Why is it that all those cute infant togs you received at the baby shower are stained with regurgitated breast milk or formula? The only recourse you have is to snap on a bib every morning or to follow your baby around with a cloth diaper after each meal. And even then, you may find puddles of spit-up scattered around the house.
The fact is that almost one hundred percent of babies have some degree of gastro-esophageal reflux or GER in the first three months of life, and some have GER even into the second year of life. There is a muscle or sphincter that prevents stomach contents from backing up into the esophagus (the food passageway leading to the stomach). In babies this muscle may be still immature or incompetent and can allow food to back up. While gravity tends to hold food in the stomach in upright humans, babies are lying down, and it is easy for the food to come right back out again. Parents often come to me after the first few months of life and say, "The baby seems to be spitting up more than ever." As the baby gets older, he takes a larger volume of milk and is more active. These two factors may make the spitting up worse. What can a parent do to avoid these spit-ups? Not much as it turns out. Doctors used to recommend keeping the baby upright for an hour after feeds, hoping gravity would help. Any parent can tell you this does not help much. The other solution was once thought to be thickening the feeds with cereal to help weight the milk down in the stomach. This solution is pretty worthless, as well. So what do I tell parents to do? Get lots of rags and bibs and wait for the baby to get older. By the end of the first year the sphincter matures and becomes more effective in holding food in the stomach and prevents back-ups.
Is GER ever a serious problem? Occasionally, the reflux is severe enough that the acidity of the stomach contents may cause heartburn, and the baby may be fussy. Acid blocker medication may be used in this situation, but in my view, these medications are not often helpful and tend to be used too frequently. If your baby has blood in his stool, has recurrent pneumonia, or is not gaining weight, then the GER may warrant serious medical attention. If your baby is actually vomiting each time he feeds (all the feed, every time), has a fever, is listless, is refusing food, or has bile (green fluid) in the spit-up, notify your pediatrician right away. These symptoms may be a sign of an intestinal blockage.
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