It’s not unusual for infants to spit up shortly after feeding, but almost all infants outgrow the problem by the age of 18 months. Some children, however, develop a more serious condition known as gastroesophageal reflux or “reflux.”

What Is Reflux?

Reflux occurs when the contents of the stomach move up into the esophagus. This takes place when the muscle at the top of the stomach (lower esophageal sphincter) relaxes at an inappropriate time, allowing the contents of the stomach to move upward into the esophagus. Regurgitation, or “spitting up,” happens as the stomach contents come out of the mouth.

Reflux can occur at any age from infancy to adulthood.

Physiologic Reflux

Typically, the majority of infants experience “physiologic reflux.” This means they may spit up after feeding without showing any other symptoms.

Most infants between 12 and 18 months outgrow the problem of spitting up as they begin to consume solid food and replace crawling with walking, assuming an upright position. The growth process also eliminates “spit up” as the esophagus gets longer.

Tips

If your infant frequently spits up after eating, try these measures to reduce the frequency and severity of reflux:

• Hold the child upright for at least 20 minutes after feedings.
• Avoid overfeeding.
• Frequently burp the child.
• Thicken the feedings.
• Do not allow the infant to sleep in an infant carrier. This puts the child in a “crunch “position, which can increase the amount of reflux.

If these measures do not help, your child’s pediatrician may suggest antacid medications, such as Zantac, Tagamet, or Pepcid, or other medications to help empty the stomach, such as Reglan.

Warning Signs

Any child with warning signs of reflux should be evaluated by a pediatrician, who  may refer the child to a specialist known as a pediatric gastroenterologist.  Warning signs of reflux in an infant include:

• excessive irritability
• feeding refusal
• poor weight gain
• spitting up blood
• spitting up bile (yellow fluid)
• breathing problems.

“Any child with warning signs of reflux should be evaluated by a pediatrician, who may refer the child to a specialist known as a pediatric gastroenterologist.”

Tests

If an infant shows warning signs of reflux, the doctor may order tests to eliminate other possible sources of symptoms. For example, an X-ray test known as an “upper GI” can help determine if kinks or twists in the stomach or bowels could be causing the child’s symptoms.

An upper endoscopy can also help determine if any irritation or damage may require additional therapy or treatment. With this procedure, a small scope is inserted into the child’s mouth and passed down to the stomach. While the child is sedated, the doctor evaluates the lining of the esophagus and stomach through the small scope.

Older Children

Reflux symptoms in older children may be as simple as heartburn or as severe as vomiting blood.  Some children may have atypical symptoms, meaning they have symptoms that are not typical for reflux, such as:

• hoarseness
• cough
• poorly controlled asthma
• recurrent pneumonia
• chronic sinusitis
• recurrent ear infections.

Treatment

For infants with reflux, follow the measures outlined here under “Tips” to manage the condition. Management of reflux in the older child involves lifestyle changes, such as limiting caffeine and avoiding spicy foods, citrus, and tomato products. They should also avoid eating at least two hours before exercising or going to bed. If your infant or child finds no relief with lifestyle changes, your pediatrician or pediatric gastroenterologist may prescribe medications such as Prevacid or Prilosec.

Dr. Laman is a pediatric gastroenterologist with Children’s Hospital at Erlanger. He is also an Assistant Professor of Pediatrics with the UT College of Medicine Chattanooga.