Your Guide to Bottle Feeding

Your Baby: Spitting Up and Vomiting

Spitting up and vomiting in babies have become a huge area of parental concern. Part of the concern is positive because it reflects a better understanding of reflux disease, but another part may be negative and reflects 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 whom 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 fine
• 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 4-5 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 so much nutrition from vomiting)

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

One misconception is that GERD is often due to an intolerance to the milk. But if you think about it, the milk has just entered the stomach and hasn't had time to be digested, much less be recognized as one type or another. So changing your baby's formula usually does not help.

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 medications and/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