Spitting up — normal or not?
Parents often come to the Pediatrician with concerns about their baby’s reflux, or “spitting up.” Nearly every infant spits up, but, often, parents are worried about it. When is spitting up normal and when should we be concerned?
Babies’ bodies still need to develop, and one of the areas that needs developing is the esophageal sphincter, which is the muscle that keeps the opening between the esophagus (or “food tube”) and the stomach closed. Since that muscle is open more than it would be in an adult or older child, babies regurgitate their food, which, in the first 4-6 months is breastmilk or formula. If a baby is eating well, gaining weight as expected, having a normal number of wet and dirty diapers a day and doesn’t seem like the spitting up is painful or causing distress, there is no reason for alarm. We even have a term for happy, healthy babies who reflux: “happy spitters.” Some babies even smile or laugh while they spit up!
In fact, normal reflux in babies might actually serve protective functions, such as exposing babies even more to the protective immune factors present in breast milk and protecting against overfeeding. Additionally, normal reflux in babies is usually not “acid reflux,” as it is normally only weakly acidic (or even weakly alkaline), as opposed to the truly acidic content we would expect to see in older children and adults. [ 1 ]
Giving baby smaller, more frequent feeds and using paced bottle feeding, if feeding with a bottle, may help reduce spitting up. Keeping baby upright for at least 30 minutes after feeds and keeping baby in an upright position for feeding and carrying may also help. Frequent burping and paying attention to how much gulping or air swallowing baby does during feeds as well as baby massage may also be helpful for some little ones. Additionally, probiotics like L. reuteri DSM 17938 may help reflux [ 2, 3 ], and also may possibly improve constipation and crying time as well! [ 2 ]. Breastfeeding is also protective against reflux (so don’t change to a “reflux formula” instead of breastmilk)! Thickening feeds can help reduce the incidence of spitting up and vomiting, but typically a baby on thickened feeds is still regurgitating. The spit up just stays in the esophagus (food tube) instead of rising all the way up and coming out of their mouth. For this reason, thickening feeds is no longer as common of a recommendation, since it doesn’t really solve the problem.
Much more rarely, however, reflux can actually be a problem. Babies who do not feed well, who are not gaining weight well, who seem to be in pain or distress when they spit up, who are not having enough wet or dirty diapers a day, who have bright green, bright yellow, bloody spit up or spit up that looks like it has coffee grounds in it, or who have abnormal stool (like bloody, black, or white stool) should be seen by their Pediatrician, as they may actually have GERD (Gastro-Esophageal Reflux Disease) or another problem. Additionally, babies who start spitting up at 6 months of age or older or who are still spitting up at 12 months or older should be seen by their doctor.
Having reflux DOES NOT mean your baby has GERD! But if you see any of the above signs (in the previous paragraph), it is very important to get your little one evaluated by their doctor asap.
For the most part, though, reflux tends to be a laundry problem and nothing more. Almost all babies stop spitting up by 12 months of age, and it frequently resolves even earlier — around when baby starts sitting up consistently. So give your happy spitter a big (perhaps messy) hug and enjoy this special time!
References
https://pubmed.ncbi.nlm.nih.gov/16831894/
https://jamanetwork.com/journals/jamapediatrics/fullarticle/1812293
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8710121/
Photo credit: https://www.freepik.com/photos/toddler