Parentpedia

What Experts Say^*

Is your baby spitting up? Grab your burp cloth and join the club. Spitting up -- more properly called reflux -- often happens after she gulps breast milk or formula without stopping for a burp.

In older children and adults, the ring of muscle between the esophagus and stomach opens only when you swallow, and then closes tightly. But this muscle is still immature in babies, so stomach contents can often flow the wrong way. Some infant reflux is normal and not harmful.

According to the American College of Pediatric Gastroenterology, what separates normal spitting up and a condition called GERD (gastroesophageal reflux disease) is if the regurgitation (spitting up) happens very frequently, causes the baby discomfort, and leads to other complications. So suspect GERD -- and discuss with your pediatrician -- if your baby is not gaining weight properly (called failure to thrive), or has breathing difficulties such as apnea or wheezing.

Reflux symptoms, both minor and more serious, tend to get better as your baby gets older, usually by 12 to 15 months. It's all about anatomy: an older baby digests his food more quickly, and his esophagus gets longer, meaning less food can make it all the way back up.

Helping Your Baby

For normal reflux, your biggest issue will be sopping up the mess and dealing with frequent clothing changes. To minimize the problem, your pediatrician may recommend:

• Peaceful feedings. If you wait until your baby is frantic with hunger, she's more likely to gulp air. Relaxed feedings lead to less regurgitation. You might also try smaller, more frequent meals.
• Staying upright. Don't feed baby lying down, and try to keep her in a semi-upright or sitting position for 15 to 30 minutes post-meal (gravity works).
• Burp often. Even if your baby seems to be eating well, stop halfway (when the bottle's half-empty, or between sides if you're nursing) to gently burp her. The best position is her sitting up in your lap while you pat her back. (Over-the-shoulder burping may put too much pressure on her abdomen.)
• Check nipple size. If you're bottlefeeding, be sure the nipple's hole is the right size for your baby's age. If it's too small, she may get frustrated and gulp air. Too big, and the milk flow may be too fast.

Contact your baby's doctor if your baby isn't gaining weight, if she spits up with great force or projection (a condition called pyloric stenosis), if she spits up more than a tablespoon at a time, resists feedings, seems hungry between feedings, has fewer wet diapers than normal, seems lethargic, or has a hoarse cry.