We have all had or known babies who spit up, but at what point is it concerning?
Gastroesophageal reflux (we’ll shorten that to GER) is defined as the passage of stomach contents into the esophagus with or without regurgitation or vomiting. Gastroesophageal Reflux Disease, or GERD, is when GER leads to troublesome symptoms and/or complications. Refractory GERD is GERD not responding to optimal treatment after eight weeks.
GER is also called acid indigestion, heartburn, acid reflux, or spitting up. Regurgitation may occur one or more times a day and is most common in babies under six months old. Seventy to eighty percent of babies will have daily regurgitation by two months old, but they usually outgrow it by twelve to fourteen months old. GERD is more severe and longer lasting than GER.
It is difficult to determine if a baby’s symptoms are caused by GERD or something else. GERD is more common in premature infants or in infants with health conditions that affect the esophagus, nervous system, or lungs. Signs your baby might have GERD include discomfort/irritability, failure to thrive, refusing to eat, arching of the neck and abnormal neck positions, recurrent regurgitation, blood in the vomit, wheezing, cough, hoarseness, anemia, apnea (breathing difficulty) spells, recurrent ear infections, recurrent pneumonia associated with aspiration, or problems swallowing. Other conditions can cause similar symptoms. Your healthcare provider will recommend tests to rule those conditions out.
Call your healthcare provider if your baby is crying more than usual or being extremely irritable, is not gaining weight as expected for their age, or has breathing problems, or has blood or what looks like coffee grounds in their vomit, or has rectal bleeding, no wet diapers for three or more hours, exhibits lack of energy, or vomits large amounts in a forceful manner (called projectile vomiting). Other areas of concern could be if the infant vomits or has regurgitation problems that begin when younger that two weeks of age or older than six months.
The first line approach to treating GERD is to avoid over feeding, thicken feeds, and, if breastfeeding, continue breastfeeding. The second line approach is a two-to-four-week trial of extensively hydrolyzed formula (ex. Similac Alimentum) The symptoms of GERD and cow’s milk protein allergy are identical, so you’ll need to contact your healthcare provider to help determine this. There are various medicines your healthcare provider can use to help with GERD. If those do not work, you may need a referral to a pediatric gastroenterology to get the problem under control.
Candice Hutchins is an RN at the Health West Pediatric Clinc. She has been a nurse for 19 years and loves working with kids. She enjoys reading, cross-stitching and being with her family.