Guide To Baby Spit Up

By Graciela Wetzler, M.D.

Concerned ParentsAs a pediatric gastroenterologist, the majority of calls I receive are from worried parents whose baby is vomiting. The baby may regurgitate once a day, or after every feeding. In fact, 40 percent of healthy infants regurgitate more than once a day. Usually, he or she is content and is gaining weight -- we call them "happy spitters" -- but the parents are nervous wrecks. They complain that their clothing is stained and their carpets smell, and they're worried that something is seriously wrong with the baby's digestive system. Although in rare instances vomiting may be a sign of a real problem, in most cases it is a benign and transient symptom.

To understand the difference, first a short lesson in anatomy:

After a baby swallows food (breast milk, formula, or solid food), the food travels through the esophagus into the stomach and then to the small intestine. There is a physiologic valve, called the lower esophageal sphincter, which prevents food from coming back into the esophagus from the stomach. For many babies, this valve relaxes at the wrong time, causing regurgitation. Some babies, especially premature ones, have delayed gastric emptying (I call this "lazy stomach"), which aggravates the problem.

When the regurgitation problem is severe, it's called Gastroesophageal Reflux Disease (GERD). The disease is associated with poor weight gain (due to lack of caloric intake), excessive crying, choking, and even respiratory symptoms (such as wheezing, coughing, hoarseness, or pneumonia). Like an adult who has heartburn, your infant may cry due to excess acid in his esophagus. There may also be arching, hiccups, funny faces (such as tongue extrusion), and feeding difficulties (such as pushing the nipple away). Gagging or choking can be dangerous in young babies since they may stop breathing and turn blue. What makes GERD a complex disease is that some babies may have frequent vomiting without any of the associated symptoms, and others may have the associated symptoms without any vomiting. When vomiting is absent, but there is excessive crying due to acid production, GERD is often misdiagnosed as colic.

For the vast majority of babies -- the happy spitters -- the regurgitation symptom peaks by four months of age and usually resolves by the first birthday. As long as your baby appears healthy and is gaining weight, you can be reassured that she will outgrow the problem.

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