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Infant Reflux and Spitting Up

Question of the Week


Updated July 16, 2014

Mother feeding her baby a bottle
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Q. My son is 2 months old. He is having trouble with his formula. He has been changed several times, will that hurt to change his formula? He spits it up a lot. I worry if he spits up a lot he wont grow like he should. He weighed 8 pounds 7 oz at birth and 12lbs and 12 oz now. Donna, Jackson, KY

A. Medically, it shouldn't hurt to frequently change your infant's formula, as long as you stick with one that is iron fortified. Some infants do have minor problems with diarrhea or constipation or have feeding problems as they adjust to being on a new formula though.

If your infant is simply spitting up and has gastroesophageal reflux, but is gaining weight well and has no other symptoms, you may not need to change his formula so often though, or at all. Experts estimate that more than half of young infants spit up at least one or more times a day. And it often looks like much more than it actually is when they do.

At this age, infants normally gain about 1 1/2 to 2 pounds a month, which he has done. That is a good sign that his spitting up isn't causing a problem for him.

In addition to difficulty gaining weight or possibly losing weight, signs that reflux is causing a problem include that an infant:

  • is often fussy or irritable
  • frequently chokes or has wheezing or difficulty breathing
  • often refuses to eat (dysphagia)
  • arches his back during or right after feedings
  • has a chronic cough
  • has a hoarse voice or cry
If your son is eating well, isn't fussy, and is obviously gaining weight well, then he may have simple reflux or be what is called a 'happy spitter.' These babies often don't need any treatment for their reflux and can be expected to outgrow it sometime around 12 months of age.

If a child is spitting up and has any of the symptoms listed above, then he may have gastroesophageal reflux disease or GERD and need further evaluation and treatment.

Unless your baby has other symptoms of a formula intolerance, like a lot of gas, diarrhea, bloody stools, in addition to vomiting or spitting up and being fussy, then changing formula isn't usually helpful. If you are going to try a different formula, then a hypoallergenic formula, like Nutramigen, may be the best choice, since some studies have shown improvement in infants who just had vomiting when changed to this type of formula.

Enfamil AR is a specialty formula that can be helpful for infants that do have reflux, and that may be an option if your child doesn't have a milk protein allergy or lactose intolerance.

For infants with reflux and GERD, treatments can include:

Lifestyle Changes

In addition to talking to your Pediatrician about a formula change, these lifestyle changes might include thickening your infant's formula by adding one tablespoonful of rice cereal per ounce of formula. Using the Enfamil AR formula is supposed to have the same effect.

Although it helps reduce episodes of reflux if you place your infant on his stomach after he eats, because that raises his risk of SIDS, it is isn't recommended that you do that unless he is going to be awake and you are watching him. It may also help if you feed him smaller amounts more frequently, instead of larger, less frequent feedings. And maybe burp him more often during each feeding and feed him in an upright position.

Reflux Medications

The most commonly used drugs to treat gastroesophageal reflux in infants and young children are the acid reducers, including Zantac and Prevacid. Keep in mind that infants who are 'happy spitters' and have good weight gain, and don't have excessive crying, or feeding or respiratory problems usually don't need to be treated with medications for their reflux.

Diagnosis, Testing, and More

The diagnosis of reflux is usually made by the characteristic symptoms. Testing, such as with an Upper GI is sometimes done, but it is often done more to make sure that an infant doesn't have another reason to be vomiting, like an obstruction, instead of confirming the diagnosis of reflux. Other testing can include a PH Probe, although that is an invasive test.

For infants with persistent symptoms, especially if they aren't gaining weight well, a Pediatric Gastroenterologist can be helpful. Occasionally, even after optimal medical management, surgical treatment with a Nissen fundoplication ends up being the only treatment option.

In Conclusion

In this specific case, unless your son has other symptoms that you haven't mentioned, you might ask your Pediatrician about trying an hypoallergenic formula, like Nutramigen, if you haven't done that yet and you really think that it is a formula problem. You might also discuss with your Pediatrician whether or not your infant may have simple reflux and could be a 'happy spitter' and that you may have to just have to protect your clothes and furniture, do a lot of laundry, and learn to live with the spitting up until he outgrows it.

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