Infant Reflux (Spit-up)

One of the most common reasons babies are seen in the office is esophageal reflux, otherwise known as "spitting up." All babies have issues with reflux. Usually, they start having issues before they are two months old, and it worsens around four months. Around their first birthday, they've usually grown out of it, although a few children can have continuing problems. The reason why babies have issues with spitting up is that the muscle that separates the esophagus from the stomach, called the esophageal sphincter, is not as tight as it will become, and this allows the formula to come back up the esophagus, sometimes coming out the mouth.

Overfeeding, which can be done by giving the baby too much formula or feeding too frequently, is one of the most common causes of reflux. Although having a baby that spits up all the time is quite annoying, if the baby is not being bothered, is gaining weight well, and has no issues with blood or choking afterward, there is generally no need for treatment.

For babies, however, who have more severe symptoms, such as poor weight gain, extreme fussiness, blood when they throw up, and or choking, usually treatment is required. Generally, I prefer to thicken up the formula by adding either rice or oatmeal cereal to the formula. Each Pediatrician will generally have their own mixing formula, but my mixing formula is usually one teaspoon of cereal per ounce of formula. For example, if you make a 4-ounce bottle, add four teaspoons of rice or oatmeal cereal. Most of the time, this is enough to improve the reflux symptoms, and as they get older, you can discontinue adding cereal to the bottles.

Sometimes, switching to a different formula is the next step for babies who have not responded very well to thickening the formula. If this doesn't help, adding a medication such as a PPI like omeprazole or an H2 blocker such as famotidine can help. I will, however, warn every parent that stomach acid is very important. Extended use of these medications is related to an increased risk of diarrhea and pneumonia and can weaken bones.