Any parent knows that long nights soothing a sick baby are no fun. You quickly become exhausted as moments of fussiness turn into hours of crying, vomiting and more. What many new parents don’t realize is that the source of their child’s discomfort could be acid reflux. But instead of being able to take an antacid like adults, what options are there for your baby, and how do you really know if infant acid reflux is what’s causing your child’s symptoms and if medical treatment is needed?
Acid reflux, the back-up of acid and stomach contents in the throat, does not just occur in adults, but can happen to kids too. It particularly happens in babies who have weak stomach muscles, spend most of their time lying down and have a primarily liquid-only diet until about 6 months old. Infant acid reflux, or GERD (gastroesophageal reflux disease) as it is often called, can be a natural occurrence in many babies and there is usually no reason for alarm. Studies show that about 50 percent of babies have some type of reflux in the first 3 to 6 months of life.
Infant acid reflux can present itself in a variety of ways. Most commonly babies will have frequent spit up or vomiting. However, it can also cause fussiness, crying, food refusal, choking during feeds, frequent coughing and chest infections. (Remember, it is important that caretakers of babies who cough or choke during feedings learn CPR.)
The “happy spitter,” as we fondly call our little ones who come to UHealth with milk stains from spit up down the front of their clothes, are often growing normally, and do not need any testing or medical intervention. Usually just a few simple precautions can help improve their reflux.
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Measures such as burping your baby halfway through and immediately after feeds can reduce spit up. Also, feeding slowly with appropriate nipple size for age, and keeping your baby upright for 30 minutes after feeds can help the stomach empty easier and reduce spit up. In some cases your doctor might even recommend thickening the formula by adding rice cereal or oatmeal so that the milk is heavier and won’t go up into the throat as easily.
Parents should also remember that their baby’s little tummy is about the size of a baby’s fist and so overfeeding can cause excess spit up. Try giving smaller, more frequent feeds instead of a big bottle all at once. In addition, breastfed babies usually have less reflux because breast milk is easier to digest and absorb, and because babies can control just how much they take in when breastfeeding.
In rare instances, babies may have pain with reflux. The pain is caused by acid irritation of the esophagus (the tube that carries food from your mouth to your stomach). These babies cry during and after feeds or during vomiting. This can be very concerning for parents, but usually improves within a few days with the use of an acid blocker.
Acid blockers are safe for babies. This medication is typically given once daily in the morning on an empty stomach but can be given up to twice daily if needed. It is usually continued until baby’s first birthday.
In the odd instance where a baby does not improve with an acid blocker, is having recurrent chest infections or problems drinking milk or gaining weight, there may be another underlying cause for the reflux, like an allergy to milk. These babies should be investigated further by their pediatrician or pediatric gastroenterologist. Occasionally your doctor may recommend further testing or may switch your baby to a different formula.
Acid reflux in babies, though disheartening for parents, can be a normal part of your baby’s development. It is typically worse during 4 to 6 months of age and improves by about 10 to 12 months as your baby starts taking more solid food, is able to sit up and walk, and his or her stomach muscles get stronger. More than 80 percent of babies will outgrow their reflux by their first birthday.
Even though changing clothes every two to three hours with spit up might be a cause of distress for parents, for most babies, reflux is usually not a sign of any serious underlying medical condition. Your baby will get the hang of keeping food in his or her tummy in no time. If you are concerned your baby has infant acid reflux and needs medical evaluation, call (305) 243-3166, or visit pediatrics.med.miami.edu/gastroenterology.
Amanda C. Fifi, M.D., is a pediatrician who specializes in gastroenterology at UHealth – the University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics.