Every parent can expect to be spit up on at least a dozen times while their baby is young, but what happens when that spit up seems like something more serious?
Does your baby spit up excessively? Do they seem bothered anytime their meal is regurgitated? Are they having trouble gaining weight?
If you have concerns about the nature of your baby’s spit up, you may want to read up on reflux in babies and what you can do to help.
What is Reflux in Babies?
Reflux can be labeled with many different names – acid reflux, indigestion, regurgitation, and heartburn – but the most commonly used by doctors is gastroesophageal reflux (GER).
Or if you are from Australia or the UK, gastro-oesophageal reflux (GOR).
According to the National Institutes of Health (NIH), GER happens when stomach contents come back up into the esophagus.
With babies, this is usually just a combination of saliva and stomach acid often accompanied by formula or breastmilk (giving it its milky color and consistency).
Causes of Reflux
Reflux is very common in babies due to their immature digestive system.
The lower esophageal sphincter, the muscle that acts as a valve between the stomach and esophagus, when working properly should remain shut after food passes through so that stomach contents do not flow back up to the esophagus.
However, this muscle is underdeveloped in babies with reflux.
Rather than closing after the food passes through, it remains relaxed and can result in babies spitting up.
About half of all babies spit up several times a day in the first several months of their lives, and it usually stops around 12 to 14 months of age, when most babies switch to a completely solid diet.
Other Types of Reflux
In addition to GER, there are a few main types of reflux that can occur in babies. Your baby’s diagnosis will depend on the severity and symptoms.
The more severe cases of reflux are labeled as GERD or gastroesophageal reflux disease.
It is less common than GER – occurring in only 5-8% of adolescent children – and requires professional attention and medical intervention.
Essentially, the baby’s case is labeled as GERD when the valve malfunctions altogether and the normal symptoms give way to more serious health conditions.
I will go into the specific symptoms shortly.
Silent reflux, or laryngeal-pharyngeal reflux (LPR), is simply a minor case of GER.
It is labeled as “silent” due to the fact that it is not usually accompanied by heartburn, unlike acid reflux.
However, silent reflux can still cause severe irritation to the throat and chest. Again, I will go into the details of reflux symptoms in the next section.
Symptoms of Reflux in Babies
Reflux can be very irritating to babies and in some cases even painful or harmful to their health, depending on the severity.
Let’s start with your standard GER. Since your baby cannot communicate their symptoms to you, you will be looking for:
- Fussiness at mealtime
- Gagging or choking
You may also notice that your little one has frequent ear infections and may be acting as if they have a stomach ache.
GERD includes these same symptoms, but often far worse and accompanied by other health problems.
These can include:
- Poor weight gain
- Refusal to feed
- Chronic coughing, particularly at night
- Wheezing or rattling in the chest
- Constant irritabilityPain in chest
- Hematemesis (vomiting blood)
- Iron deficiency anemia
These symptoms can seem very scary, but they will vary from case to case, with some babies never experiencing some of them.
The most common to watch out for is excessive regurgitation several times a day for over 3 weeks and poor weight gain.
When to Call a Doctor
As I said, every baby will experience some form of spit up or reflux within the first year or so of their lives and most cases of reflux don’t require any sort of medical attention.
So, how do you know when it is time to call a doctor?
Most babies can be considered happy spitters.
This simply means that their regurgitation is only on occasion and they don’t seem bothered by it. They spit up with little to no fuss.
However, when you observe the following changes you should call a doctor immediately:
- Spitting becomes more frequent, and/or more forceful (projectile)
- The regurgitated milk has a colored tinge to it (green or yellow can signify bile; red could be blood)
- You baby starts exhibiting new symptoms (constantly crying, won’t feed)
- Your baby does not gain weight
- There are issues with reflux beyond their first birthday
Of course, if you have any concerns, even if it is just the occasional spit up with a bit of fussiness, you should always call the doctor to alleviate your concerns.
How is it Diagnosed?
Once you take your baby to the doctor, the diagnosis process will begin.
Typically, your pediatrician will begin with a physical exam and will just take some time to talk with you about your baby’s symptoms. Most cases of GER are diagnosed with this process alone, without having to do anything invasive.
However, if there is something unclear or if the case is severe, further testing may be required. These tests can include:
- Ultrasound – detects any narrowing of the opening from the stomach to the small intestine
- Blood and/or urine tests – rules out other possible causes of vomiting and poor weight gain
- Esophageal pH monitoring – measures acidity in the esophagus; may require a hospital stay for the duration of the test
- X-ray – looks for obstructions and the like in the digestive tract
- Upper endoscopy – investigation with a small tube and camera down the baby’s esophagus; usually done under general anesthesia
These tests may seem extensive, especially on one so small, but with the severity of the symptoms, the doctor will want to rule out any other possible causes for your baby’s condition.
Just as with any other medical condition, your baby can experience complications resulting from prolonged or ignored symptoms.
These can include:
- Breathing problems
- Redness and irritation of the esophagus (esophagitis)
- Bleeding in the esophagus
- Scar tissue resulting from acid erosion
Seek medical help immediately if your baby’s symptoms seem abnormal.
Treatments for Reflux
Your baby’s diagnosis and medical history will determine the course of treatment that follows if treatment is even required (most cases resolve on their own).
The method of treatment is often a joint decision between parent and doctor, whether they decide to go the medical route or a more natural way.
Most of the medicinal remedies for reflux involve tampering with internal acid levels. The aim is to try to reduce the level of acid in the stomach to help avoid irritation and regurgitation.
These treatments are available in 3 forms:
- Antacids – just like we adults take for heartburn and indigestion, antacids provide temporary relief to minor cases
- Histamine H2 Antagonists – work similarly to antacids (reducing the amount of stomach acid) but are in liquid form, making them the choice drug treatment for children
- Proton Pump Inhibitors – these are used in the most severe cases when the child needs complete acid suppression (chronic respiratory disease, neurological disabilities, etc.)
It is important to keep in mind that your baby is still small and may have negative reactions to or prolonged side effects as a result of these medications more easily than an adult would.
An article in Science News addresses the increased use of proton pump inhibitors, based on research presented by pediatrician Laura Malchodi in 2017.
She closely examined the medical records of around 900,000 children – 7,000 proton pump inhibitors, 67,000 H2-blockers, and 11,000 with both (prescribed by the age of 6 months).
It was discovered that the children who received the proton pump inhibitors, either alone or in conjunction with an H2 blocker, suffered more broken bones over the next five years than children who did not take it.
There is no definitive proof stating that the proton pump inhibitors caused weaker bones, but there is a strong link between the two.
All of that to say, you want to always consider the long-term side effects that some prescription drugs may have on your child before deciding to use them.
Personally, I am a fan of the natural route, both for myself and for my child.
Granted, there are some ailments that do require medical assistance, but if there is a more natural way to solve it, that is what I go for first.
Thankfully, there are some great home remedies for reflux you can try with your baby.
Of course, you should always consult with your pediatrician first and determine the severity of your baby’s case before trying any home remedies.
- Massage – baby massage can be beneficial any sort of gastrointestinal distress. Start by rubbing your baby’s belly in a clockwise motion for a few minutes, and then move to the back in the same way. Finish by running your hands down their arms and legs with gentle by firm strokes.
- Exercise their legs – no, I don’t mean taking your baby out for a run. Just lay your baby down on their back, hold onto their lower calves/ankles, and move their legs as if they were riding a bicycle. This should help to improve digestion. Keep in mind not to do this too close to a feeding session though (before or after).
- Apple cider vinegar (ACV) – this seems to be nature’s cure for everything. Mix ¼ teaspoon of ACV into a glass of lukewarm water, and give a few spoonfuls to your baby at regular intervals. Be sure you speak with your pediatrician first as this is considered “adding a solid” to your baby’s diet and the wrong mixture can cause severe pH imbalance.
- Peppermint, lavender, or chamomile – with the increasing popularity of essential oil use, many parents are asking when it is safe to introduce them to their little ones. Always consult a doctor first, but generally, chamomile, lavender, and peppermint are safe to use for diffusion or massage (when diluted with a carrier oil), and they can help relieve symptoms of reflux.
You may also see suggestions for changing your baby’s sleep position to help with reflux symptoms, but you should be wary of doing so.
Babies should always be put to sleep on their backs to reduce the risk of suffocation and Sudden Infant Death Syndrome (SIDS).
Placing anything in your baby’s crib or bassinet to elevate their head, such as a pillow or towel, put them at an increased risk for suffocation.
If you do wish to try to relieve reflux symptoms by elevating your baby’s head while they are lying down, do so while they are awake and you are supervising them closely.
Reflux prevention is just as important as treatment (if not more so). Here are some things you can do to try to prevent flare-ups.
One of the best things you can do to prevent reflux in your baby is to breastfeed.
That’s not to say breastfed babies never experience spit up (I can say from first-hand experience that is not the case), but it can decrease the likelihood of chronic reflux in your little one.
Formula-fed babies have reflux episodes more often than breastfed babies and they typically last longer. This is likely due to the fact that
a) formula is man-made (as opposed to breast milk),
b) formula is harder to digest, and
c) bottle-feeding increases the likelihood that the baby will swallow air while feeding, forcing the liquid to come back up later.
Foods to Avoid
As a breastfeeding mother, you may not realize that your diet can play a role in your baby’s reflux. What you are eating may be the cause of your baby’s symptoms as they are ingesting certain compounds through your breast milk.
The best thing you can do is change up your diet a little bit and avoid ingesting:
- Spicy foods
- Carbonated drinks
- Fried foods
- Artificial fruit juice
- Kidney and black beans
Basically, if it causes you gas or heartburn, it could do the same to your baby once it is digested and processed in your breast milk.
There are several little adjustments you can make to your daily routine with your baby that can prevent reflux episodes.
Take a moment to burp your baby whenever you notice your baby slowing down during a feed and at the end of a feed to prevent air bubbles that can force milk to come back up later.
Try changing your baby’s diaper before feeding to avoid lying them down on their back after eating.
If you do need to change them afterward (because babies don’t always cooperate on the parents’ schedule), try propping them up on a wedge pillow to keep their head elevated.
Keep your baby in an upright (or flat, i.e. on tummy) position when holding them or using a baby carrier. This allows for better digestion by keeping the head and digestive tract in line.
Keeping them upright also keeps their food down thanks to the help of gravity.
Reflux is a common occurrence in all babies, but that doesn’t mean it’s something to ignore. Prolonged symptoms can lead to a more serious condition, which can cause developmental delays or pain in your baby.
If you have any concerns, always consult your pediatrician.
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