For most infants, spitting up is an inevitable part of life. But for their parents, deciphering how much spit-up (or reflux) is acceptable can be confusing. Is there such a thing as too much spit-up?
First, let’s talk about the normal aspects of infant reflux.
Normal or physiologic reflux can start somewhere around two to four weeks and occur several times a day. Reflux hits a peak around four months, and usually resolves somewhere between 6 months and 1 year of age. Only about 1% of infants still experience symptoms at 1 year of age. One reason your infant may be having reflux is that the band or sphincter around the lower part of your child’s esophagus has intermittent periods of relaxation. When the sphincter is relaxed, food and fluids are more likely to come back up.
If your infant continues to be mostly happy and comfortable, has a good appetite and gains weight appropriately, then spit-up poses more of a danger to your baby’s clothes than his health. If you think of reflux symptoms as being graded on a spectrum, this presentation is on the mild end. An infant who is fussy during feedings and/or during spit-up episodes, but is otherwise happy may have a more moderate degree of reflux. Symptoms such as coughing or wheezing are very rare presentations of reflux. So when should you be concerned about spit-up? If your infant is persistently fussy and uncomfortable (most of the day) or refusing his bottle due to discomfort, it may represent a more severe degree of infant reflux. Definitely have your infant evaluated by your pediatrician if the spit-up is more forceful or “projectile.” A good way to think of projectile vomiting is spit-up that could shoot straight out and hit the wall behind you if you had your infant on your shoulder.
There are simple and noninvasive ways to help your infant who has mild to moderate reflux. Positioning your infant on their left side (taking care not to position them in a way that they may easily roll over onto their tummies) and keeping them upright for 30 minutes after a feeding may help to alleviate the symptoms. Thickening your infant’s formula or breast milk with rice cereal, or using a formula with rice starch added may also be helpful.
The topic of reflux has become a sensitive one these days, as pediatricians have had to recognize that we are over-diagnosing and over-treating infants. It can be hard to tell a tired and worried mom or dad to “just give it time,” but in most cases it proves to be the safest route for infants. Medications like Zantac are being overused to treat reflux and can be harmful to infants. It’s an issue that was addressed at a recent Nemours conference, “Hot Topics in Pediatrics.” Here’s what you should know about medications such as Zantac:
- They do not stop the amount of stuff that’s coming back up, just the type of stuff that’s coming back up. So while it might burn less, the infants are spitting up just as much food.
- They do not help the atypical symptoms, such as cough or other respiratory symptoms.
- They may put your infant at increased risk of colds and stomach viruses. By changing the acidity of your infant’s reflux, these medications alter the beneficial environment in his stomach that inhibits the growth of harmful viruses.
