As a parent, chances are you’ve seen it or have even worn it on your shirt: spit-up. Sometimes, it may feel as if your baby spits up everything they’ve just been fed, and after every meal! Spit-up is a common occurrence in babies, but if there are other symptoms, it’s important to check in with your pediatrician.
What’s up with spit-up?
Everyone experiences reflux from time to time, but it is especially common for babies as their esophageal sphincter is still developing. The esophageal sphincter is a muscle located at the bottom of the esophagus — the tube that runs from the throat to the stomach. It relaxes to let food and drink into our stomach and to let air (burp) come up. When this muscle relaxes too much, food, drink and digestive juices can travel back up the esophagus. This may cause some discomfort or may just be messy. Because a baby’s esophageal muscle is not as strong as an adult’s and their stomach is much smaller, it relaxes more frequently and results in spit-up.
When it’s time to talk to your doctor
Another name for regular spit-up is gastroesophageal reflux (GER). When your baby’s spit-up is causing concerning symptoms like poor weight gain or low hydration, or your baby is spitting up blood or bile, it may be a sign of gastroesophageal reflux disease (GERD).
Because of the constant spitting up of stomach acid, GERD can cause irritation and inflammation of the stomach and the lining of the esophagus which can be painful for the infant and may result in ulcers. It’s important to note that GERD isn’t necessarily related to how often your baby spits up. If your baby is continuing to gain weight, and is generally not irritable with spit-up, they are likely a “happy spitter.” But if you have concerns about slow weight gain, talk to your doctor and confirm that your baby is reaching milestones at regular well-child checkups.
If your pediatrician suspects your baby might have GERD, he or she will perform a physical examination and obtain a medical history. Your doctor may order a test such as a barium swallow study or prescribe medication for stomach acid. Medication does not stop spit-up, but it does make it less acidic.
At-home diet and feeding tricks
Often, medical treatment isn’t necessary for spit-up. While there are medications that can decrease stomach acidity and heal ulcers or irritation, these medications can come with side effects, including headaches and constipation. If the medications are used long-term, they can also put your child at an increased risk for pneumonia and intestinal infections. Generally, GER improves when your baby starts eating infant solids, and resolves itself spontaneously by 12-14 months of age. In the meantime, here are a few home tricks to help reduce your baby’s spit-up:
- Keep your baby upright (not in a car seat) for 30 minutes after feeding.
- If bottle-feeding, prevent your baby from swallowing too much air by keeping the bottle nipple filled with milk.
- Burp your baby several times during feeding.
- Feed more frequently, but with smaller amounts. Babies often reflux more with a full stomach.
- For babies on formula and who have a milk protein intolerance, changing to a soy-based, hydrolysate, or elemental formula may be helpful.
- Using a reflux formula, which contains added rice starch, can help improve the frequency of spit-ups for some infants, and works best if the infant is not on acid-blocking medication.
- Adding rice cereal to formula or breastmilk has also been shown to benefit babies with frequent reflux, though it may result in constipation.
Have no fear
Infants will outgrow their reflux symptoms as their esophageal muscle becomes stronger. Gastroesophageal reflux can be managed through diet and lifestyle changes, and medication can be prescribed for more serious cases like GERD. This may be handled through your baby’s pediatrician, or you may be referred to a provider who specializes in GERD in infants. With a little guidance, you’ll be well on your way to relieving your baby’s spit-up.
Margaret is an advanced practice nurse practitioner within the Gastroenterology, Liver and Nutrition Program at Children’s Hospital of Wisconsin. She works within a team of experienced pediatric nurse practitioners who specialize in caring for babies 18 months and younger with heartburn and reflux.
Learn more about Margaret Friedhoff, APNP.