Infant Reflux: Why Does My Baby Spit Up?

Every day more than fifty percent of all babies spit up at least once.  Spit up sadly is considered normal with tiny babies. Infant reflux also known as GERD (gastroesophageal reflux) is extremely common.  It is when food backs up coming back up the esophagus and causing the spit up. This happens because a baby’s esophageal sphincter isn’t developed fully allowing the fluid to flow backwards. Infant reflux is usually not harmful and usually goes away on its own. Common signs of infant reflux are excess spitting up, difficulty eating, wet burps, hiccups, gagging or choking, and disturbed sleep. 

Spit up is not forceful, that is the difference between spit up and vomit.  Vomit in babies is extremely forceful where their stomach contracts and the vomit is usually projectiled out through the mouth and nose.  Spit up will just kind of easily flow out of the mouth following a burp or feeding. Spit up happens so often because baby’s tend to lay flat most of the time causing the food to never really settle down.  Another cause for excess amounts of spit up is because small babies are on a liquid only diet, whether that’s formula or breastmilk. The liquid is easier to flow back up and sometimes isn’t heavy enough to stay down in the belly. 

Infant reflux is usually nothing to worry about.  There are some things to look for that may be reason to contact your doctor.  If your child isn’t gaining any weight because they are spitting up too much you will want to reach out to your doctor.  Other things to be on the lookout for is projectile vomit. If your child starts to refuse to eat, or are irritable after eating you may want to reach out to your doctor.  If there is blood in the spit up, or if the spit up is green or yellow. Another thing to check is blood in the stool, could be a sign of a milk allergy. Infant reflux is normal in tiny babies, but if it just starts after 6 months of age you will want to reach out to your doctor.  

Spit up sometimes looks like it is a lot.  You may have fed your baby, they burp and spit up what looks like the entire bottle you just fed them.  To see if it is truly a lot fill a tablespoon up with formula and pour it on the burp rag too and see if the stains are similar.  A tablespoon of liquid is a lot more than you think. If you see that the amount is more than a tablespoon call your doctor. Because infant reflux is so common and usually dies down once your baby starts eating solid foods, if your baby is still gaining weight your doctor may not be concerned.  Just be prepared to be doing lots of loads of laundry for you and your baby. 

If you are worried about infant reflux your doctor will start off with a physical exam of your baby, to see if they are gaining weight and look healthy.  They will also ask you questions about the symptoms your baby is having. Such as are they feeding ok, how often do they spit up, how much spit up does it look like? If they aren’t seeing that your baby is gaining weight they may go on to other forms of identifying what is going on.  They may do an Ultrasound, or x-ray to see if there is something wrong with the digestive tract. Blood or urine samples may be taken to see if there is any sign of an infection or illness. Esophageal monitoring may be done to check the acidity of the spit up. In worse cases your doctor may want to do an upper endoscopy to put a camera down your baby’s throat and into their stomachs to see how their digestion is and if there are issues in the esophagus.

Things your doctor will be looking for when they run some of these tests are signs of something more serious.  Such as if there is too much acidity in the relux that it can damage the esophagus. Another more serious condition is pyloric stenosis which is where the food cannot move from the stomach into the small intestines.  This causes almost like a back up of food so the only way for it to go is back up. Your doctor may also be looking for a food intolerance, the most common one a milk allergy. A less common diagnosis is Eosinophilic esophagitis, where white blood cells attack the esophagus.  

If your baby doesn’t have a more serious condition causing their infant reflux there are some things you can do at home.  You can try doing smaller feedings more frequently. Some people cringe at that thinking this is retroing back to days of no sleep at night, but smaller feedings will help your baby’s stomach not get overloaded causing them the more likely chance of spitting up.  You can also try burping in the middle of feedings. Stop after a bit, make sure to get a burp before continuing on. This alleviates any excess gas build up which could lead to a spit up if waiting to the end. After you feed try keeping your baby upright for 20-30 minutes.  This can help the food to settle down in the stomach before laying your baby flat again. If it is really bad you can always try switching formulas. Most brands have a sensitive kind for babies with reflux or gas that the proteins are easier for your baby to digest and hold down.  If you are breastfeeding try eliminating foods from your own diet to see if it takes away some of your baby’s symptoms. You can also try a different bottle or nipple to try and eliminate excess air intake during feedings. After speaking with your doctor you can try and thicken the formula by adding some baby rice cereal or oatmeal, the thicker consistency will make it harder for the food to flow back up.  If you have tried all of these and the symptoms still do not lessen, your doctor may prescribe you some reflux medicine for your baby, but this is usually the worst case and isn’t very common.  

Infant reflux is normal, and common for most tiny babies.  It usually will resolve itself on its own and as long as your baby is still feeding well and gaining weight there really isn’t anything to concern yourself with.  Just make sure you are stocked up on laundry detergent for all the loads of laundry you may have to do in the coming months. Reach out to your doctor with any questions or if the reflux has started after six months of age.  

Common signs of infant reflux are excess spitting up, difficulty eating, wet burps, hiccups, gagging or choking, and disturbed sleep. 



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