Dirk Steinert, MD Pediatrics Columbia St. Mary’s Germantown

August 04, 2008

All babies spit up, especially in the first few months of life. In medical terminology, it is called “gastroesophageal reflux” or just “reflux” for short. Reflux occurs when the stomach’s contents come up above the muscle in the stomach into the esophageous.

Many parents, especially new parents, worry when their babies spit up. They often ask, How much is normal? What can we do to reduce it? Is my baby okay?

The good news is that most reflux is normal and very common, so parents needn’t worry. Most babies don’t even notice when they spit up. While it is messy, just having a soft cloth on hand to wipe up usually takes care of it. However, there are steps parents can take to reduce normal reflux and signs to indicate when to be concerned. By learning a few tips, as well as symptoms of something more serious, parents can cope with reflux confidently.

Easing normal reflux
To reduce normal reflux, try the following techniques:

• Hold your baby in an upright position when feeding and afterwards
• Burp well. Each baby has a different pattern of burping. Some burp right away, others don’t. Learn what works best for your baby.
• Try laying your baby on her right side for sleeping.
• When your baby is awake, provide some “stomach time” for your baby.
• When breastfeeding, Mom should continue eating the same foods she did when pregnant for the first six weeks of breastfeeding, as her baby is used to those foods.
• For bottle-fed babies, experiment with different nipples to find what works best.
• For formula-fed babies, try thickening the formula with rice cereal.

Symptoms of something more serious
While reflux is usually perfectly normal, if your baby has any of the following symptoms, you should contact your doctor right way:

• Spits up more than two or three tablespoons
• Is not gaining weight
• Has pain or discomfort when spitting up
• When lying on his back, he arches his back and turns his head to the right
• Has fewer wet diapers than normal
• Seems overly tired

When reflux needs medical treatment
If your baby is not doing well, there are a number of well-tested treatment options available. In most cases, your pediatrician or family doctor can readily treat your baby by recommending an over-the-counter or a prescription medication. Certain over-the-counter medications work by suppressing acid in the stomach, allowing the reflux to lessen. More recent prescription medications, called proton pump inhibitors, have been found to heal Gastroesophageal Reflux Disease (GERD) more efficiently for more severe disease.

When a problem reoccurs or is more serious, your baby’s physician may recommend your baby see a gastroenterologist, a doctor who specializes in conditions of the gastrointestinal tract.