GERD – IS IT SPITTING UP? IS IT VOMITING? SHOULD I BE WORRIED?
All infants from 0-6 months have a certain amount of gastroesophageal reflux (milk coming back up after reaching the stomach). A large portion of infants spit up milk after they are fed. Often milk comes up when being burped or sometimes a mouthful of milk spills out of baby’s mouth within an hour after feeds. Occasionally if there is a large air bubble in the stomach or if the baby is overfed, they can also forcefully vomit after a feed. These are all events that are not out of the ordinary for a normal baby.
When to worry? Not uncommonly, babies can become uncomfortable after feeds because of the reflux. It is thought that the acidity of the stomach contents causes irritation of the lower esophagus making baby uncomfortable. Often if this is occurring, babies will arch their backs, turn red in the face and cry within the first 1-2 hours after a feed. They may or may not be a baby that spits up. If it is really bad, they may appear uncomfortable amidst the feed and not appear keen to continue feeding. In this situation there are non-medicinal and medicinal management options.
These include:
1) Burping the baby frequently. In the middle of the feed, pull baby off the breast or bottle and burp them to help get any extra air out. Too much air in the stomach will promote reflux of stomach contents during and after a feed. Continue to burp baby after a feed as per usual.
2) Put baby on their tummy for a few minutes before a feed. This can help expel extra air already in the stomach before a feed.
3) Keep baby upright for 20-30 minutes after a feed. This will allow time for the milk to move past the stomach and into the upper intestine and leave less volume to potentially reflux up into the esophagus.
4) If your milk flow is very fast at the beginning of your breastfeeding, then consider pumping off the first few milliliters of milk before feeding or leaning back while you breastfeed to slow the flow of the milk. This will help decrease how much air baby swallows while trying to feed from the fast rate of your milk flow.
If all of these measures do not appear to improve baby’s discomfort after feeds, you can speak to your physician about prescribing an acid reducer such as ranitidine for your baby. Babies usually grow out of reflux by 6 months of age. Anatomically they have less reflux of stomach contents, they are starting solids at this time and they are starting to spend more of the day upright and less on their backs.
When to worry about vomiting? If your baby is vomiting persistently with increasing force, severity and frequency, they must be seen immediately by a medical professional. If the vomit ever contains blood or bile this is an abnormal event. Bile is army green in colour and it is not normal for an infant to produce vomit this colour.
I hope this information is helpful to you but of course if you have any concerns you should be sure to schedule a visit with your doctor or pediatrician.
Dr. Kelly Chow 