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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Spitting Up by Infants (GE Reflux)
What is spitting up?
Spitting up (also called regurgitation or reflux) is the
effortless spitting up of one or two mouthfuls of stomach
contents. Formula or breast milk just rolls out of the
mouth, often with a burp. It usually happens during or
shortly after feedings. It begins in the first weeks of
life.
Spitting up is harmless as long as your infant doesn't spit
up large amounts that interfere with normal weight gain.
This condition is also called gastroesophageal reflux (GE
reflux).
What is the cause?
Spitting up results from poor closure of the valve (ring of
muscle) at the upper end of the stomach. Spitting up is
normal and harmless for over half of all babies. It becomes
a problem if it causes poor weight gain (from spitting up
large amounts), choking, or acid damage to the lower
esophagus (esophagitis).
How long does it last?
Spitting up improves with age. By 7 months of age, most
reflux has decreased or is gone. The reasons for this are
probably because the baby is old enough to sit up or is
eating solid foods. By the time your baby has been walking
for 3 months, even severe reflux should be totally cleared
up.
How can I take care of my child?
- Feed smaller amounts.
Overfeeding always makes spitting up worse. If the
stomach is filled to capacity, spitting up is more
likely. Give your baby smaller amounts (at least 1 ounce
less than you have been giving). Your baby doesn't have
to finish a bottle. Wait at least 2 and 1/2 hours
between feedings because it takes that long for the
stomach to empty itself.
- Avoid pressure on your child's abdomen.
Avoid tight diapers. They put added pressure on the
stomach. Don't put pressure on the stomach or play
vigorously with him right after meals.
- Burp your child to reduce spitting up.
Burp your baby two or three times during each feeding.
Do it when he pauses and looks around. Don't interrupt
his feeding rhythm in order to burp him. Keep in mind
that burping is less important than giving smaller
feedings and avoiding tight diapers.
- Keep your child in a vertical position after meals.
After meals, try to keep your baby in an upright position
using a frontpack, backpack, or swing for 30 minutes.
When your infant is in an infant seat, keep him from
getting scrunched up by putting a pad under his buttocks
so he's more stretched out. After your child is over 6
months old, a jumpy seat or infant play station can be
helpful for maintaining an upright posture after meals.
- Use a proper sleep position.
Most infants with spitting up problems can sleep on their
backs, the position recommended by the American Academy
of Pediatrics to reduce the risk of SIDS. If the
esophagus becomes irritated (esophagitis), talk to your
doctor about your baby sleeping on his right side facing
down. Try to elevate the head of the bed a bit. If your
child is having breathing problems (choking or sleep
apnea), talk to your doctor.
- Add rice cereal to formula.
If your infant still spits up large amounts after all the
previous treatments have been tried, you can try
thickening the formula with rice cereal. Add 1 level
teaspoon of rice cereal to each ounce of formula. You
also need to make the nipple opening bigger.
- Acid blockers or liquid antacids.
Children with severe reflux or symptoms of heartburn need
temporary reduction of stomach acid.
Your child's oral medicine is ___________________. Give
________ every _________ hours for _________ days.
When should I call my child's health care provider?
Call IMMEDIATELY if:
- You see blood in the spit-up material.
- The spitting up causes your child to choke or cough.
Call during office hours if:
- Your baby doesn't seem to improve with this approach.
- Your baby does not gain weight normally.
- You have other concerns or questions.
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