It's Messy, but Parents Can Relax about Reflux
By Sam Smith, MD, Surgeon in Chief, Arkansas Children's Hospital
Babies are pure joy – but boy can they be a mess! All expectant parents know they'll encounter spit-up during that first year, but many are surprised by how much and how often spit-up dribbles from their little one's mouth. Moms and dads can relax, though, because reflux is completely normal in young infants.
To understand why babies spit up so much, it's helpful to know more about their anatomy. We all have a muscular valve at the top of the stomach that acts as a kind of door to the esophagus above. It opens back and forth to let food travel down to the stomach and then to keep the contents like food and acid in place. Because this muscle isn't fully developed in babies, it flops a little bit and food comes spilling back up.
The majority of babies with reflux are what we call "happy spitters." They spit up after just about every meal, but they don't cry or fuss when they do. They're fairly content after a bottle or nursing; they just leave a lot of that meal behind. If the baby is gaining weight and seems to be thriving, there is little to worry about. Spit-up is, of course, inconvenient for whoever happens to be holding the little bundle of joy when it happens – but it's unlikely to cause any problems beyond extra loads of laundry.
In these cases, symptoms can be helped with a few steps:
- Giving smaller more frequent meals to avoid overfeeding;
- Burping the infant often; and
- Keeping the infant in an upright position for about 30 minutes following feedings.
If a baby refuses meals or consistently screams after feeding, a pediatrician may work with the family to change what the baby eats. For breastfed newborns, this may mean Mom has to cut out certain foods from her own diet. If a child is formula-fed, the parents may try a different brand or a variety that is formulated for babies who have bad reflux. Thickeners may be another solution.
If diet changes aren't helpful, a pediatrician may prescribe medicine – usually the same kind of treatment adults take for heartburn, but in a carefully calculated liquid dose for infants.
If, however, reflux seems to worsen, it's possible that the baby has severe gastroesophageal reflux disease. This is basically a more extreme case of reflux in which the esophagus muscles relaxes too much. In some of the cases the reflux is so severe that despite medicine and other treatments, the baby doesn't gain weight or even loses weight. Pediatricians call this "failure to thrive." In other cases wheezing or other breathing problems can occur from the reflux irritating the breathing tube in children. If your child's doctor notices these issues, he or she will begin to look at why the reflux is so severe and whether surgical treatment could be helpful
Here at Arkansas Children's Hospital we have another condition called pyloric stenosis that presents with forceful vomiting in babies that can be confused with reflux. This condition occurs when the lower stomach muscles or pylorus swells, essentially narrowing the channel that allows digested food to pass from the stomach to the intestines. This leads to an obstruction, and the food has to go back up. Symptoms of pyloric stenosis usually appear between three to five weeks after birth and is often described as projectile vomiting of formula. The Nemours Foundation estimates that three in 1,000 babies develop this condition, which is more common in boys and tends to run in families.
These kids will require surgical intervention. We perform several of these procedures at ACH almost every week, and most babies resume eating within hours and go home the next day after surgery.
While the spectrum of issues associated with reflux is wide, the majority of babies will not face complications. Infants will generally outgrow their habit of spitting up by the time they're about 9 months old.
As long as the baby is otherwise healthy, parents just need to have a little patience in the meantime – and maybe a few extra dollars in their dry cleaning budget!
Here's another tip: Be sure to download the new MyACH iPhone app, free from Arkansas Children's Hospital in the App Store. Everything a busy parent needs – from a health library to storage for your child's health info, insurance, medications and more.
Sam Smith, MD, is surgeon in chief at Arkansas Children's Hospital and a professor of Surgery at the University of Arkansas for Medical Sciences. He writes a column each week covering a variety of kids' medical concerns. If you have a topic you'd like him to consider addressing, email firstname.lastname@example.org.