Spitting up: gastroesophageal reflux

(Photo provided)

Parents have been bringing up lots of questions about their babies who tend to spit up a lot. This week, let me try to keep down their concerns and provide some information on this “spitting up” topic we call infant heartburn or reflux.

Spit up specifics

Now, all babies will spit up or vomit small amounts of formula or breast milk after a feeding. In fact, I guess we can say that spit happens — especially after being burped or during periods of movement. Usually, spitting up peaks when a child is 3 to 4 months of age and is gone before the first year of life.

Should I be worried?

So when do we worry? We worry when stomach acid contents repeatedly go up the food pipe (also known as the esophagus) to the point that the esophagus becomes irritated. This irritation makes feedings quite painful for infants. This pain can result in poor weight gain, bloody or projectile vomiting, inconsolable crying and even chronic cough, wheezing, and pneumonia. This occurs due to food going up the food pipe and down the windpipe or trachea into the lungs. This degree of reflux certainly warrants a call to your child’s health care professional to better determine why so much spitting up is occurring.

Treating reflux

The good news is that this problem of reflux can be treated with a number of approaches.

It may be as simple as avoiding overfeeding. To stop overfeeding, stop the feed as soon as the spitting up starts. If your baby is bottle-fed and spitting up, just burp the baby more frequently — at least every 3 to 5 minutes or every 1 to 2 ounces during a feeding. Additionally, don’t jostle or play vigorously with a baby after a feeding.

Another approach is to consider thickening feeds by adding 1 tablespoon of rice cereal per bottle of pumped breast milk or formula.

If your baby does spit up a lot, keep them upright for at least 30 minutes after feeds. Additionally, avoid tight diapers. These diapers can put pressure on the stomach and send things more forcefully back up the food pipe, worsening the problem.

When in doubt, call your child’s health care professional

If these suggestions don’t work, there are medications that your child’s health care professional can recommend. These medications are available over the counter or by prescription, and will oftentimes take care of the frequent reflux.

Hopefully tips like these will burn brightly in your mind, but not in your baby’s esophagus or food pipe, when it comes to knowing what to do if your baby or child spits up due to reflux.


Lewis First, MD, is chief of pediatrics at The University of Vermont Children’s Hospital and chair of the Department of Pediatrics at the University of Vermont College of Medicine. You can also catch “First with Kids” weekly on WOKO 98.9FM and WPTZ Channel 5, or visit the First with Kids video archives at www.UVMHealth.org/MedCenterFirstWithKids.


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