Spitting up, reflux and formula changes

Every baby spits up a little bit. I think that if I ever write a parenting book, that the first page will say, "Congratulations on your new baby! All you need for the baby is a washer and dryer."

I worry about the spitting up when your baby is doing it so much that they are losing weight or seem to have pain associated with eating. Otherwise, it's just a mess. It probably has nothing to do with the choice of formula. It's more about anatomy.   If you are nursing, the spit up can be from oversupply.

Reflux is normal in newborns, gets the worst it's going to get at about 6 months, and then gets better after that until we poison our body with tobacco and caffeine and other things that cause heartburn.

It's caused by food coming back up the esophagus instead of behaving itself and going into the gut.  The liquid can slink up a little, so that nobody even knows it's happening (sub-clinical reflux), can come up to the level of the collarbones or so, and make kids choke and gag, or come shooting out the mouth or nose.

Overfeeding is a pretty common reason for this to occur.  The stomach can only hold so much-- you'll wear the extra food that you have given.  A nice rule of thumb is that kids will puke if you give them half of what they weigh...a ten pound kid will reach their "puke zone" at 5 ounces.  Formula takes 3 hours to digest, so if they are getting fed formula more frequently than that, they may puke-- formula left over from the prior feeding added to the stuff you are giving may cause stomach overload, and the forceful ejection of whatever they just ate.  Breastmilk is very quickly digested, and the kids who are breastfed are less likely to spit up, unless of course, mom has too much milk.

You can minimize spitting up by choosing the right size nipple: one that is not collapsing as the baby is sucking, or making them gulp as they eat, or that is attached to a breast. All those nipples make controlling flow easier, minimizing the amount of extra air the kids get in.  And bottles fed kids should be burped frequently.  Breastfed kids tend not to burp, since they can control the rate of flow of the milk and tend not to take in extra air.

You can also help lessen reflux episodes by keeping the kids elevated, maybe sleeping in a swing or car seat, or elevating the head of their bed.  That lets gravity act as our friend, and keeps food in the stomach instead of creeping back up.  You could thicken the feedings by adding rice cereal to the formula.  I don't think this is the greatest idea though, since it is a bit of a bandaid.  Thickening the feedings just makes the reflux less noticeable.  The same amount of reflux events occur, but they don't come up as high, and may not come out, so that we think we have "fixed" something when we have just covered it up.  And as I have mentioned elsewhere on this site, rice cereal is a simple carbohydrate with little nutritional value.  If we can avoid empty calories, we should.

Reflux disease means that normal reflux has taken an evil turn.  The acid normally present in the belly is creeping up the esophagus, burning that sensitive tissue and causing pain. It happens while the kids are eating or afterwards, pretty much anytime there is food in the belly.  Formula is in the belly longer than breastmilk, so formula-fed kids are more likely to have symptomatic reflux episodes.  The pain may happen shortly after the kids start eating; they will start to squirm, may do some back arching and look generally uncomfortable.  They may cry alot, and the cry will be different from others they have.  This one will sound like pain.

Some evidence, but not a whole bunch, points to cow's milk in a nursing mom's diet as a culprit in breastfed babies.  So we might talk about decreasing cow's milk for a bit to see if that helps.

Formula fed kids who have reflux are not necessarily having a formula problem.  Diarrhea is the hallmark of formula intolerance.

Treatment, in addition to the stuff above, is medications like zantac or prilosec or plain old mylanta.  These medications do not make reflux stop happening. They make the acid part go away, and therefore make reflux episodes less painful.  The kids will still spit up.

If you think your child has a reflux problem that requires medication, then you need to see me.  Check out the colic page too, since reflux and colic are often hard to tell apart. Spit up with every feeding, in a child about 4 weeks old or so can be indicative of a surgical problem called pyloric stenosis, which means that there is a real blockage to the out-going part of the stomach.  It can happen in kids who are younger than 4 weeks, and sometimes a little older, but the important part for you as parents is that the spitting up happens each time the kids have eaten

"See me" list...

See me if your child is losing weight, spitting up with every feeding, seems miserable with eating or has a behavior change you think may be related to food.  .

updated July 5, 2007