Clinical Reference Systems: Pediatric Advisor 10.0
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Description

Spitting up (also called reflux or regurgitation) is the effortless spitting up of one or two mouthfuls of stomach contents. Formula or breast milk just rolls out of the mouth, often with a burp. It usually happens during or shortly after feedings. It begins in the first weeks of life. More than half of all infants spit up to some degree.

Spitting up is harmless as long as your infant doesn't spit up large amounts that interfere with normal weight gain.

This condition is also called gastroesophageal reflux (GE reflux) or chalasia.

Cause

Spitting up results from poor closure of the valve (ring of muscle) at the upper end of the stomach.

Expected Course

Spitting up improves with age. By 7 months of age, most reflux has decreased or is gone. The reasons for this are probably because the baby is old enough to sit up or is eating solid foods. By the time your baby has been walking for 3 months, even severe reflux should be totally cleared up.

Home Care

1. Feed smaller amounts.

   Overfeeding always makes spitting up worse. If the stomach is filled to capacity, spitting up is more likely. Give your baby smaller amounts (at least 1 ounce less than you have been giving). Your baby doesn't have to finish a bottle. Wait at least 2 and 1/2 hours between feedings because it takes that long for the stomach to empty itself.

2. Avoid pressure on your child's abdomen.

   Avoid tight diapers. They put added pressure on the stomach. Don't double your child up during diaper changes. Don't let people hug your child or play vigorously with him right after meals.

3. Burp your child to reduce spitting up.

   Burp your baby two or three times during each feeding. Do it when he pauses and looks around. Don't interrupt his feeding rhythm in order to burp him. Keep in mind that burping is less important than giving smaller feedings and avoiding tight diapers.

4. Keep your child in a vertical position after meals.

   After meals, try to keep your baby in an upright position using a frontpack, backpack, or swing for 30 minutes. When your infant is in an infant seat, keep him from getting scrunched up by putting a pad under his buttocks so he's more stretched out. After your child is over 6 months old, a jumpy seat or walker can be helpful for maintaining an upright posture after meals. To make the walker safe, remove the wheels or buy one without wheels.

5. Use a proper sleep position.

   Most infants with spitting up can sleep on their back, the position recommended by the American Academy of Pediatrics to reduce the risk of SIDS. Another option for severe reflux is sleeping on the right side. If the esophagus becomes irritated (esophagitis), talk to your doctor about sleeping prone (face-down). Try to elevate the head of the bed a bit.

6. Clean up messes.

   One of the worst aspects of spitting up in the past was the odor. This was caused by the effect of stomach acid on the butterfat in cow's milk. The odor is not present with commercial formulas because they contain vegetable oils. A more common concern is clothing stains from milk spots. Use the powdered formulas; they stain the least. Also, don't pick up your child when you have your best clothes on. Try to confine your baby to areas without rugs (for example, the kitchen).

Call Your Child's Physician Immediately If:

• Any blood is seen in the spit-up material.
• The spitting up causes your child to choke or cough.

Call Your Child's Physician During Office Hours If:

• Your baby doesn't seem to improve with this approach.
• Your baby does not gain weight normally.
• You have other concerns or questions.