A: If your baby's spitting up several times a day, he probably has GER, also known as gastroesophageal reflux (it's the same thing as heartburn in adults). GER is extremely common in infants, but these lifestyle and feeding changes may help minimize the spit-up: - Keep your baby as upright as possible during feedings. Frequent, small feedings are often recommended to decrease reflux because there's simply less food for your baby to regurgitate. Some babies with GER will even self-regulate, preferring to drink small amounts often, although others with reflux cry if their hunger isn't satisfied and insist on taking a full feeding. - Avoid bouncing and jostling your baby after meals. Instead, keep her quiet and upright for about 30 minutes after feedings. If you don't have time to hold her upright, carry her in a front pack or prop her in a swing. - Don't smoke. You already know it's bad for you, but smoking also triggers reflux by boosting your baby's stomach acid secretions and loosening the muscles that prevent them from coming up. - Keep your baby's diaper loose to reduce pressure on his belly, and avoid changing his diaper right after he eats, as laying him on his back or bending him at the waist during a diaper change can provoke spitting. - If you're using formula, check with your pediatrician about thickening baby's feedings by adding rice cereal (up to 1 tablespoon of dry rice cereal for each 1 to 2 ounces of milk) if he's older than 4 months. This increases the caloric content of feedings, which lets you feed your baby less food overall. The thickened formula, which may need to be fed through a cross-cut nipple (widening nipples isn't recommended for other formula), decreases episodes of reflux. Some formulas are available (such as Enfamil AR) with added rice cereal that thickens when it reaches the stomach. - Although reflux is most likely to occur when a baby is on his back, this sleeping position is recommended to reduce the risk of crib death. Elevating the head of the crib (by sticking a wedge under the mattress) may help decrease reflux during sleep, as will giving your baby tummy time after feedings when he's awake. If frequent reflux causes injury to the lining of the esophagus, the baby can develop additional symptoms and complications, known as gastroesophageal reflux disease, or GERD. If your infant cries excessively, doesn't eat well, or has difficulty sleeping, GERD may be the cause. During feedings, infants with GERD often appear irritable and uncomfortable, frequently arching while pulling away from the breast or bottle, presumably due to heartburn. Babies with GERD may also gain weight slowly, due to difficulty feeding or excessive loss of nutrients from frequent regurgitation. Other symptoms of GERD include coughing, wheezing, choking, and gagging. These respiratory symptoms are the result of acid irritation of the airways and inflammation in the lungs. Constant reflux increases the risk that stomach contents can enter the windpipe through inhalation, and can ultimately cause pneumonia. To further compound these potential complications, anemia can be yet another risk because of bleeding from the damaged esophagus. There's no single test to confirm that a baby has GERD. The diagnosis is often made after an infant is referred to a pediatric gastroenterologist for severe reflux.
Originally published in American Baby magazine, August 2005. Updated 2009.