Many babies spit up occasionally with feeds.  If weight gain is good, the baby eats eagerly and seems satisfied after feeding, and the baby is cheerful and sleeping well, then I am not usually concerned.

If the baby’s vomiting is excessive, the baby is unhappy, or if other symptoms of illness are present, the child should examined.  If the child is not suffering from another illness, I may diagnose Gastroesophageal Reflux (GE Reflux).

If your baby suffers from GE Reflux, I suggest keeping the baby upright as much as possible, so that gravity can minimize the spitting.  Sometimes, thickening the formula with rice cereal may be advised.  (Obviously this is not practical for the nursing baby.)  Occasionally, switching the formula to a soy-based formula, or a low allergy formula (Nutramigen or Alimentum) might reduce symptoms; if you try changing formula, give it 5-7 days to see if the symptoms improve.

If more severe symptoms persist, medications or X-Ray studies might be indicated.

GE Reflux often runs in families; several siblings may all suffer with it.  Typically, infants grow out of GE Reflux by 9-12 months of age.  But in about 15% of cases, it may persist beyond 12 months; in these cases, the child may require treatment for a few years until he grows out of it.

One of my biggest concerns about long-term consequences of GE Reflux is the potential for a “feeding aversion.”  If the esophagus is inflamed from acid reflux, the baby may learn that it hurts to eat.  If he avoids eating for months or years because of the fear of pain, nutritional problems might result.  Usually, this can be avoided by early recognition and treatment of the reflux.

–  David Epstein, MD