Spitting up or reflux: What to look for
Is a pediatric gastroenterologist at the Children’s Center for Digestive Health Care / GI Care for Kids, whose books on nutrition for parents led him to start Nutrition4Kids with his co-founders.
Problem for the baby or a happy spitter?
The fact that most babies completely outgrow reflux doesn't make life any easier for the mom who is changing either her or her baby's clothes a dozen times during the day, or for the baby who is wailing after a meal until he brings up some or most of what he just ate, or worse, for the baby who is pulling away from the breast or bottle .
When Spitting Up is Normal
Spit up is fairly common when babies have "wet burps." Wet burps occur when a tablespoon or two of formula comes up once or twice right after a feeding. Typically, a baby who wet burps will not be phased by their spit up and remain satisfied from their feeding.
Worth noting, by 3 months of age, wet burps can worsen; however, this is nothing to worry about. Usually, this is caused by the more active baby putting pressure on their stomachs. By 5-6 months of age, most babies will improve as they are able to sit upright more and start eating table (or complementary) foods. The wet burp reflux is grown out of as early as 6-8 months of age, with 95% over the problem by 14 months of age.
When Spitting up can be a Concern
If your baby spits up and is constantly crying, irritable, refusing to eat, their reflux may be of concern. Some babies may have a weak valve that is supposed to keep the stomach contents from coming back up. Others may be overfed which puts too much pressure on their stomachs and forces its way back up. Fortunately, this can be fixed by feeding smaller amounts more frequently, and adding infant cereal to thicken the formula (or pumping and adding it to breast milk). We recommend feeding babies every 2-3 hours in the beginning and adding about a teaspoon of infant cereal per ounce of formula. (Oatmeal won't cause as much constipation as rice)
As far as the fretful infant or poor eater, that can usually be explained by understanding that the stomach acid and enzymes may also be coming up into the esophagus and causing some inflammation and irritation there. That may require medicines and certainly a discussion with your pediatrician or primary care provider.
Another less obvious type of reflux is silent reflux. This occurs when the contents of the stomach (acid, enzymes and food) ends up in the lungs, sinuses, and ear canals. As a result, a baby may suffer from many respiratory infections. Silent reflux is hard to detect because some babies do not become irritable nor do they spit up. If your baby continuously gets respiratory infections, silent reflux could be the culprit!
Watch out for the symptoms of reflux including:
- Poor weight gain
- Excessive crying or irritability
- Head usually tilted to one side
- Feeding problems
- Respiratory problems, including
- wheezing, difficulty with or noisy breathing, apnea
- recurrent pneumonia, bronchitis, or sinus problems, ear infections
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