Check out the 2 PedsDocTalk YouTube Videos about infant spit-up and GERD
Infant Spit-Up vs. GERD: How to Tell the Difference
Spit Up and GERD in Infants: Management Tips
Bringing home your newborn is an exciting and emotional time, filled with snuggles, feeding routines, and all the joys of bonding with your baby. However, as you settle into a routine, you might notice more spit-up after feedings. When does normal spit-up become a cause for concern? It’s helpful to know the difference between spit-up and GERD, why they happen, when it’s time to see a clinician, and a few tips for management.
What is spit-up?
Spit-up is a common occurrence in infants and is often referred to as gastroesophageal reflux (GER). Simply, spit-up happens when milk or formula from the stomach flows back up into the esophagus and out of the mouth. Many babies experience this in their early months, and it’s usually harmless. These babies are known as “happy spitters” – despite the mess, they’re feeding well, gaining weight, and generally not bothered by the spit-up.
Spit-up tends to peak between 4 to 5 months of age and gradually improves as your baby’s digestive system matures and they develop better head control. By the time your baby is 9 to 12 months old, the episodes of spit-up usually decrease significantly.
When does spit-up become GERD?
While spit-up is normal, GERD is a more serious form of reflux. GERD occurs when the stomach contents not only come back up but also cause discomfort, irritation, or other symptoms due to increased acid production. In contrast to “happy spitters,” babies with GERD are often uncomfortable, arch their backs, cry during or after feeding, and may even refuse to eat. GERD can lead to poor weight gain, frequent coughing, and difficulty soothing after feedings.
It’s important to note that GERD can sometimes start as mild spit-up and worsen over time. If you notice these symptoms, especially if your baby is showing discomfort, it’s best to consult your child’s clinician.
Causes of GERD and spit-up
There are several reasons why your baby might experience spit-up or GERD:
- Immature lower esophageal sphincter: The muscle that closes off the esophagus from the stomach is still weak in infants, allowing food and stomach acid to come back up.
- Swallowing too much air: If your baby swallows air during feedings, it can mix with the milk in their stomach and lead to spit-up. A poor latch, tongue tie, or feeding too quickly can also increase the risk.
- Overfeeding: A baby’s stomach is small, and giving too much milk in one sitting can overwhelm it, leading to spit-up.
- Torticollis: Tight muscles in the neck can restrict movement and impact digestion, increasing the risk of GERD.
- Gas: Babies who are gassy may also spit up more frequently, as the buildup of air in the stomach can force milk back up into the esophagus.
When to see a clinician
While spit-up is usually harmless, there are certain red flags that indicate you should see your child’s clinician.
- You’re concerned about your baby’s weight gain
- Your baby is tense or cries during feeding, or pulls away from the breast or bottle
- You’re concerned with how they feed– they cough, gag, or arch their back during or after feedings
- You notice blood in your baby’s stool
Other red flags: Projectile vomiting, especially if it happens after every feeding, can be a sign of a condition called pyloric stenosis. If your baby is projectile vomiting and still seems hungry afterward, it’s important to get them evaluated.
Management of spit-up and GERD
If your baby is a “happy spitter,” there is usually no need for medical intervention as long as they’re gaining weight and growing well. However, there are ways to reduce the spit-up if you want to try. For babies with GERD, management often begins with lifestyle changes before moving to medication if necessary.
Non-medicated options and lifestyle modifications:
- Feeding techniques: Consider paced bottle feeding or side-lying feeding positions to slow the feeding process and reduce spit-up. These methods allow the baby to control the flow of milk and minimize the amount that comes back up.
- Burping: Burp your baby frequently during and after feedings to release the trapped air.
- Smaller, frequent feedings: Rather than larger, infrequent meals, try offering smaller amounts of milk more frequently to avoid overwhelming your baby’s stomach.
- Upright positioning: Keep your baby upright for at least 20-30 minutes after feedings to allow gravity to help keep the milk down.
- Floor time: Don’t avoid tummy time just because your baby spits up. Floor time is essential for motor development, and you can always place a cloth in front of your baby to catch any spit-up.
Medications for GERD
If lifestyle modifications don’t improve GERD symptoms, your child’s clinician may recommend medications such as proton pump inhibitors (PPIs) to reduce acid production and help your baby feel more comfortable. These medications are typically reserved for babies who have severe reflux and aren’t gaining weight or are experiencing significant discomfort. It’s important to discuss the risks vs. benefits with your child’s clinician.
Final thoughts on GERD and spit-up
Spit-up and GERD are common issues that many babies experience during their first year of life. While most babies outgrow spit-up as they mature, some may need medical evaluation if they’re experiencing symptoms of GERD. Remember that time is often the best healer, but lifestyle changes and feeding techniques can help make your baby more comfortable.
Always trust your instincts– if you’re concerned about your baby’s feeding or discomfort, it’s important to consult your pediatrician. Early intervention can prevent discomfort and help you feel confident in managing your baby’s reflux.
Watch the PedsDocTalk YouTube Videos about infant spit-up and GERD
Infant Spit-Up vs. GERD: How to Tell the Difference
Spit Up and GERD in Infants: Management Tips
