General Health & Wellness • Oct 24, 2011

Acid Reflux: When is it more than just spit up?

Spitting up is a common complaint during infancy.  My daughter would spit up after each feeding.  She was exclusively breast fed and would spit up immediately after every feed.  She was my first baby and I was convinced she was starving since she was spitting up so much.  She was never fussy, never had forceful vomiting, and was gaining weight despite all the spit ups.  I was reassured by my pediatrician that my “chubby baby” was indeed healthy and she was spitting up due to gastro esophageal reflux.  My daughter did not require any treatment and outgrew her symptoms by 12 months of age.

 What is gastro esophageal reflux (GER)?  It is just a medical term for spitting up.  It happens because the stomach contents flow back into the esophagus or into the mouth.  It occurs most often after a feed but can also occur when your baby coughs, cries or strains.  Most babies outgrow this by 18-24 months of age.  Most babies with GER are healthy and no tests or treatment is necessary. 

If your baby is fussy and is bothered by the spitting up, a few measures can improve the symptoms.  

  • If your baby is bottle fed, thicken feeds in the bottle–add up to 1 tablespoon of rice cereal to 2 ounces of infant milk. You can add cereal to expressed milk if you are breastfeeding. 
  •  Burp your baby after feeding 1 or 2 ounces of formula. For breast-fed infants, burp after feeding on each side.
  • Do not overfeed.
  • If possible, hold your baby upright in your arms for 30 minutes after feedings.

When to call the doctor?

  • If it is more than spit up—there is large or forceful vomiting
  • vomiting fluid that is green,  that looks like coffee grounds or blood
  • difficulty breathing after vomiting or spitting up
  • there is weight loss or poor weight gain
  • excessive crying and irritability

 My son was also a spitty baby but his symptoms were slightly different.   He would spit up frequently, was very fussy and spit ups would be accompanied by cough.  He also would frequently arch his back and cry as if he was in pain.  His symptoms were more suggestive of gastro esophageal reflux disease (GERD).  

 What is gastro esophageal reflux disease (GERD)?

 Reflux becomes GERD when the acid in the reflux irritates or injures the esophagus.  This only happens in a SMALL percentage of babies who spit up.  Symptoms that suggest that your baby has GERD are:

  • fussiness/refusal to eat
  • frequent spit up/vomiting
  • frequent crying
  • arching of the back or neck as if in pain
  • poor weight gain
  • frequent coughing or wheezing

How do you diagnose GERD?

Diagnosis is based on medical history and physical examination.  Your doctor may order some tests which include:

  • Lab tests: May include blood and urine tests to rule out other causes of frequent vomiting and poor weight gain
  • Chest X-ray:  If there is concern for aspiration of stomach contents into the lungs from the history and exam.
  • Esophageal pH monitoring. To determine if the fussiness and other symptoms are caused by GERD, a thin tube inserted through your baby’s nose or mouth into the esophagus. The tube is attached to a device that monitors acidity. A diary is kept of symptoms during a 24 hour period and is compared with the pH reading to determine if the symptoms are due to acidity in the esophagus. 
  • Upper GI series. A test to determine if the vomiting is due to obstruction in the upper part of the digestive system.  Your baby is given white liquid called barium to drink and then X-rays are taken.  The barium coats the inside of the organs which will show up on X-ray and any abnormalities can be detected. 
  • Upper endoscopy.  A test to look directly into the esophagus and stomach using a special tube with a light and camera at the end (endoscope).  Tissue samples can also be taken during this test.  For infants and children, endoscopy is usually done under general anesthesia.

How do you treat GERD?

It depends on the severity and the impact on weight gain and symptoms.  As always, start with conservative measures such as that described above for GER.  Diet changes for the breast feeding mother may also be helpful.  If conservative measures fail, your doctor may prescribe medications similar to those used for heartburn in adults.  These medications may include H-2 blockers, such as cimetidine (Tagamet) or ranitidine (Zantac), or proton pump inhibitors, such as omeprazole (Prilosec) or lansoprazole (Prevacid).  If your baby is not growing well, higher calorie feeding or feeding tube may be recommended.  Rarely, a surgical procedure called fundoplication may be performed. 

More information for GERD can be found by clicking here.