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GERD & Spit-up – What’s the difference?

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And when to be concerned!

Gastroesophageal Reflux Disease (GERD), is one of the hardest diagnoses for new parents. It can really rob joy seeing your baby uncomfortable.

Let’s start with what the difference between being a “Happy Spitter” and GERD is.

Many infants will be happy spitters. This is when they spit up and it causes a mess, but baby is thriving in weight and overall not uncomfortable with the spit-ups.

GERD is when the contents of the stomach are being pushed up the esophagus, and the combination of the force of this and the amount of the spit-up can lead to acid production and irritation as well as discomfort in some babies.

Babies with reflux or GERD may be:

  1. Spitting up immediately after feeds or in-between feeds
  2. Uncomfortable/crying with those spit-ups
  3. Arching their back in pain
  4. Frequently coughing associated with the spit-up (and they’re not sick)
  5. Experiencing poor weight gain
  6. Harder to console

This can get better on its own. For happy spitters, there is no management. Doing smaller and more frequent feedings can help with the mess. Most babies are born with the immature muscle/valve placement that leads to spit-ups, and eventually as they grow, this gets better. Time helps and eventually it resolves.

Some babies with GERD or more severe reflux may need more intervention.

So when should I be concerned and what are some reasons I should see the clinician for spit-up/reflux?

  • Poor weight gain
  • Blood in stool
  • Mucus in stool with poor weight gain
  • Excessive spit-up that is causing poor weight gain and/or back arching after feeds
  • Baby very uncomfortable around feeds or dreads them (pulls away)

Depending on the severity and symptoms, the clinician may recommend formula changes, changes to maternal diet (removing dairy), and/or medications.

Remember the goal of treatment is not to STOP the spit-up (as this happens in most babies) but rather to help with the discomfort and/or poor weight gain.

How can I help my baby who has reflux but doesn’t need any intervention?

  • Feed baby in an upright position. Gravity can help the milk down and make it less likely to come up.
  • Smaller frequent feedings. This may seem overwhelming, but find a volume that may work for your baby in a frequency that works for them. Their bellies are small and more volume can mean more potential for spit-up.
  • Hold baby upright for 20 minutes after feeding. This also allows gravity to help. You can carry them in a carrier or hold them.
  • Burp baby as often as possible.
  • Consider probiotics. Similar to colic, studies of L.reuteri (a probiotic in certain formulas) saw that there can be decreased spit-ups and colic episodes in babies. These are available over the counter if you are breastfeeding, but speak to a clinician before using.
  • Speak to a clinician about thickening feeds. Only proceed if they advise.
  • If formula feeding, speak to clinician for guidance.

What are some ways to keep them upright after feeds?

  • In a carrier on you
  • Walking around the house with you holding them
  • Lying on you (do remember, if they fall asleep, you can put them in a crib and use any soothing techniques that work for you!)

Remember to speak to your child’s clinician on options to manage the discomfort, with an understanding that it can take time. It can be very hard as you patiently wait for their GI system to develop, but I promise you, it does get better.

If you enjoyed reading about this topic, I think you’ll enjoy listening to this episode where I take the conversation further and also discuss how to advocate for your baby with your clinician!

P.S. – I have a whole module on The New Mom’s Survival Guide that discusses how GERD/spit up will affect their sleep and other reasons your baby may be fussy – Fussy Baby 101. Join the community to learn more and have access to these resources!

Dr. Mona Admin

Hi there!

I’m a Board Certified Pediatrician, IBCLC, and a mom of two.

I know the ups and downs of becoming a mom and raising kids.

I help moms ditch the worry and second-guessing so you can find more joy in motherhood.


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All information presented on this blog, my Instagram, and my podcast is for educational purposes and should not be taken as personal medical advice. These platforms are to educate and should not replace the medical judgment of a licensed healthcare provider who is evaluating a patient.

It is the responsibility of the guardian to seek appropriate medical attention when they are concerned about their child.

All opinions are my own and do not reflect the opinions of my employer or hospitals I may be affiliated with.