Tummy troubles

As a first-time mom, I find myself utterly perplexed by the happenings in my little one’s stomach. At our hospital discharge meeting, I clearly remember the nurse instructing us that when it was vomit, we would know. And sure enough, the first time my tiny guy threw up, everyone—even our dog—knew exactly what had just happened. But when it’s not so clear-cut, how do you tell the difference between simple spit-up and more serious issues like gastroesophageal reflux disease (GERD)? I needed help clarifying the facts about these common stomach ailments, and I’m happy to share what I found out along the way.
Commonplace
“Spitting up is the normal process of bringing up milk (formula or breast milk) from the stomach via the esophagus when an infant burps or soon after a baby feeds,” explains Lynn Davidson, MD, assistant professor at Albert Einstein College of Medicine and attending pediatrician at Children’s Hospital at Montefiore in New York. “It does not cause discomfort, choking, gagging or arching of the back.” In fact, it is not a forceful process and the amount of spit up is minimal. “In essence, a baby who spits up is a ‘happy spitter,’ and it is [merely] a laundry problem,” suggests Davidson.
So what is the cause of this gleeful purge? Biologically, food is prevented from being regurgitated by a muscle that is located between the stomach and the esophagus, says Davidson. Since this muscle is often underdeveloped in newborns and infants, it doesn’t always contract at the right time.
Overfeeding is frequently a catalyst. “Symptoms will improve by decreasing each feed by a small amount and by more frequent burping,” says Davidson, who notes that in the case of very small newborns or premature babies, you should consult with your pediatrician before decreasing or changing feeds. Davidson also recommends feeding baby in an inclined position, keep-ing baby upright for a few minutes following a feed, and not bouncing baby with a full stomach to decrease the amount of spitting up.
If you aren’t sure what your tot is experiencing is spit-up, ask your pediatrician. She can assess the situation by reviewing health history, looking for clinical symptoms, and conducting a physical examination. Davidson points out that spitting up is generally not treated with medication or a change in diet. “Spitting up gets better over time and usually is gone by the time a child is sitting or occasionally by the time a child walks,” she says.
Out of the ordinary
You know your baby better than anyone else, and if you think your mini-me might be suffering from something more serious than plain old spit-up, it’s possible your little one is dealing with GERD. Like spit-up, “GERD is also regurgitation of the stomach contents which, in infancy, is usually milk often mixed with stomach acid,” says Davidson. “Instead of getting better over time, GERD gets worse, with more frequent episodes.” If you think this might be what is ailing your infant, look for symptoms like irritability, weight loss, choking, arching of the back and refusal to feed. “In extreme cases, it can cause hoarseness of the voice, wheezing and breathing difficulties,” Davison adds.
Just like spit-up, GERD stems from the inability of the muscle to contract properly after feeding. As an infant grows, stomach muscles normally become better coordinated and stronger. But Davidson explains, “When the acid from the stomach causes repeated irritation of the esophagus, the condition is called GERD.” In extreme cases, she notes that the food contents will enter the trachea and cause breathing trouble.
You can minimize symptoms by employing the same tactics used to manage spit-up, such as decreasing the amount of food (per doctor’s orders), elevating while eating, keeping baby upright postmeal, and avoiding jarring activities. Your pediatrician may also recommend thickening the milk or changing formulas, Davidson notes. Prescription medications may be an option as well: “When all other techniques have failed and baby is still having symptoms of GERD, medications like acid-blocking medicines may be tried,” says Davidson.
To diagnose GERD, visit your pediatrician, who can determine whether your baby is actually showing signs of the disorder. “In severe or unusual cases,” explains Davidson, “a radiological study, where the baby will swallow a contrast material like barium, or endoscopy, where a specialist will go down into the esophagus and stomach using a scope, will be necessary.”
Occasional episodes of spit-up are a normal part of infancy. Davidson suggests, however, that if spitting up is frequent (more than once or twice a day) or baby is vomiting forcefully, has a fever or diarrhea, throws up material that does not look like milk (green, yellow, black or bloody), or is not drinking adequate amounts, he should be seen by a doctor as soon as possible.