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Spitting up and vomiting in babies have become a huge area of parental concern. Some of the concern is positive because it reflects a better understanding of reflux disease; but some may also be negative, reflecting a push to blame vomiting for all problems (such as colic). As a result, there is a trend to place younger and younger infants on medications they may not really need and for which possible side effects have not been determined.

What Causes Reflux in Babies?

After your baby swallows milk, it glides past the back of the throat into a muscular tube (the esophagus) and, from there, into the stomach. At the junction of the esophagus and the stomach is a ring of muscles (lower esophageal sphincter) that opens to let the milk drop into the stomach and then tightens to prevent the milk (and the stomach contents) from moving back up into the esophagus. If the stomach contents should happen to re-enter the esophagus, this is called "reflux."

Infants are especially prone to reflux because:

  1. Their stomachs are quite small (about the size of their fists or a golf ball), so they are easily distended by the milk.
  2. The lower esophagus valve may be immature and may not tighten up when it should.

Is Your Baby a "Happy Spitter?"

Every baby spits up or vomits occasionally, and some do quite often or even with every feeding. If, despite the spitting, your baby is

  • Content
  • In no discomfort
  • Growing
  • Experiencing no breathing problems from the vomiting

she is what pediatricians call "a happy spitter" and no treatment is needed. Typically, the lower esophagus valve tightens up sometime in the first year, usually around 4 to 5 months of age, at which time the spitting up may go away.

Could Your Baby Have Gastroesophageal Reflux Disease (GERD)?

Unlike happy spitters, babies are diagnosed with GERD if the vomiting seems to be causing significant problems, such as:

  • Discomfort and pain (presumably heartburn due to the acid-filled stomach contents irritating the esophagus)
  • Breathing problems of any kind (gagging, choking, coughing, wheezing, and, worst-case scenario, pneumonia due to inhalation of the stomach contents into the lungs, called aspiration).
  • Poor growth (due to the loss of nutrition from vomiting)

If your baby has any of the above GERD symptoms, talk to your pediatrician, who can perform different tests to diagnose and treat it correctly.


Tips for Concerned Parents

For any spitter, there are a few things that might help:

  • Keep your baby upright for a half hour or so after a feeding (to let gravity help out).
  • Make sure there's no pressure on the stomach after a feeding. For example, try to wait at least 30 minutes after feeding before putting baby in her car seat.
  • Thicken feedings (usually by adding some rice cereal) so they're heavier and less likely to come back up.

Sometimes these simple maneuvers help enough to keep your baby as a happy spitter. But when they don't work, your pediatrician may suggest antacid drugs or medications that tighten the valve. Each has potential benefits and side effects, and only your pediatrician can decide which, if any, is right for your baby.

When to Worry About Baby's Spitting Up and Vomiting

If your baby is a spitter and experiencing discomfort, poor growth, choking, gagging, coughing, or frequent respiratory symptoms, then GERD should be considered.

However, most babies who have reflux are happy spitters. Medications in such cases should be avoided!

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