Infant Reflux: When “Spit Happens”
May 18, 2021
There’s a good reason why “spit-up” cloths often make an expecting mom’s gift registry list. Babies naturally experience spit-ups, also known as infant reflux. Typically, there is no reason for concern but there are things that can exacerbate reflux.
Aubrey Bonhivert, MD, FAAP, board-certified pediatrician with the Franciscan Physician Network in Greenwood, Indiana, shares important information for parents, including ways to mitigate infant reflux.
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What Causes Infant Reflux?
Infant reflux occurs when breast milk or formula moves from the stomach up into the esophagus. Oftentimes, it ejects from both the baby's mouth and nose.“The reason babies are so prone to reflux, especially at first, is that the ring of muscle that helps keep milk in the stomach is not fully developed. It's not as strong, and so it makes it pretty easy for the breast milk or formula to come back up from the stomach. Luckily, over time and as that muscle gets stronger, the spitting up tends to improve,” states Dr. Bonhivert.
Risks Factors For Infant Reflux
Infant reflux can be triggered by:
- Temporary relaxation of lower esophageal sphincter after feeding
- Frequent large-volume feedings
- Short food pipe
- Laying down
The following conditions raise the risk of experiencing infant GERD:
- Hiatal hernia
- Neurodevelopmental disorders
- Cystic fibrosis
- Epilepsy
- Congenital food pipe disorders
- Asthma
- Premature birth
- Obesity
- Parent history of reflux
Distinguishing Between Infant Reflux And Other Gastric Issues
Otherwise healthy babies commonly have issues with spit-ups. Up to two-thirds of normal, healthy babies will have a spit-up at least once a day. Dr. Bonhivert clarifies that infant reflux is not the same as vomiting.
“Spit-ups are usually kind of quiet. They appear effortless. And, the spit-up doesn't really travel very far. It gets all over our clothes, but it's not projectile by any means. Whereas vomiting is forceful, because it's associated with contraction of the abdominal muscles; it appears a lot more dramatic and uncomfortable to the baby,” she explains. “Spit-ups are usually nothing to think about, but actual vomiting in a young baby would be pretty worrisome.”
Listen Now: Spit Happens
Dr. Aubrey Bonhivert, board certified pediatrician with the Franciscan Physician Network, shares important information for parents, including ways to mitigate infant reflux.While “reflux” is in the name, infant reflux is not the more severe gastroesophageal reflux disease (GERD).
“We consider a baby to have GERD when their reflux or spit-ups are causing problems, such as poor weight gain, significant pain, or sometimes even breathing problems,” adds Dr. Bonhivert. “Healthy babies certainly can develop GERD, but it's much more common for them to just have simple reflux. We call those babies ‘happy spitters’ and explain that it's really more of a laundry problem than a problem with your baby.”
How To Treat Infant Reflux
Medications are available to treat infant reflux, but that approach is not recommended as a first line of treatment. Dr. Bonhivert encourages tactics for reducing reflux, such as burping the baby halfway through a feed and then again at the end of the feed. This helps prevent babies from swallowing extra air and also allows them to release air. It’s helpful if the baby is kept upright after a feed for at least 20 minutes.
Parents should avoid bouncing the baby or doing “tummy time” directly after a feed. “That just gives gravity a bit more time to let the milk go through the stomach,” notes Dr. Bonhivert.
Sometimes, parents accidentally overfeed their baby. Babies' stomachs are only a certain size, so if they’re given too much milk, some of it is bound to come back up. Dr. Bonhivert suggests smaller meals more frequently throughout the day in order to avoid overfeeding.
When Should Parents Be Concerned?
Most babies grow out of their reflux by around six months. They have more muscle tone by then and are sitting up on their own. Some babies’ reflux persists until 12-18 months of age, which can still be considered “normal.” If reflux continues beyond a year and a half, a pediatrician may enlist a gastroenterology specialist to investigate.
“It's really a rare occasion that a baby or a child will need surgery to help them with their reflux. And, babies with normal reflux are typically not at an increased risk for reflux later on in life,” assures Dr. Bonhivert.
Of course, it’s natural for parents to worry that something might not be “right,” especially among first-time parents. Dr. Bonhivert urges consistent communication with your pediatrician to make sure your concerns are being addressed. Parents can also visit resources like the American Academy of Pediatrics (AAP) website or the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHN). “They have a good slogan that I like: ‘Spit happens.’”
