From time to time all babies spit up! Just one of the reasons why we have so much laundry. Some babies bring up a small amount of spit up during burping, some during positional changes (like diaper changing or transitioning into the crib) and some with no stimulation at all. The amount can be from teaspoon sized to the entire feeding. There is more of a concern when an infant spits up an entire feeding. Small amounts of spit up even during every feeding can be considered normal as long as the infant is gaining weight and it doesn’t contain any blood. However further investigation should be considered when an infant spits up a large volume after or during a feeding especially if it appears to be the entire feeding. An infant that spits up a large amount after each feeding should be evaluated by a gastroenterologist. You should first discuss this with you pediatrician however if your child is not gaining or losing weight insist on a specialist. Underlying GI issues could be present thus causing such emesis. Some examples could be GERD or reflux, pyloric stenosis or dysfunction, delayed gastric emptying or gastroparesis, allergies or esophageal narrowing.
The most common of cause however is GERD. Everyone has gastroesophageal reflux (GER), the backward movement (reflux) of gastric contents into the esophagus. Extraesophageal Reflux (EER) or Laryngopharyngeal Reflux (LPR) is the reflux of gastric contents from the stomach into the esophagus with further extension into the throat and larynx. A child or infant with EER or LPR is typically termed a silent refluxer in which they do not spit up. Instead they have a persistent cough and present with a hoarse cry or vocal quality.
The diseases associated with reflux are known collectively as Gastro-Esophageal Reflux Disease (GERD). GERD occurs when a valve known as the LES of the esophagus malfunctions. Normally, this muscle closes to keep acid in the stomach and out of the esophagus. The continuous entry of acid or refluxed materials into areas outside the stomach can result in significant injury to those areas.
While GER and EER/LPR in children often cause relatively few symptoms like heartburn or complain of a stomach ache. Symptoms in an infant can include crying/irritability, poor appetite/feeding and swallowing difficulties, failure to thrive/weight loss, regurgitation (“wet burps” or outright vomiting), stomach aches, abdominal/chest pain (heartburn), sore throat, hoarseness, apnea (stops breathing), asthma/wheezing, chronic cough and throat clearing, chronic sinusitis and ear infections/fluid. Effortless regurgitation is very suggestive of GER. However, persistent vomiting (which is not the same) does not necessarily mean a child has GER.
Some basic changes that could assist with spit ups during and after feedings could be- feeding position (use a more upright angle), keep the infant upright after meals and avoid inversion (like during a diaper change), burp frequently, feed slower (choose a slower nipple), feed more frequent in less volume rather then larger volume less frequently.
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The above is the opinion of this writer. This should not take the place of your pediatrician. You should always consult your pediatrician for medical advise regarding introduction of feedings and related issues.
