Doctors’ Notes


Reflux in Infants

She just spit up what looks like her whole bottle! What is “too much” when we’re talking about a baby spitting up? Do all babies spit up?  When is all this laundry going to slow down?

Bringing home a new baby can mean a lot of wondering “is this normal?” One frequent “is this normal?” issue in infants is spitting up — which is also known as reflux, gastroesophageal reflux, or GER for short.

a-maddalenaReflux in infants is usually a mechanical issue. Like the rest of their muscles,the muscle that keeps milk in babies’ stomachs is not fully developed. This allows the milk, whether breastmilk or formula, to move back up the esophagus and sometimes come out the mouth or nose. This normal “spitting up” in infancy is often not bothersome to the baby, but often greatly bothers those taking care of the baby!

Babies can spit up what looks like large amounts after each feeding, and are still happy and gaining weight well. In these cases, we can observe and watch for the baby to grow out of the reflux, usually after 4-6 months.

Something to note here: in most cases, the amount of spit up is actually not as much as you might think it is. Sometime as an experiment, spill just 1 ounce of water onto a table — or your shirt if you’re really brave! — and see what it looks like. Most likely your baby is actually NOT spitting up her entire bottle, even if it looks like it! In short, these “happy spitters” create quite a laundry pile, but thankfully are still healthy and thriving.

What You Can Do

While you wait for your baby to outgrow reflux, here are some things you can do that might make it better:

• Try to feed your baby in a more upright position (for a breastfed baby this might mean fewer pillows propping him up at the breast).

• Keep your baby upright after feeding as well, for an hour or so.

• For sleeping, elevate the head of your baby’s bed (by placing a rolled-up towel UNDER the mattress in the crib or bassinet, or by placing blocks under the crib legs).

• Feed more frequently with less volume.

• Interrupt feedings to encourage burping, especially for bottle-fed babies.

Do not add solids (such as infant cereal) to your baby’s bottle unless recommended by your provider. Though widely used in the past, this practice adds unnecessary calories to your baby’s diet.

Medication (in Rare Cases)

In some rare cases, the stomach acid that comes up the esophagus can irritate the baby, causing symptoms of heartburn. The baby may be very fussy during and after feedings, may pull away from the breast or bottle, and may have difficulty sleeping. In severe cases, a baby may not gain weight appropriately. In these cases, medication (such as Zantac for infants)may be prescribed to decrease the acid content. It’s very important to know that this medicine does NOT decrease the spitting up. Your baby will STILL spit up, sometimes in large quantities. The medicine will decrease the acid content in that liquid, so he or she should be less fussy and more comfortable. All medications have side effects, so it’s important to weigh the risks and benefits when considering starting them.

Thankfully, most spitting in babies is messy but not harmful. It is usually a short-lived problem that your child will outgrow. Hopefully these tips will help in the meantime, and as always, if you have any concerns about your baby, please call the office.

Dr. Amy Maddalena, a Kids Plus Doc since 2006, teaches The Fussy Baby Class, and a monthly Expectant Parent Orientation at our Pleasant Hills office.