GE Reflux (gastro-esophageal reflux)

Many babies (up to 50%) spit up frequently. There are a few reasons for this. The infant's lower esophageal sphincter, the muscle that acts as a gate between the esophagus and the stomach is very relaxed during the first few months of life, making it easy for milk to "slosh up" the esophagus when the baby's stomach is full. Certain factors such as an overly full stomach, intestinal gas, and lying flat make it easier for the milk to spill backwards up the esophagus. The good news is that reflux is not unusual and that it is temporary for most infants. At about six months, infants take advantage of gravity to help keep the milk down in the stomach by sitting up more and taking some spoon-fed solids. The lower esophageal sphincter gets stronger with age, so that most infants fully outgrow their reflux by about one year old.

You can help your baby feel more comfortable by holding him as upright as possible during breast or bottle feeding. Keeping the baby upright for about 20 minutes after eating also helps decrease the frequency of spit up. Some infants do better with smaller but more frequent feedings to reduce the gaseous distention. If gas is a problem, trying Infant Mylicon Drops (0.3 mL up to 4 times a day either alone or mixed with the bottle) is reasonable. Most of the time, this is all that is needed. If the reflux is very persistent despite these measures, it may be worth changing the baby's diet for 2 weeks to see if this helps the reflux. Since reflux can also be a sign of a milk protein intolerance, some babies will benefit if the mother avoids soy and dairy products (remember to take calcium vitamins!) or a trial of a hypoallergenic formula such as Nutramigen or Alimentum. This diet should only be continued if it is successful in reducing the frequency of the infant's spit up.

NEVER place the baby in the prone position for relief. The risk of sudden infant death syndrome (SIDS) more than outweighs any possible benefit for reflux. Options such as thickened feeds with rice cereal and prescription medications are available but should be discussed with your doctor first.

For most babies, reflux is a laundry problem and not a medical one. However, some babies have more significant problems with reflux. If your baby shows any of the following signs, it is worth a visit or call to the doctor.
• feeding refusal
• bloody stools
• trouble with feeds such as arching, irritability, turning the neck away, or lifting the chin high
• poor weight gain
• wheezing or recurrent lung infections
• projectile vomit (vomit that reaches several feet across the room)
• green or bilious vomit
• vomiting that begins after six months of life
• diarrhea or constipation
• fever
• lethargy
• a bulging fontanelle (the baby's soft spot)
• increased abdominal distention

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