Story by: David Steen Martin on March 2, 2021
Spitting up, or reflux, can be normal in infants and may not always require treatment. Reflux is in babies is different from reflux in adults because the part of the esophagus that closes when we’re not eating is still developing. Reflux in infants actually peaks around 4 to 6 months of age and improves with time.
Babies can be difficult to diagnose because they cannot describe their symptoms. In babies who are otherwise happy and growing well, spitting up is usually not a sign of bad reflux, or GERD. Unexplained crying in a healthy infant is also not typically due to GERD.
In babies with spit up, weight loss or difficulty gaining weight is not normal and should be evaluated by a physician. This may be due to GERD or it may be completely unrelated because there are many causes of spit up other than reflux.
Thickening feeds is one intervention that has been shown to help a baby with reflux, according to Tsega Adera Temtem, M.D., FAAP, pediatric gastroenterologist with Norton Children’s Gastroenterology, affiliated with the UofL School of Medicine. Additionally, a commonly missed cause of frequent spit up in babies is overfeeding. Appropriate feeding volumes should be discussed with your child’s pediatrician.
Should your child see a pediatric gastroenterologist?
Acid suppression medication is not recommended for reflux in healthy infants. Proton pump inhibitors come with potential side effects, including increased respiratory infections, infectious diarrhea, bone fractures, kidney injury, and overgrowth of bad bacteria in the small intestine, according to Dr. Temtem. These medications should not be taken for long periods and should only be used after trying other measures as directed by your child’s doctor.
Older children and adolescents can describe their symptoms, which may make GERD easier to identify.
“Reflux in the older child or adolescent is most often caused by lifestyle or diet choices, but sometimes we can also see it secondary to other conditions such as uncontrolled constipation,” Dr. Temtem said.
Dr. Temtem recommends that older children and adolescents with GERD undergo counseling and education on diet and lifestyle before trying acid suppression medication if necessary.