Gastroesophageal reflux (GERD)
Is it normal for my baby to spit up so much?
That depends. It's perfectly normal for babies to spit up after feedings, or even to vomit once in a while, without apparent cause or warning. Frequent vomiting or spitting up is called gastroesophageal reflux (or just reflux), and most babies outgrow it.
Your baby might have other symptoms along with spitting up or vomiting that could mean she has gastroesophageal reflux disease, or GERD. For instance, she might show signs of abdominal pain, like arching her back, drawing up her legs, and waking screaming from her sleep, or she's coughing or gagging during feedings.
If your baby vomits forcefully after feedings, schedule a doctor's appointment. This is called projectile vomiting, and it's just what it sounds like — she's spewing. Projectile vomiting is a sign of pyloric stenosis, a condition that can lead to serious problems like malnourishment and dehydration.
What causes GERD?
All babies are getting used to the process of eating and digesting, but some have more trouble nailing it than others — and so have more spitting up and vomiting than others. If your baby has GERD, it's probably because her esophageal sphincter (the valve connecting the esophagus to the stomach) is weak or not working properly yet. This allows food and gastric juices to flow back up out of her stomach and into her mouth.
How serious is it?
Most babies with reflux grow out of it in their first year, as the sphincter muscle gets stronger. But that doesn't mean you should take reflux lightly.
If your baby has GERD, it's important to monitor her weight. Some babies with GERD don't gain properly because they simply aren't keeping enough food down. Others lose their appetite because all that stomach acid pushing up into the esophagus (called heartburn in adults) can hurt the throat and, in severe cases, make it hard to swallow.
If some of her stomach contents enter her nose and lungs, a baby with GERD might develop respiratory problems like pneumonia, a cough at night, and sinus and ear infections. The stomach acid can also damage tooth enamel. GERD can make your early days together very difficult, as you struggle to comfort, feed, and clean your baby up.
What can I do to ease my baby's suffering?
Try holding her in a more vertical position while feeding, and keep her upright for a bit right after feedings, too. (Don't put her down for tummy time right after she eats, for example.)
Giving her less breast milk or formula at each feeding (if you can get away with it) may help, too. You can make up for the smaller quantity with more frequent feedings.
If your baby is formula-fed, you might also try adding a little rice cereal to the bottle or using a formula that comes with "added rice." (First ask your baby's doctor whether you should try this and how to mix in the cereal.)
These suggestions aren't guaranteed to soothe your baby — they may even make her crankier — but they're worth a try.
Should I take my baby to the doctor if I think she has reflux?
If your baby spits up quite a bit but doesn't seem uncomfortable and is gaining weight just fine, then you probably don't need to. If you're concerned, by all means mention it at her next checkup.
On the other hand, if your baby has more serious symptoms — especially if you think the reflux is distressing her and affecting her weight gain — schedule an appointment as soon as you can. Your baby's doctor can tell you whether she has GERD and help you ease her suffering.
What will the doctor do?
For starters, he may prescribe medication. Some babies respond right away to antacids or acid blockers, and that's the end of the problem. Most infants can tolerate children's antacids and low doses of acid suppressors (but never give these to your baby without consulting a doctor).
Ideally your baby won't have to take these medications for more than a month or so before the reflux tapers off.
Drugs that work to keep things moving downward in the digestive tract are also available. If your baby has the signature symptoms of GERD, her doctor should be able to find the treatment that best settles the uprisings without side effects.
How is GERD diagnosed?
Your baby's doctor may be able to diagnose GERD simply by examining your baby and listening to you describe her symptoms. If he's in doubt, or if your baby has been unable to find relief by taking the drugs described above, the doctor might do further tests or refer you to a gastroenterologist to be sure that GERD is the problem.
These tests may include X-rays of the area (this is called an upper GI series). For damage to show up on an X-ray, your baby needs to drink a chalky substance called barium beforehand.
The doctor might also do a scope of the digestive tract, complete with biopsies (small tissue samples) and something called the 24-hour PH-probe study, in which a very thin tube is threaded through the nose down to the base of a baby's esophagus and monitored for 24 hours. No, it's not a lot of fun for your baby (or you), but it will provide lots of helpful information for figuring out what's ailing your baby.
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