The Low Down on Spit Up

How to help your baby with infant reflux.



When my daughter was an infant, I used to make frequent trips to the pediatrician’s office because of her spitting up. I worried she wasn’t getting enough nutrition or that something was wrong with my feeding routine.

Spitting up is common. In fact, studies show that about half of all infants experience this during the first few months of life. Infant reflux occurs when food in the stomach goes back up into baby’s esophagus. I spoke with Dr. Mark Corkins, chief of pediatric gastroenterology at Le Bonheur Children’s Hospital to find out how you can help baby through this phase.

How and why does infant reflux occur?

Dr. Mark Corkins: Spitting up is very normal in infants. It most often happens after a feeding. The nervous system controls the valve between the stomach and the esophagus. When the infant’s immature nervous system forgets to tell the valve to stay shut, very often food travels up, and out it comes. The problem is not that the muscle is weak, it works just fine.

If I breastfeed, is there a diet I should follow to avoid reflux? Is there a special formula that helps?
Corkins: Breast-fed babies seem to exhibit more tolerance to this condition. It is because breast milk empties out of the stomach better. Traces of what a mother eats remain in the breast milk. So foods that cause reflux, like beverages high in caffeine, should be avoided.

For bottle-fed babies, thickening the milk by adding cereal to the formula helps. It may not change the reflux but will lower the amount of formula that baby spits up. There is a formula available designed to thicken in the stomach to improve reflux symptoms.

Infant reflux usually doesn’t affect baby’s growth. When should I see a doctor?

Corkins: When baby shows signs of severe spitting up, he or she may have a protein allergy. Your doctor may recommend a low allergy formula to try for two weeks. Also, see your doctor if your baby has poor weight gain, if reflux causes discomfort, or if other signs of illness like wheezing, asthma, or lung-related problems, persist. A pediatric gastroenterology clinic may suggest occasional use of medicines to treat reflux.  

When can normal reflux lead to more serious conditions like gastroesophageal reflux disease or pyloric stenosis?

Corkins: When babies have frequent episodes of infant reflux, the infant reflux more accurately known as gastroesophageal reflux (GER) may upgrade to gastroesophageal reflux disease (GERD). Pyloric stenosis is a thickness in the valve that is at the end of the stomach. Reflux doesn’t cause pyloric stenosis but the symptoms seem like severe reflux. In GERD, the spitting has some effect on their health like poor growth or breathing problems. A very small percentage of babies are affected by GERD.

How long does it take for reflux to resolve on its own?  

Corkins: Most infants outgrow reflux by the time they turn 1. Try these tips to help minimize it.

• Give baby smaller, more frequent feedings.
• Keep baby in an upright position for 30 minutes after feeding.
• Burp baby during and after each feeding to prevent air bubbles from building in the stomach.
• Thicken formula by adding a small amount of rice cereal.

Where can I learn more?

Visit Pediatric/Adolescent Gastroesophageal Reflux (PAGER) Association at reflux.org.

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