Concerned about your baby spitting up?

Babies spit up. In fact, almost two-thirds of healthy babies spit up, and despite the inconvenience of a foul-smelling milk stain on your clean shirt, there is often nothing to worry about.

While some children do have a medical problem related to reflux, experts have become concerned that in recent years medications that treat reflux disease are being overused and given to children who aren’t seeing much benefit from them.

The American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition have offered new guidelines that can help parents and their pediatricians discern when a child may have a disorder that needs further testing or treatment and when they should be managed without unnecessary tests and medications.

Here are some of the important things the experts want you to consider:

Know the difference between reflux and reflux disease

Spitting up is known in medical terms as gastroesophageal reflux (GER). It occurs when the connection between a baby’s esophagus and his stomach relaxes and allows food to pass from the stomach back into the esophagus. This can result in baby effortlessly regurgitating one or two mouthfuls of his stomach contents.

It’s important to know that this is a normal, painless occurrence for most babies. It happens because of the way the baby’s body is formed, and it will resolve as the child grows.

It’s also important to know the difference between gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD). Spitting up, or reflux, isn’t a disease that needs to be treated unless your baby has troublesome symptoms or complications related to the reflux. In infants, these symptoms may appear as irritability associated with spitting up or vomiting, refusing to eat, poor weight gain, difficult or painful swallowing or arching of the back during feedings. Coughing, choking, wheezing or other breathing problems can also be a sign that an infant is having complications related to reflux.

If your child isn’t having any of these troublesome symptoms or complications, further testing and treatment often are not necessary.

Consider changes to the way you feed your baby

Whether you’re faced with reflux disease (GERD) or just frequent spitting up, there are changes you can make to your baby’s feedings that may be of benefit. Keeping baby upright or lying on his tummy after a feeding can help minimize spit-ups. Keep in mind, though, that baby should be awake and monitored if lying on his stomach, as sudden infant death syndrome (SIDS) is a serious risk that is more likely to occur in infants sleeping on their stomachs.

And, while it may seem to make sense that placing the infant in a car seat might be a good compromise, studies have shown that when babies are placed in car seats or other partially reclined positions, their reflux symptoms actually worsen.

Another strategy is offering thickened formula to an infant with reflux. Adding 1 tablespoon of rice cereal per 1 oz. of formula may help decrease symptoms, but parents should discuss this with their pediatrician. For infants born before 37 weeks gestation, there could be serious risks involved, so it’s important to let your pediatrician guide your decision. Changing baby’s formula or, for breastfed babies, modifying the mother’s diet also may be an important option to discuss with your pediatrician, as some infants are intolerant to cow’s milk protein and symptoms can look very similar to GERD.

For many infants, it can help to reduce the amount of each feeding. Overfeeding is one of the main triggers of reflux, and preventing the stomach from becoming too full can often prevent spitting up. For babies older than one month and who aren’t having trouble gaining weight, consider decreasing their formula by 1 ounce at each feeding (for breastfed babies, limit their time at the breast). To make sure baby is still getting adequate nutrition, you can decrease the amount of time between feedings, providing the same nutrition but in smaller more frequent amounts.

Don’t expect medications to offer a cure

There are a variety of medications available to treat GERD in adults and children. Some of these medications also can be used in infants, but it is important for parents to know that in babies they often are not effective. Studies that compared infants who were given medication (known as proton pump inhibitors or PPIs) with those given only placebo showed no difference between the two groups in reducing baby’s irritability. Other medications such as metoclopramide that help move food faster through the infant’s GI tract can be effective, but significant side effects often limit its use.

Infants who are experiencing reflux but do not have complications of the disorder known as GERD should not receive medication. For those babies who are diagnosed with GERD, parents should weigh their options carefully with their pediatrician. When determining the next steps, keep in mind that medication is often not the cure that parents are hoping for, and the potential side effects that come along with them can bring unwanted and unnecessary problems.

Perhaps one of the most important things for parents to remember as they try to manage these issues is that for most infants, it will get better over time. As a baby grows, his body is better able to handle the feeding challenges of infancy. Though it requires patience and persistence, parents can take comfort in knowing that there is a light at the end of the tunnel.