Stop stressing -- most likely everything is just fine. Almost all babies have gastroesophageal reflux (GER), usually just called reflux. "Seventy percent of infants under 3 months will spit up three times a day, and it's even perfectly normal for them to be spitting up as often as 10 or 12 times," says William Byrne, MD, chief of pediatric gastroenterology at Doernbecher Children's Hospital, in Portland, Oregon. The most common reason is that the muscle at the bottom of the esophagus, which opens and closes to let food into the stomach, is still very weak at this age -- so it's easy for stomach contents to escape and come back up. Your baby is most likely to spit up after a feeding, but this can also happen when she cries or coughs forcefully.
Yes, your baby is probably taking in enough. Your pediatrician will evaluate your infant's weight gain at his well-baby checkups. If everything's on track, that means he's getting the calories he needs. It may seem like his whole meal is coming back up, but it's likely less than a tablespoon, says Dr. Byrne. So don't "top off" your baby with more milk if he spits up after eating. In fact, overfeeding can lead to even more reflux.
If your baby refuses to eat to begin with, reflux may be the culprit. It's possible that the stomach acids flowing back up the esophagus are causing it to redden and swell. An irritated esophagus hurts, and it can discourage some infants from eating. So talk to your pediatrician if your child seems to have a poor appetite. He might diagnose your baby with gastroesophageal reflux disease (GERD) -- see "What is GERD?"
No, but you can try to minimize it. An overly full belly is a major cause of reflux, so avoid overfeeding her, says Aeri Moon, MD, a pediatric gastroenterologist in New York City. And swallowing too much air while eating leads to gas bubbles in the stomach that can trap some of her meal. When the air comes back up as a burp, so does the breast milk or formula. Ensuring that your baby is latched on correctly and burping her before, throughout, and after each feeding can help reduce this problem. If she's formula-fed, consider using a product that reduces bottle-induced gas, such as Playtex Drop-Ins (the liners collapse as your baby sucks) or Evenflo Comfi Nurser Bottles. If your baby is 4 months or older and your pediatrician approves, you can try thickening the formula to help it sit better in her stomach (mix in a tablespoon of rice cereal for every 4 ounces of formula).
Gravity is on your side when it comes to reflux, and it can make a big difference in helping food stay down. Keep your baby in an upright position and as still as possible for at least 30 minutes following each feeding so that the food can travel out of the stomach and into the small intestine. Reduce spit-up at night and during naps by putting a wedge under the head of the mattress so that she sleeps at a 30-degree angle. (Never put the pillow directly under her head because of suffocation risks.)
Don't worry, the day will come when you won't need to do laundry after every feeding. While it may seem like your baby is spitting up more as he gets older, that's only because he's eating more. GER symptoms tend to decrease around 6 months, once your baby's digestive system has matured and he starts sitting upright and eating solid foods. By the time your child is 12 months old the problem will probably have tapered off completely, although a few babies continue spitting up until 24 months. But don't be surprised if it gets worse before it gets better; some children's symptoms reappear when they learn to crawl and their stomach contents shift around.
GER isn't something to worry about -- even the healthiest babies have it. But when a child develops problems or pain due to the condition, it's known as gastroesophageal reflux disease, or GERD, a more serious condition. If your baby won't eat, isn't gaining weight, is extremely irritable, suffers from forceful projectile vomiting, or develops respiratory problems from aspirating food, he may have GERD. The condition can't be cured, but it can be treated. However, if tests don't indicate GERD, you should skip the meds. A new study published in Pediatrics found that antireflux medications are being overprescribed for infants whose test results indicate GER, not GERD -- and in these cases the medication has no effect.
Copyright © 2008. Used with permission from the February 2008 issue of Parents magazine.
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