A frequent question I am asked about in clinic is what is normal for infant spit up.  To answer this question, physicians need to determine if the baby has normal gastroesophageal reflux (GER) or gastroesophageal reflux disorder (GERD).

What is the difference between GER and GERD?

The esophagus is the tube that carries food from our mouth to our stomach. Gastroesophageal reflux (GER) is a normal process where stomach contents are refluxed from the stomach into the esophagus without any symptoms or complications. 

Babies can often reflux or “spit up”.  As long as they are otherwise happy and healthy with good weight gain, this is considered normal GER. 

Gastroesophageal reflux disease (GERD) is the process where stomach contents go into the esophagus and cause complications such as esophagitis (inflammation of the esophagus) or poor weight gain.

Risk factors for GERD

Babies that are at higher risk of getting GERD are: premature babies, babies exposed to cigarette smoke and those with certain health problems such as Down syndrome or cerebral palsy. 

Symptoms of GERD may include: poor weight gain, feeding refusal and irritability.

If your baby is spitting up frequently you can try:

  1. Keeping the baby upright after feeds for 20 to 30 minutes.
  2. Avoiding overfeeding.  Smaller more frequent feeds can help reduce reflux.
  3. Quitting smoking.  Smoke exposure can make your babies reflux worse.
  4. Consider a two week trial of milk and soy free diet.  Some babies have problems digesting cow milk or soy proteins.
  5. Try thickened feeds if the reflux is causing problems like poor weight gain.  To thicken, add baby cereal to standard formulas or breast milk or use a thickened formula.

Most infant reflux will resolve after the first year. 

If your baby is having significant signs or symptoms of complicated reflux (GERD), your doctor may recommend a trial of acid suppressing medications.  

This post was co-authored by Stephanie Liu, MD, MSc, CCFP, BHSc and Erin Manchuk, BScPharm, BCGP .

Reference

Rosen et al. Pediatric Gastroesophageal Reflux Clinical Practice
Guidelines: Joint Recommendations of the North
American Society for Pediatric Gastroenterology,
Hepatology, and Nutrition and the European Society
for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018 Mar;66(3):516-554.