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Baby
BABY SPIT-UP: WHAT'S NORMAL, WHAT'S NOT
By Graciela Wetzler, M.D.
As a pediatric gastroenterologist, the majority of calls I receive
are from worried parents whose baby is vomiting. The baby may
regurgitate once a day, or after every feeding. In fact, 40 percent of
healthy infants regurgitate more than once a day. Usually, he or she is
content and is gaining weight -- we call them "happy spitters" -- but
the parents are nervous wrecks. They complain that their clothing is
stained, their carpets smell, and they're worried that something is
seriously wrong with the baby's digestive system. Although in rare
instances vomiting may be a sign of a real problem, in most cases it is
a benign and transient symptom.
To understand the difference, a short lesson in anatomy:
After
a baby swallows food (breast milk, formula or solid food), the food
travels through the esophagus into the stomach and then to the small
intestine. There is a physiologic valve, called the lower esophageal
sphincter, which prevents food from coming back into the esophagus from
the stomach. For many babies, this valve relaxes at the wrong time,
causing regurgitation. Some babies, especially premature ones, have
delayed gastric emptying (I call this "lazy stomach"), which aggravates
the problem.
When the regurgitation problem is severe, it's
called Gastroesophageal Reflux Disease (GERD). The disease is
associated with poor weight gain (due to lack of caloric intake),
excessive crying, choking and even respiratory symptoms (such as
wheezing, coughing, hoarseness, or pneumonia). Like an adult who has
heartburn, your infant may cry due to excess acid in his esophagus.
There may also be arching, hiccups, funny faces (such as tongue
extrusion) and feeding difficulties (such as pushing the nipple away).
Gagging or choking can be dangerous in young babies since they may stop
breathing and turn blue. What makes GERD a complex disease is that some
babies may have frequent vomiting without any of the associated
symptoms, and others may have the associated symptoms without any
vomiting. When vomiting is absent, but there is excessive crying due to
acid production, GERD is often misdiagnosed as colic.
For the
vast majority of babies -- the happy spitters -- the regurgitation
symptom peaks by four months of age and usually resolves by the first
birthday. As long as your baby appears healthy and is gaining weight,
you can be reassured that she will outgrow the problem.
In the meantime, here are a few tips to help an infant who vomits:
- Avoid overfeeding Smaller and more frequent feedings will empty the stomach faster.
- Minimize intake of air during feeding If the bottle is too low, the baby can swallow air, causing gas and crying.
- Don't jiggle the baby during and after feeding Too much movement may cause reflux.
- Sit her in an upright position after feeding Sitting and lying on the back makes reflux worse. Hold the baby in your arms as much as you can.
- Elevate the crib at a 30-degree angle I suggest using a book under the legs at the head of the crib. Do not use pillows since this can cause suffocation.
- With your pediatrician's approval, put a baby with severe GERD to sleep on her tummy
The American Academy of Pediatrics recommends that babies sleep on
their backs in order to avoid SIDS. There is an exemption for babies
with severe GERD, since it can improve gastric emptying. Only follow this under doctor's orders.
- Avoid exposure to tobacco smoke This relaxes the esophageal sphincter.
- Thicken formula with rice cereal Add one tablespoon of
rice cereal for every two ounces of formula and cross-cut the nipple to
facilitate the flow of this mixture. Although this may improve reflux,
it can cause excessive gas and constipation. Consult your doctor before
trying.
When these lifestyle measures do not improve the symptom of
vomiting, the following medical therapies are available, but should
only be tried under doctor's advice:
- Antacids Maalox and Mylanta are over-the-counter drugs, and Zantac liquid is available by prescription.
- Drugs to improve gastric emptying The most popular
drug, Propulsid, is no longer available due to dangerous side effects.
But another drug, Reglan, is available, but has side effects that must
be considered.
- Hypoallergenic formula Babies who are allergic to cow's
or soy milk may require a different formula. Breast-feeding mothers
should go on a milk-free diet with calcium supplement.
Top
About The Author
Graciela Wetzler, MD, is a pediatric gastroenterologist at Maimonides Medical Center in Brooklyn, New York.
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