New parents often come in concerned about their baby spitting up. They typically ask, “does my baby have gastroesophageal reflux (GER)?”. I reassure them that “spit happens” and it occurs in more than 2/3 of perfectly healthy infants. Whether you want to call it GER or spit up, it is regurgitation and in most cases it goes away with time.
GER is defined as “the physiologic passage of gastric contents into the esophagus”, while GERD is “reflux associated with troublesome symptoms or complications”. GER in infants is typically painless and does not affect growth. We call these babies “happy spitters”.
For a “happy spitter” parents need to know that spitting gets worse before it gets better and typically lasts for 5-6 months, with the worst spitting occurring around 3-4 months of age.
The best treatment for benign GER is lifestyle management. Small things like thickening feedings with either rice or oatmeal cereal will often decrease the volume of spit up ( parents get sick of wearing towels over their shoulders). Thickening feedings does increase the calories a baby receives. There are also formulas available that contain thickening agents if parents prefer trying them that have the same amount of calories as other formulas. Thickening feeds has been shown to decrease crying time in some irritable infants with GER and also increases sleep time for fussy babies. It is always worth trying.
While many parents try putting their baby in a car seat to help with reflux and spitting, car seats may actually make the problem worse. Infants have less reflux when in the prone (tummy) position, but remember your baby must NEVER sleep on their TUMMY!
Babies who are spitters may also benefit from smaller more frequent feedings. When a baby is fussy, parents may try to keep feeding their baby and overfeeding may actually make the spitting worse. Just because a baby is crying, does not always mean they are hungry, especially if they have just been fed. Sucking in and of itself may help reflux, so a pacifier may be the trick and provide non nutritive sucking.
For babies with GERD who are extremely irritable, may refuse feedings and even lose weight further work up and management with pharmacotherapy may be necessary. Talk to your doctor about options if lifestyle management does not seem to help.