Spitting up is sometimes associated with gastroesophageal reflux disease (doctors often refer to this as GERD for short), which is usually a temporary mechanical hitch. If your baby’s stomach is full or his position is changed abruptly, especially after a feeding, the stomach contents—food mixed with stomach acid—press against the valve at the top of the stomach called the lower esophageal sphincter. This ring of muscle normally relaxes to let food pass from the esophagus into the stomach and then tightens again to keep the food there. When it is not fully developed or it opens at the wrong time, the stomach contents move back or reflux into the esophagus. In babies, gastroesophageal reflux rarely causes symptoms or distress and usually disappears as the upper digestive tract functionally matures. Reflux is mainly a messy problem, not a serious one.
If your bottle-fed baby spits up unusually often, your pediatrician may recommend thickening his formula with a very small amount of baby cereal. Never add solids to the bottle unless your pediatrician advises it. Unless carefully supervised, this practice not only may add unnecessary calories to your baby’s diet but also can interfere with the transition to solid foods. Be careful not to overfeed your baby. Consider smaller and more frequent feedings, but be sure her total daily intake is sufficient to keep up normal growth and development. You may find it helpful to keep your baby in an upright position in a stroller or carrier for the first hour or so after feeding.
In very rare cases, gastroesophageal reflux is severe enough to cause symptoms such as blood in vomit or stools, wheezing and hoarseness, or failure to gain weight. Such vomiting may also be caused by other medical conditions. A baby with severe reflux may refuse to feed or be irritable after feeding. An older child may complain of abdominal pain or describe the discomfort typical of heartburn, and vomit or complain of a sour taste after the food comes back up. In any such case, children with such symptoms need medical evaluation and attention.
Reflux in Older Children
An older child with reflux should avoid fried and fatty foods because fat slows down the rate of stomach emptying and promotes reflux. Peppermint, caffeine (an ingredient of colas and many other soft drinks), and certain asthma medications can make the lower esophageal sphincter relax and allow stomach contents to flux back into the esophagus. Some experts believe that tomato-based products have a similar effect. If any food seems to produce reflux or heartburn, keep it out of the diet for a week or two and then reintroduce it. If symptoms recur, avoid that food for a while.