Spitting is par for the course in babies as new parents well know. If your baby is spitting up, it’s usually nothing to worry about.
But occasionally, frequent and persistent spitting up accompanied by other symptoms or poor weight gain can be an indication that your baby has acid reflux, or GERD. Here's how you can tell the difference between normal spitting up in babies and GERD.
What is infant acid reflux (GERD)?
Gastroesophageal reflux disease, or GERD, is similar to heartburn (acid reflux) in adults. Normally when swallowing, the esophagus propels food or liquid down to the stomach by a series of squeezes. In the stomach, the food is digested by acid. When this mixing occurs, the band of muscles at the lower end of the esophagus becomes tight, sealing off the food from coming back up.
But in infants, the area between the esophagus and stomach is underdeveloped, which means the muscles there relax when they should be contracting. This allows milk and stomach acid to come back up into the esophagus and sometimes the back of the throat, causing symptoms of GERD.
Keep in mind that GERD is not nearly as common as GER (gastrointestinal reflux) — a fancy term for spitting up. A majority of babies have some form of GER in the first year. While reflux is normal, it is considered a disease, or GERD when the reflux is associated with other symptoms or complications such as poor weight gain.
Signs of acid reflux in babies
Symptoms of newborn acid reflux usually first show up between weeks 2 and 4. They tend to peak around 4 months and begin to subside around 7 months, when baby begins to sit upright and take more solid foods.
Talk to your pediatrician if your baby is experiencing symptoms like:
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- Frequent spitting up or vomiting (sometimes forcefully)
- Vomiting that contains blood
- Gurgling, congested or wheezing sounds during feedings
- Excessive drooling
- Sudden or inconsolable crying (usually due to pain)
- More than the usual fussiness
- Arching of the back during feeding (again, because of pain)
- Erratic feeding patterns (baby refuses food, or eats constantly)
- Slow weight gain
- Poor sleep
Breastfeeding and GERD
If it’s possible, aim to breastfeed (or pump and bottle-feed your baby breast milk), since GERD is usually less severe in breastfed babies. That’s because breast milk is more easily and quickly digested than formula.
But if you choose not to breastfeed, don’t stress: Home remedies as well as medications, if necessary, can help soothe GERD symptoms.
How to soothe baby acid reflux
GERD treatment and home remedies for GERD aim to help baby feel better until she outgrows her infant reflux, but they don't cure the condition. Try following these tips:
- Feed frequently and avoid overfeeding. Instead of larger, less frequent feedings, offer smaller amounts of breast milk or formula more often, which can help combat newborn acid reflux.
- Switch formulas and bottles. If your baby is formula-feeding, ask your doctor if you should switch to a different kind, and use a slow-flow nipple.
- Practice the right after-feeding etiquette. Try to burp baby, and avoid active play (like bouncing baby) right after feedings to help alleviate symptoms of GERD.You can also offer a pacifier when you’re done feeding, since sucking may soothe her.
- Prop baby upright. If possible, try to feed baby upright and prop her up for 20 to 30 minutes afterward. Never use sleep positioners or wedges, even those marketed for babies with GERD, since they’re considered a SIDS hazard.
- Talk to the doctor. Your practitioner can provide some additional tactics to try, like thickening feeds or trying a different formula. When those other tactics don’t work, some medications can safely help reduce or neutralize stomach acids (like Pepcid or Prevacid). Just keep in mind that they can occasionally cause side effects and should only be used with a doctor’s supervision in babies with GERD, not in babies with ordinary GER. You can also talk to your doctor about giving your child probiotics, which are available as drops for infants who are breastfeeding or as powder that mixes into baby’s bottle. If you’re formula-feeding, you can use a formula that already has probiotics mixed in, but again, check with your pediatrician first.
Possible effects of acid reflux in infants
Choking
Choking — i.e. gagging — during feedings can be a sign of newborn acid reflux or GERD, since some of the contents of the stomach back up into the esophagus.
If your baby seems to be choking during or after feedings, try the home treatments and remedies outlined above (particularly feeding baby in an upright position and propping her up afterwards). If those strategies don’t help, talk to your doctor.
Nasal congestion
Nasal congestion can also be a symptom of infant GERD. Though experts aren’t sure exactly why the two are linked, stomach acids could reach the back of the nasal cavity in babies with GERD, causing inflammation (and therefore stuffiness) of the nasal passages.
If your baby has nasal congestion along with other symptoms of GERD, try home remedies for GERD and talk to your doctor about medications. In the meantime, if congestion is severe, try these tactics for stuffy nose relief.
Pyloric stenosis versus GERD
If your newborn projectile vomits in the first few months of life, keep an eye out for symptoms of pyloric stenosis, since it can sometimes be confused with GERD in infants.
In addition to forceful vomiting at feedings, symptoms of pyloric stenosis include constant hunger, dehydration, constipation and, rarely, blood in the vomit. While uncommon, the condition — characterized by a narrowing of the opening at the bottom of the stomach — does require diagnosis by a doctor and surgery to treat it.
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