Gastroesophageal Reflux Disease (GERD)
Graciela Wetzler, MD
Director, Pediatric Gastroenterology & Nutrition
The majority of calls we receive are from worried parents who are concerned whether their baby’s spit-up is normal. The baby may regurgitate once a day or after every feeding. In fact, 40 percent of healthy babies spit up more than once a day. Usually, he or she is content and is gaining weight -- we call them “happy spitters” -- but the parents are nervous wrecks. They complain that their clothing is stained, their carpets smell, and they’re worried that something is seriously wrong with the baby’s digestive system. Although in rare instances spit-up may be a sign of a real problem, in most cases it is a normal, benign, transient symptom.
After a baby swallows food (breast milk, formula or solid food), the food travels through the esophagus into the stomach and then to the small intestine. The lower esophageal sphincter prevents food from coming back into the esophagus from the stomach. For many healthy babies, this valve relaxes at the wrong time, causing regurgitation. Some babies, especially premature ones, have delayed gastric emptying, which aggravates the problem.
For the vast majority of healthy babies, the spit-up symptom peaks by four months of age and normally resolves by the first birthday. As long as the baby appears healthy and is gaining weight, we can reassure parents that she will outgrow the problem.
Here are a few tips for parents to help an infant who spits up:
- Avoid overfeeding. Smaller and more frequent feedings will empty the stomach faster.
- Minimize intake of air during feeding. If the bottle is too low, the baby can swallow air, causing gas and crying.
- Don’t jiggle the baby during and after feeding. Too much movement may cause reflux.
- Sit her in an upright position after feeding. Sitting and lying on the back makes reflux worse. Hold the baby in your arms as much as you can.
- Elevate the crib at a 30-degree angle. We suggest using a book under the legs at the head of the crib. Do not use pillows, since this can cause suffocation.
- Avoid exposure to tobacco smoke. This relaxes the esophageal sphincter.
- Thicken formula with rice cereal. Add 1 tablespoon of rice cereal for every 2 ounces of formula and cross-cut the nipple to facilitate the flow of this mixture. Although this may improve reflux, it can cause excessive gas and constipation.
When these lifestyle measures do not improve the symptom of spit-up and the regurgitation problem is severe, it may be gastroesophageal reflux disease (GERD). This condition is associated with:
- Poor weight gain (due to lack of caloric intake)
- Excessive crying
- Respiratory symptoms (such as wheezing, coughing, hoarseness, or pneumonia)
- Arching, hiccups, funny faces (such as tongue extrusion)
- Feeding difficulties (such as pushing the nipple away)
- Gagging or choking, which can be dangerous in young babies since they may stop breathing and turn blue
Treatments include antacids, H2 blockers, proton pump inhibitors, and eventually a trial of a hypoallergenic formula. In severe cases, naso-gastric tube feeding may be indicated.