to spit up when their stomach is too full. Increasing the frequency of feedings while decreasing the amount at each feed will likely help.
A less-full stomach puts less pressure on the lower esophageal sphincter (LES). The LES is the ring of muscle that prevents food from going back into the esophagus from the stomach.
Feed them upright
If you can, feed baby upright and keep them in that position for about 30 minutes after. This can aid in preventing acids from creeping up.
Check bottle and nipple size
If you bottle feed, keep the nipple filled with milk throughout feedings to avoid air gulping. Try a variety of nipples, avoiding those with larger holes that can cause milk to flow too fast.
Buy slow flow bottle nipples online.
Thicken breast milk or formula
With your pediatrician’s approval, adding a small amount of infant rice cereal to formula or breast milk may be an option to lessen spitting up.
Thickening the food is thought to help stop stomach contents from sloshing up into the esophagus. This option has not been shown to decrease other reflux symptoms. Check with your doctor before trying this option.
Burp them more often
Whether you bottle-feed or breastfeed, make sure to frequently burp your baby. Burping your infant during a feeding may help with reflux symptoms.
Burp bottle-fed infants after every 1 to 2 ounces (or more frequently if they eat less). Burp breastfed babies any time they pull off the nipple.
Your infant’s sleeping position
Always put baby to sleep on their back on a firm mattress. Make sure the crib or sleeping area is free of thick blankets, pillows, loose objects, or plush toys.
Consider scheduling a bit of time between sleeping and eating instead of changing positions.
Medication and surgery
If lifestyle changes don’t help, your pediatrician may recommend further investigation into other causes of your baby’s symptoms, such as GERD.
Although medications like omeprazole (Prilosec) have been frequently used for treatment, studies question their effectiveness. The main function of these medications is to reduce stomach acid.
Surgery may be an option if medications and lifestyle adjustments don’t help ease your baby’s symptoms and if your baby isn’t gaining weight or has other complications. Tightening the LES makes it more stable so that less acid flows back into the esophagus.
The need for this type of surgery is rare, especially in infants. The procedure, called fundoplication, is usually reserved for babies whose reflux causes severe breathing problems or prevents growth.
Acid reflux in an infant is a treatable condition. Finding the lifestyle changes that work for your wee one will likely help get their acid reflux under control.
In many cases, adjustments at home may be all that’s needed to make your infant more comfortable. Mild cases can also go away with time.
Symptoms may also overlap with other conditions such as pyloric stenosis. This is a serious condition that causes abnormal tightening of a muscle that prevents proper emptying of the stomach. Pyloric stenosis causes forceful vomiting and should be evaluated by a doctor.
No matter what your baby’s symptoms, talk to your doctor about your concerns, so they can accurately diagnose the problem and help you find the best method for reducing your baby’s discomfort.