Reflux/spitting up in infants

It is not uncommon to wind/burp a baby and have some altered milk returned with the process. Some babies are known as "happy spitters" and from the begining these babies return mouthfulls of altered feed when they are encouraged to release any wind they may have swallowed. If this is an occasional rather than an regular occurance then there is no need to take any action. Other children suffer from gastro oesophageal reflux (GERD) to a degree that makes them very uncomfortable. Imagine having persistent heartburn which worsens with feeding. This makes feeding a much less comforting and enjoyable experience.

What causes this problem?

In newborn babies, and especially in babies born before their due date, the gastric tract can be immature and the muscles at the top of the stomach are less efficient than they should be. These muscles are there to allow air out but keep feeds, which are mixed with the acids in the stomach, in their place. When they are less efficient semi digested food is returned with the acids of the stomach, to the oesophagus and to the outside world. Over time, if this is untreated, asthma can result. For many years thickeners were added to feeds in an attempt to reduce reflux but research shows that this is totally ineffective and only results in increasing the time that food remains in the stomach.

What are the symptoms?

The most common include :-

Frequent spitting up or vomiting
Irritability when feeding
Refusing food or eating only small amounts
Sudden or constant crying
Arching the back while feeding
"Wet" burps
Frequent hiccups
Frequent coughing
Poor sleep habits with frequent waking

Bad breath

What can I do about this?

Give baby smaller feeds more regularly.

Wind/burp baby regularly during a feed.

Keep baby upright for 30-45 minutes after a feed and gravity will help keep feeds down.

Put baby down to sleep on his/her back but raise the mattress by putting a pillow or folded towel underneath the mattress so that there is a slope keeping baby's head slightly higher than baby's feet.

Do not thicken baby's feeds. This does not work and can result in other problems. Starting semi solid feeds early does not help and can increase the risk of allergy or other gastric problems. If baby is consistently upset by reflux do see your Doctor because there are suitable medications which will help. By the age of one year many babies will no longer have symptoms.