Symptom definition:

• The effortless spitting up or reflux of one or two mouthfuls of stomach contents.
• Usually seen during or shortly after feedings.
• Occurs mainly in children under 1 year of age and begins in the first weeks of life.
• More than half of all infants have occasional spitting up ("happy spitters").
• Also called reflux or regurgitation.

• If baby spits up a large volume and comes out forcefully, see vomiting.

Causes :

• Main cause: Poor closure of the valve at the upper end of the stomach.
• Complications: Choking on spit up milk, heartburn from acid on lower esophagus, poor weight gain.
• Smaller amounts often occur with burping ("wet burps").
• Larger amounts can occur after overfeeding.

 Reflux Versus Vomiting: How to Tell

• During the first month of life, newborns with true vomiting need to be seen immediately because the causes can be serious. Therefore, it’s important to distinguish between reflux and true vomiting.
• Reflux: The following suggest reflux (spitting up): infant previously diagnosed with reflux, onset early in life (85% by 7 days of life), present for several days or weeks, no discomfort during reflux, no diarrhea, hungry, looks well and acts happy.
• Vomiting: The following suggest vomiting: uncomfortable during vomiting, new symptom starting today or yesterday, associated diarrhea, projectile or forceful vomiting, looks or acts sick.

Call your doctor now (night or day) if:

• Your child looks or acts very sick.
• Blood in the spit up.
• Choked on milk and turned bluish or became limp.
• Baby is less than 1 month old and looks or acts sick.

Call your doctor during office hours if:

• You think your child needs to be seen.
• Poor weight gain.
• Frequent unexplained fussiness.
• Spitting up becomes worse.
• Age older than 18 months.
• You have other questions or concerns.

Parent care at home if:

• Normal reflux with no complications and you don't think your child needs to be seen.

Home care advice for spitting up

1. Feed smaller amounts: Bottlefed: Give smaller amounts per feeding (at least 1 ounce less than you have been). Keep the total feeding time to less than 20 minutes (reason: overfeeding or filling the stomach to capacity always makes spitting up worse). Breastfed: If the mother has a plentiful milk supply, try nursing on one side per feeding and pumping the other side. Alternate sides.

2. Longer feeding intervals: Wait at least 2½ hours between feedings, because it takes that long for the stomach to empty itself. Don't add food to a full stomach.

3. Loose diapers: Avoid tight diapers. It puts added pressure on the stomach. Don't put pressure on the abdomen or play vigorously with your child right after meals.

4. Vertical position: After meals, try to hold your baby in the upright (vertical) position. Use a front-pack, backpack, or swing for 30 to 60 minutes. Reduce time in sitting position (e.g., infant seats). After 6 months of age, a jumpy seat is helpful (the newer ones are stable).

Expected course:

• Reflux improves with age. Many babies are better by 7 months of age, after learning to sit well.

Call your doctor if:

• Your baby doesn't improve with this approach.
• Your child becomes worse or develops any of the "Call Your Doctor" symptoms.

Parent Care for Pediatric Symptoms. Copyright © 2005. Barton D. Schmitt, MD, FAAP