Acid reflux, or “spitting up,” is very common among infants. Because the ring of muscle between the esophagus and the stomach (lower esophageal sphincter) is not yet mature in infants, it is unable to effectively hold stomach contents down. Spit up can also occur when your baby simply drinks too much and too fast, creating air bubbles in the esophagus which push liquid up and out of baby’s mouth.
Although infant acid reflux most often occurs after feeding, it can happen anytime your baby coughs, cries or strains. Signs and symptoms of infant acid reflux include:
- spitting up
- irritability during or after feedings
- refusing to eat
- crying when placed on his or her back, especially after a feeding
- in severe cases, your baby may arch his or her back while crying and this may look like your baby is having a seizure.
To minimize reflux, consider these tips:
- Feed your baby in an upright position. Follow each feeding with 15 to 30 minutes in a sitting position. Gravity helps stomach contents stay down. Be careful not to jostle or jiggle your baby while the food is settling.
- Try smaller, more frequent feedings.
- Frequent burps during and after each feeding can keep air from building up in your baby's stomach. To burp, sit your baby upright, supporting his or her head with your hand. Avoid burping your baby over your shoulder, which puts pressure on your baby's abdomen.
- If you're using a bottle, make sure the hole in the nipple is the right size. If it's too large, the milk will flow too fast. If it's too small, your baby may get frustrated and gulp air. A nipple hole that's the right size will allow a few drops of milk to fall out when you hold the bottle upside down.
- Ask your doctor about thickening your baby’s formula or breast milk. If your doctor approves, add a small amount of rice cereal to your baby's formula or expressed breast milk. You may need to enlarge the hole in the nipple to make sure your baby can drink the thickened liquid.
When to be concerned
If your baby spits up, but is happy and smiling, you shouldn’t worry as most cases clear up on their own around 12 to 18 months of age, without causing problems for your baby.
Some symptoms, however, may indicate more serious conditions, such as gastroesophageal reflux disease (GERD) or pyloric stenosis. Contact your doctor right away if your baby has any of these symptoms:
- Isn't gaining weight
- Repeatedly spits up forcefully, causing stomach contents to shoot out of his or her mouth
- Spits up green or yellow fluid
- Spits up blood or a material that looks like coffee grounds
- Repeatedly resists feedings
- Has blood in his or her stool
- Has other signs of illness, such as fever, diarrhea or difficulty breathing
- Begins vomiting at age 6 months or older
- Severe abdominal pain