Babies Spitting Up—Normal in Most Cases
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It's easy to understand why some parents and other caretakers are concerned. Is the infant getting enough nourishment? Is frequent spitting up a sign of a more serious illness? Does the baby need medicine to treat the problem?
According to Andrew E. Mulberg, M.D, a pediatrician and pediatric gastroenterologist at the Food and Drug Administration (FDA), frequent spitting up is absolutely normal in most cases and not a symptom of poor health. As long as the child is alert, reasonably content, gaining weight, and not showing other signs of illness, this is not usually a cause for concern, he says.
So what is causing the baby's food to come back up so frequently?
In infants, the ring of muscle between the esophagus and the stomach—the lower esophageal sphincter (LES)—is not fully mature, allowing stomach contents to flow backward, Mulberg explains. In time, the LES will mature and open only when the baby swallows and will remain tightly closed the rest of the time, keeping stomach contents where they belong.
"By the time the child is 18 months of age or younger, the problem—known as gastroesophageal reflux (GER)—usually resolves itself," Mulberg says.
In a small number of cases, a more serious condition known as GERD (gastroesophageal reflux disease) may exist. GERD also can cause excessive spitting up, but requires treatment to avoid additional health complications, such as tissue damage in the lining of the esophagus. A health care professional should be consulted immediately if a baby shows such symptoms as spitting up blood, blood in the stool, weight loss, failure to thrive including lack of weight gain and persistent coughing or wheezing, Mulberg says.
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However, PPIs sold over the counter are not approved by FDA to treat reflux in infants, says Mulberg.
An FDA advisory committee met in November 2010 to discuss four clinical trials investigating the effects of PPI treatment of infant GERD. The committee concluded that PPIs should not be prescribed as therapy for otherwise healthy infants less than 1 year old, Mulberg says, unless there is evidence of tissue erosion in the esophagus.
As for what drugs may or may not be needed, that's a determination the health care professional must make after conducting a thorough physical examination. Mulberg suggests that parents should be ready to discuss the baby's mealtime behaviors in some detail, as well as the child's general mood. Before an appointment, parents should be prepared to answer questions such as:
- Does the baby spit up at every feeding?
- How much liquid is the baby spitting up?
- Are you breast-feeding?
- If not breast-feeding, what type of formula are you using?
- Have you recently switched formulas?
- Holding the baby in an upright position when feeding.
- Feeding the baby smaller portions at a time.
- Thickening feedings with rice cereal or other infant cereals, which help the food to sit in the stomach longer.
- Making a switch to a different formula.
This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.
August 5, 2013
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