It is common for babies to vomit or take a “puff” of milk from time to time. In fact most parents are always prepared with a muslin, gauze or bib for these “events”. But where is the limit of normality? When do we say that a baby’s vomiting is not normal? Is there anything we can do to avoid or prevent them?
Spitting up in babies
Spitting up occurs when stomach contents involuntarily return to the mouth. Doctors also refer to regurgitations as physiological gastroesophageal reflux . We see that the baby takes a little milk, a “puff”, usually without force. It is very common in children under 4 months, up to 75% regurgitate several times a day .
The reasons for this to happen are multiple. For one thing, the muscle that closes the stomach is still immature, making it easier for food to return to the mouth. In addition, the movement of the esophagus is not optimal and it is difficult for it to send the food content to the stomach.
In addition, babies spend a lot of time lying down (gravity acts less) and only drink milk, which makes it easier for it to return to the mouth (purees or solids have it more difficult). Little by little, the stomach closure mechanism matures and at around 6 months we begin to introduce complementary feeding, so the reflux episodes diminish until they disappear around one year of life (between 12 and 18 months of age).
For most children who spit up, this is not a problem. They look happy, it doesn’t seem like it bothers them and they gain weight well. Only in a small percentage, as we will see below, these physiological regurgitations or gastroesophageal reflux can trigger a problem.
Gastroesophageal reflux disease
We speak of gastroesophageal reflux when the contents of the stomach return to the esophagus . Sometimes it reaches the mouth (regurgitation or vomiting). As we have seen, most of the time this does not cause any problems in babies. However, sometimes this returning content can damage and inflame the esophagus (esophagitis). When symptoms and / or complications appear, we speak of gastroesophageal reflux disease .
The symptoms of reflux disease are usually digestive: vomiting with little weight gain and / or symptoms of esophagitis such as irritability, sleep disturbance and refusal of food in children.
Older children and / or adults will notice burning, pain, or a burning sensation. Sometimes other symptoms also appear, such as coughing, recurrent respiratory infections, apnea pauses, or abnormal postures.
As parents, when should we suspect reflux disease and consult?
As we have seen, in most cases reflux is physiological, that is, normal and typical of age. It is common for babies to spit up more after feeding, but some take longer to digest milk and spit up a long time later; nothing happens. If our baby is happy, does not look upset and is gaining weight well, we do not have to worry.
On the contrary, if our baby is irritable all day, rejects food, does not sleep well and / or does not gain weight or has respiratory problems, we should consult . Some babies stretch a lot when they eat and put their heads very extended backwards: this is called Sandifer syndrome and it is typical of babies with reflux disease. It should also be assessed if the vomiting is strong, green or contains blood .
How is it diagnosed?
In most cases, the diagnosis of gastroesophageal reflux in babies is clinical , that is, through the medical history (what you tell us) and the physical examination. In some specific cases, a complementary test may be necessary to quantify reflux episodes or intensity or to assess whether there are lesions in the esophagus.
How is it treated?
In the case of regurgitation or physiological gastroesophageal reflux, no treatment is necessary. As the baby matures and when we begin to introduce foods other than milk, the regurgitations will gradually spread out until they disappear.
However, these regurgitations can be minimized with simple postural measures such as keeping the baby semi-upright 20 or 30 minutes after feeding and / or raising the head of the crib a little (remember that it is more difficult for babies to spit up if they are upright). Porting is usually a good measure in these children.
In the event that symptoms of reflux disease appear and we do not observe improvement despite the postural changes, it is usually necessary to establish some treatment. In a significant percentage of babies, these reflux symptoms are due to a non-IgE-mediated allergy to cow’s milk protein (also known as cow’s milk protein intolerance).
That is why in many cases we will propose a change from milk to hydrolyzed formula and, in the case of breastfeeding, that the mother completely eliminates cow’s milk proteins from her diet . In other cases, or if the change in diet is not enough, we can prescribe medications that reduce stomach acid , so that when the content rises into the esophagus it does not inflame it.
In very severe cases, and fortunately very rare, if these measures are not enough, it may be necessary to resort to surgery (a kind of loop or band is placed in the upper part of the stomach that prevents the content from returning to the esophagus).
As a summary, we will emphasize that most babies spit up (that is, they pour a little milk, without force, involuntarily, after feedings). In most cases, this is not a problem: the babies are happy and gain good weight.
However, if we see that our baby vomits with force, or the vomits are green or bloody, or we notice that he is very irritable, that he gains little weight or that he begins to reject food, we should consult , as it may be a disease caused by gastroesophageal reflux.
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