Reflux and Spitting up; cause for concern?

What causes reflux or spitting up?

In infants, the ring of muscle between the esophagus ( the tube from the mouth) and the stomach — the lower oesophagal sphincter (LES) — is not yet fully mature. As your baby grows, this develops and will open only when your child swallows, remaining tightly closed at other times, keeping stomach contents where they belong. Nearly 50% of infants will experience reflux or spitting up; contents come back up into the esophagus from their stomachs during their first three months after birth.

It may only reach the lower part of the esophagus, or it may exit from the mouth, i.e., your baby spits up. Babies can have reflux many times in a day, and generally, this is not a serious problem. The stomach contents contain little acid and do not usually irritate the throat or esophagus. It will improve as your baby grows, usually disappearing by 12months of age.

If your baby is thriving, growing well, healthy and content, there is no need for concern.

On occasion, infant reflux can be a sign of a medical problem, such as an allergy, gastroesophageal reflux disease (GERD) or rarely a blockage in the digestive system.

Some babies will have silent reflux where the stomach contents only go as far as the esophagus and are then re-swallowed. This can cause pain but no spitting up, gagging, choking, frequent burping or hiccoughing, bad breath and restless sleep.

You should take your baby to a doctor if any of the following occur:

• Isn’t gaining weight
• Consistently vomits – where contents are forcibly projected several inches from the mouth
• Spitting up green or yellow fluid, blood or material that looks like coffee grounds
• Refuses food
• Has blood in their stool
• Has difficulty breathing or a chronic cough
• Begins spitting up at age six months or older
• Is unusually irritable after eating

Causes of infant reflux

Some factors contribute to infant reflux, and they cannot always be avoided. They include lying flat, a liquid diet and premature birth.

Other more serious causes are rare but can involve:

Pyloric stenosis. The exit valve from the stomach to the intestines is too small, interfering with the stomach emptying.
Food intolerance. Allergy or intolerance to a food that is eaten directly or through breast milk. Common triggers are cow’s dairy products, wheat, corn, soy and eggs.
Eosinophilic esophagitis. A particular type of white blood cell (eosinophil) builds up and injures the esophagus lining.

Diagnosing serious causes:

Your doctor can advise you as to whether you should be concerned about your baby spitting up. If serious issues are suspected, they may recommend testing:

Ultrasound to detect pyloric stenosis.
Lab tests. Blood and urine tests can help identify or rule out possible causes of recurring vomiting and poor weight gain.
Esophageal pH monitoring. A thin tube with an acidity monitor is passed from the mouth into the stomach.
X-rays. This can look at the structure of your baby’s digestive tract.
Upper endoscopy. A tiny camera and light (endoscope) are passed from the mouth into the esophagus, stomach and first part of the small intestine. It is usually done under general anesthesia for babies and small children.

Treatment options

To reduce reflux, you can try the following:

• Feed smaller, more frequent meals.
• Burp your baby during, not just after feeding.
  Keep your baby upright for 20 to 30 minutes after feeding. You can also raise the head of their crib. Laying babies to sleep on their tummy to prevent spitting up isn’t recommended as it is linked to SID (sudden infant death).
• Avoid active play, bouncing and swings immediately following feeding.
• Consider an allergy test or try removing potential allergens from Mom’s diet if breastfeeding and also from any formula or food given directly to the baby. Start with cow’s milk products, wheat, corn, soy and eggs and remove for at least two weeks.
• Experiment with the size of the nipple on baby bottles. Your infant can swallow air if the nipple is too small or too large.
• Rice cereal can be used to thicken milk or formula if done in gradual increments. It does, however, add extra calories to your baby’s diet.
• Visit an Osteopath who offers cranial treatments. These can often improve symptoms.

Medication and surgery

Medications can prevent absorption of calcium and iron and increase the risk of certain intestinal and respiratory infections, so they are not recommended unless there are severe health concerns. Surgery is a last resort and is usually only used when the reflux is severe enough to cause breathing issues.

Remember, if you are concerned about your baby’s health, it is important to seek medical advice as soon as possible. There is rarely anything seriously wrong; however, it is always best to be certain.