Spitting Up: Is this something to worry about?

in every baby. Virtually all babies have GER in the first three months of life. The reason for this regurgitation lies in an immature muscle at the end of the esophagus. The lower esophageal sphincter is a smooth muscle that serves as a safety valve to prevent stomach acid from backing up into the esophagus. In infants, this muscle is incompetent— that is, it does not work very well. Over time, this muscle tightens up and prevents regurgitation. By 15 to 18 months, about 70% of toddlers have outgrown this tendency to spit up. By a year, 40% have outgrown it. 

Is spitting up harmful? It is harmful to your brand new pashmina and may stain the carpet, but for most babies themselves, it is innocuous. There are three conditions where GER can be a harmful medical condition.

1. The first is failure to thrive, where the baby is simply not getting enough nourishment from the breast milk or formula because he is spitting up so much. This is rare.
2. The second condition is blood in the stool, also known as melena if the blood is hidden or hematochezia if the stool is overtly bloody. This can be caused by such severe GER that the base of the esophagus is irritated and bleeding. This, too, is rare and usually occurs after long-standing GER. Bloody stools in infants are much more likely to be caused by an allergy to a protein found in cow's milk or a rectal fissure or cut.
3. The last condition that can be caused by GER is aspiration pneumonia. In this disease, when the stomach contents are coming up, some of the reflux gets into the lung and causes an infection. This condition is rare in healthy babies and usually occurs when a child is neurologically impaired.

As long as the three conditions above are not occurring, you can rest assured that your baby will most likely outgrow this annoying but harmless condition.

Does GER cause the pain known as heartburn? This is a controversial question. Some doctors think that GER can cause heartburn and babies should be treated for their pain. Zantac or other acid suppressants have been used to treat the pain. There was a time when motility agents such as Propulsid and Reglan were prescribed to propel the stomach contents along so that the regurgitation would not occur. We now know that these agents are not effective for GER. Some physicians do prescribe acid blockers, especially for colicky babies. It is not at all clear whether colic responds to these agents or even whether babies have heartburn. 

Babies cry. Whether it is from pain, fatigue, hunger, boredom, irritability, or just plain orneriness is not often clear. If your baby cries for long periods, you should talk to your doctor about possible causes. She or he may or may not want to try a medication for possible heartburn, especially if your baby spits up a lot.

Dr. Victoria McEvoy graduated from Harvard Medical School in 1975 and is currently an Assistant Professor of Pediatrics at HMS. She is the Medical Director and Chief of Pediatrics at Mass General West Medical Group. She has practiced pediatrics for almost thirty years. She has been married to Earl for thirty six years and raised four children. She currently enjoys writing, traveling, reading, almost all sports, and spending time with her two grandsons.

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