Posted: Oct 02, 2012 8:00 AM
Babies spit up: Some do so more often, while others cry, appear to be in pain and spit up after every feeding. Could you simply have a "happy spitter" on your hands or is it something more?

When you become a parent, the occasional spit-up over your just laundered shirt is pretty much par for the course. There's a reason you receive so many burp cloths at your first baby shower.

However, some babies spit up a lot! Sometimes, after every feeding. Many parents come in wanting to know why and if they should worry.

Why do babies spit-up?

Baby spit-up (aka reflux) is a normal physiologic process in about 50 percent of all newborns. It's much more common in premature babies. The reason? A simple mechanical issue where the lower esophageal muscle is weaker and not yet at maturity.

This relaxed muscle allows for back flow of consumed breastmilk or formula. Most of these babies who spit up will grow, thrive and seem unfazed by the spit-up. We call these babies happy spitters because we know they'll outgrow this phase (usually by 1 year of age) and they don't have any other symptoms (described below) associated with pathologic reflux (or GERD).

RED FLAG!^ If your baby's spit-up is forceful or projectile and more like vomit, it could be a sign of pyloric stenosis. In which case, your baby will need surgery to correct it.

When should I worry?

  • Reflux associated with intense crying, irritability, grimacing and/or arching of the back.
  • Failure to gain weight as expected. It's normal for newborn babies to lose up to 10 percent of their birth weight. By 2 weeks of age, your baby should have regained his/her birth weight and go on up from there.

What you can do

For uncomplicated reflux, (aka your happy spitters): Time is typically the best treatment. Employing some simple reflux precautions such as keeping your baby elevated for 20 minutes after feeding, burping frequently and offering smaller and more frequent feeds is helpful.

Remember that by 1 year of age most happy spitters will have completely outgrown the spit-up phase.

Treatment for pathologic reflux

If your babe is irritable, crying, and/or not gaining appropriate weight, your child's doctor may advise one or several of the below treatments:

  • Consider an allergy to cow's milk protein, particularly if there is a strong family history of eczema and/or allergies. In this case, eliminating dairy from your diet (if you are breastfeeding) or switching to a hypoallergenic formula (if you are formula feeding) may alleviate the symptoms of reflux. This could also help ease the symptoms of colic if your baby is going through that too.
  • Anti-reflux medications may be considered for your baby.
  • Breastfeeding has been shown to be protective against reflux.
  • Thickening your baby's formula or breastmilk with rice cereal. (Caution: Do not use SimplyThick. The FDA has released a warning that babies who use this are at increased risk for a serious complication called necrotizing enterocolitis.)
  • Referral to a pediatric gastroenterologist may be in order if your baby continues to have significant reflux to assess the need for further work-up and evaluation.

Dr. Mom's Bottom Line^ Baby reflux is extremely common and in most cases will resolve on its own without any detrimental effect on your baby's health. Knowing when to worry and when to let time work its magic is half the battle.

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