Infant reflux: When your baby constantly spits up

All babies spit up, some more than others. They have immature digestive systems and sometimes the muscle at the top of the stomach isn’t yet strong enough to stop the stomach contents coming back into the gullet or even the mouth (reflux). When reflux begins to get painful and frequent, you may be dealing with gastro-esophageal reflux disease (GERD).

When Luke was two weeks old, he was already showing the typical symptoms of gastro-esophageal reflux disease with constant vomiting. “It was incredibly stressful,” says his mom, Naomi. “It wasn’t just the milk in his stomach coming back up, it was also the acid, which made him scream. He would arch his whole body back in an attempt to lessen the pain.” Refusal to feed is common in babies with severe GERD. “He’d cry because he was hungry, but when he tried to feed it hurt him too much. I began to dread breastfeeding.”

Happy spitters and scrawny screamers

If a baby is otherwise well, happy and gaining weight, most parents and health practitioners consider the reflux a laundry problem rather than a medical issue. But if a baby is showing symptoms of GERD, it’s time to seek help. “We’d go through six changes of clothes on a good day. It was frustrating, but we could cope. However, Luke’s breathing was affected by his reflux. He’d scream constantly. He developed a chronic cough, and we were constantly worrying if he was getting enough milk.” After referral to a paediatrician, a barium swallow test showed Luke had severe reflux with esophageal scarring.

It’s important to see your doctor if your baby isn’t gaining weight, there is blood in the vomit, or there is persistent coughing or chest infections due to stomach fluids getting sucked into the lungs. Usually, no tests will be necessary to diagnose GERD, although a 24-hour ph-Probe study is considered one of the more definitive tests. (A thin flexible probe is inserted to sit just above the stomach to test the amount of acid.)

Once a diagnosis of GERD has been made, there are various medications that can be used to treat it. Antacids are usually tried first and work well with mild cases. Drugs that neutralize acid such as Zantac have been used effectively for more than 20 years, and a newer development is the use of drugs like Prevacid that actually stop acid production. Motility drugs can sometimes be prescribed to help the stomach empty quicker. “Luke was put on Zantac,” says Naomi. “It took a couple of weeks to see the difference and we often had to adjust the dose as it was very weight-specific, but it made such a change to all our lives. Seeing him learn to love food was just the best.”

The great news is that ultimately it’s something 98 percent of babies grow out of, and surgery is necessary only in
the most extreme cases. “Luke was on medication until he turned two, but he’s finally over it and symptom free. We called it the reflux rollercoaster.”

What you can do to help:

  • Minimize spit-ups by keeping your baby as upright as possible, particularly after eating.
  • Keep the head-end of the crib propped up at a thirty-degree angle to reduce reflux episodes.
  • Breastfeed. Breastmilk is digested more easily, so empties out of the stomach quicker.
    Plus, breastfed babies take in less air when feeding.
  • Give small, regular feeds.
  • Once babies are on solids, gravity does a great job of keeping the food in the stomach.
  • Remember that most babies outgrow reflux.

Originally published in ParentsCanada: Best Wishes, Fall 2009.

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