Reflux

There is this fine line between worrisome reflux and spitting up in babies and infants.  All babies spit up.  They need to at times.  Their stomachs are basically the size and elasticity of a small water balloon with an open end.  If you fill up that water balloon and then tip it one way or another, some of that liquid is going to come out.  Or, if you over fill that water balloon, liquid is easily going to come out the top.  That is what normal spit up is in babies, nature’s natural pop-off valve for little ones who don’t really know how big their tummy is and can’t let you know at 2 months old that they are quite full.  What parents should see for normal spit up is basically a few drops, to a few tablespoons, to even what seems like a whole bottle of milk coming up with a burp, hiccup, or tummy squeeze.  The kiddo should care less as there isn’t much muscle involvement.  They’ll spit up and smile at you while you groan because you now have to change your clothes for the 4th time that day.  That is what we call a “happy spitter”. 

Now, if parents tell me that their kiddo is spitting up, but it looks painful or that their kiddo is spitting up more than a few tablespoons of milk after each feed no matter what parents do for burping or taking breaks from feeds, then that sounds more like gastroesophageal reflux or GERD.  What do we do for babies with GERD?  If they are otherwise growing well and acting well, then not much other than smaller feeds more often and taking pauses with longer burp breaks. We will give their stomach time to get bigger and more muscular to help retain liquid.  If a kiddo is not gaining weight, then we often investigate possible issues with the GI tract itself or start a trial of an anti-reflux medication to help decrease the amount of stomach acid in the baby’s tummy.  By reducing tummy acid, you do two things:  1. less acid means that when there is reflux coming up, it is not as painful 2. by reducing stomach acid, you remove some of the standing volume of liquid from the stomach so if baby does over feed, they have more room to do so before it starts coming out the stomach into the esophagus. 

In older kids who complain of reflux or heartburn, it is usually related to dietary choices. By reducing the usual culprits: processed foods, coffee, tea, citrus fruits, spicey foods, and fried foods; we are usually able to reduce symptoms dramatically without medication.