Q: My baby has acid reflux and his pediatrician put him on Zantac and told me to add cereal to his soy formula. He is still spitting up after almost every feeding... a lot. Why is this and what can I do to help him?
A: Reflux (excessive spitting up or vomiting) it a common issue with infants. The spit up is caused by the muscle at the top of the infant's stomach simply relaxing at the wrong time. The spitting up usually gets worse as the child becomes more active during the first few months of life and gets better as they eat more solid foods and spend more time sitting and standing up.
Try simple changes first: burp the infant frequently during and after feeds, keep the baby upright for at least 30 minutes after each feed, and feed smaller amounts more often. A baby's stomach is roughly the size of their closed fist and overfeeding is a common cause of spitting up. For some infants making the formula heavier with rice cereal or oatmeal may lead to less spit up but can also lead to excessive weight gain as it will add calories. For a small number of infants changing to a hypoallergenic formula (such as Nutramagen or Alimentum) may be help. Give each formula at least a two week trial to see if it is helpful. Ask your pediatrician for their reccomendations prior to adding cereal or changing formulas.
The spit up is usually not acidic so acid reducers and acid blockers may or may not help with fussiness and do little for the actual amount being spit up. If your infant is happy and gaining weight well nothing further (other than more laundry) needs to be done and things should get better with time. If your baby is fussy for hours every day, not growing well, or the spit up is projectile more workup may be appropriate.
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