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Infant Reflux
Infant reflux, commonly known as spitting up, happens when food moves back into the esophagus from a baby’s stomach. It happens in healthy infants and is usually not a cause for alarm. It usually stops after 18 months of age. Reflux can be exasperated when babies lie flat for much of their day. Premature birth and consumption of an almost completely liquid diet can also contribute. There are some ways to minimize reflux such as feeding the baby in an upright position, trying smaller and more frequent feedings, taking time to burp the baby and putting the baby to sleep on his or her back.
Featuring:
Aubrey Bonhivert, MD
Aubrey Bonhivert, MD, is a board-certified pediatrician practicing at Pediatric Associates of Greenwood. She is a graduate of The Ohio State University College of Medicine and completed her pediatrics residency at the Northwestern Univ. Feinberg School of Medicine/Ann & Robert Lurie Children's Hospital of Chicago. In the past, Dr. Bonhivert has developed presentations on such topics as sleep issues, breastfeeding, infant formula, toilet training, sun safety, skin findings in the newborn, and social determinants of health. Transcription:
Scott Webb: Commonly known as spitting up happens when food moves back into the esophagus from a baby's stomach. It happens in healthy infants and is usually not a cause for alarm and it usually stops after 18 months of age. Reflux can be exacerbated when baby's life flat for much of their day. Premature birth and consumption of an almost completely liquid diet can also contribute. There are some ways to minimize reflux, such as feeding the baby in an upright position, trying smaller and more frequent feedings, taking time to burp the baby during feedings and putting the baby to sleep on his or her back. And joining me today to discuss all of this is Dr. Aubrey Bonhivert. She's a board certified pediatrician with the Franciscan Physician Network.
This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, thanks so much for your time today. We were just talking, you know, my daughter had infant reflux when she was little. So everything I owned for the first six months had spit-up down the left shoulder and many family members just thought she was cute, but really didn't want to hold her until the reflux stopped. But for all of our listeners, please explain what is infant reflux?
Dr. Aubrey Bonhivert: Yes. I can tell you infant reflux also commonly known as spit-ups is when breast milk or formula moves from the stomach up into the esophagus or the food pipe. And oftentimes, it's coming out of the baby's mouth and sometimes even their nose.
Scott Webb: Yeah, that's exactly the way I remember it. And I guess I'm wondering, do we know what causes spit-up or infant reflux?
Dr. Aubrey Bonhivert: The reason that babies are so prone to reflux, especially at first is that there's this ring of muscle. It helps keep food or, in a baby's case, milk in the stomach. And that ring separates the esophagus from the stomach. And in babies, that ring of muscle is not fully developed and so it's just not as strong. And so it makes it pretty easy for the breast milk or formula to just come back up from the stomach. But luckily over time, as that muscle gets stronger, the spitting up tends to improve.
Scott Webb: Yeah, definitely. And as you and I were talking about it, it was just like one day I noticed, and I didn't want to jinx it, but after it had been about a week or so, I said to my wife, I'm like, "Have you noticed that she's not spitting up anymore? "And she's like, "I have," and it was the best day.
So are otherwise healthy infants at risk for reflux or are they just all sort of generally at risk simply because they're all still developing?
Dr. Aubrey Bonhivert: Otherwise healthy babies commonly have issues with spit-ups. We know that up to two-thirds of normal healthy babies will have a spit-up at least once a day, actually. And the way that I think about reflux, there are two important distinctions to make.
And so one is that spit-ups are not the same as vomiting. Spit-ups are usually kind of quiet. They appear effortless when it happens. And the spit-up doesn't really travel very far. You know, it gets all over their clothes, but it's not like it's projectile by any means. Whereas vomiting is actually, you know, forceful and that's because it's associated with contraction of the abdominal muscles. And so usually that appears a lot more dramatic and uncomfortable to the baby. And you kind of know it when you see it. So whereas spit-ups are usually nothing really to think about, actual vomiting in a young baby would be pretty worrisome.
And then the second distinction I always explain to families is that there's a difference between reflux and GERD, which is G-E-R-D. So a lot of people will be familiar with the term GERD, stands for gastroesophageal reflux disease. Many babies have reflux, so they have the G-E-R part of it, but not necessarily the disease associated with their reflux.
So we consider a baby to have GERD with a D when their reflux or spit-ups are causing problems. So poor weight gain, significant pain, or sometimes even breathing problems. So those two distinctions being made, basically otherwise healthy babies certainly can develop GERD with a D, but it's much more common for them to just have simple reflux and we call those babies happy spitters and explain that it's really more of like laundry problem than a problem with your baby. So that's the way I usually explain it.
Scott Webb: That is a great explanation. And, yeah, I see what you're saying. It's sort of the GERD without the D so they just have the GER and that the GER is pretty common. And you're absolutely right. You're so right. It really was more of a laundry problem, mom and dad just keeping their clothes clean. And over time, I felt like I could see sort of a look on her face. Somehow I could just sort of sense, maybe it was just my spidey sense, but I could sort of tell, I'm like, "Uh-oh. Here it comes." Are there any other symptoms? Are there things that parents can be on the lookout for?
Dr. Aubrey Bonhivert: So usually, it's just the spit-ups themselves. As I mentioned, babies, where it becomes more of a problem or the GERD with a D will have problems where they seem like they're having a lot of pain or irritability. They might have trouble feeding where they seem like they don't want to feed because they know that it's going to be painful for them.
Some babies will arch their backs. Other babies will develop problems with like wheezing or coughing from their reflux because they're kind of aspirating a little bit of that reflux into their lungs. So, again, this is definitely the rare case. But those are things that they can look out for to know that it's more of a problem.
Scott Webb: Yeah. And in our case, as I said that one day she just stopped and it was great. It was a glorious day, so much less laundry to do. But are there medications that you use to treat reflux?
Dr. Aubrey Bonhivert: So there are medications available. It's something that parents will want to talk to their pediatrician about. It's certainly not the first line of treatment for reflux though. Typically, there are a few things that I recommend parents try first. These things won't necessarily eliminate spit-ups, but they can help minimize it so it's at least a little bit less of a problem until the baby grows out of it. So that includes burping the baby. I usually recommend parents burp a baby halfway through the feed. And then also again at the end of the feed. And that just helps prevent them from kind of swallowing extra air and helps the babies release that extra air. Parents can also keep their baby upright after a feed for a good 20 minutes, can be helpful.
Scott Webb: Or hours.
Dr. Aubrey Bonhivert: Yeah, sometimes it takes a while
Scott Webb: Or just never put them down, you know? Yep.
Dr. Aubrey Bonhivert: Yeah. And sometimes no matter what you do, the reflux is going to happen sometimes and that's okay too. But these things, at least you can feel like you're doing something and sometimes they help. So yeah, you don't want to bounce the baby or do tummy time right after a feed because that makes it much more likely that that milk is going to come back up. So really it's just giving gravity a little bit of time to let the milk go through the stomach. And then, you know, if the baby is bottle fed, you can try different positioning or a different nipple flow to try to prevent the baby from swallowing extra air.
And then sometimes parents will actually accidentally overfeed their baby. Babies' stomachs are only a certain size. And so if you give them too much milk, some of it's just going to come back up. So one thing that sometimes can be helpful is giving the baby a smaller feed and then just feed the baby more frequently so that the baby is still getting enough throughout the day to grow, but not so much that the tummy's overfilled basically.
So it's these things that I just described are not helping and the reflux is a problem, there are a few other things that parents can talk to their pediatrician about. One as you mentioned is medication. That's usually actually the last resort that we go to just because medications are not without side effects. And they aren't usually super helpful, but in some babies, it's necessary. And so the babies that are considered for those medications are, again, the ones that have GERD with a D. So the reflux is associated with poor weight gain or extreme irritability or breathing problems. And again, that's something that they'll want to talk to their pediatrician about.
The other two things are trying different formulas or thickening feeds. And so as far as the formulas, it is quite rare that a baby needs a change in the formula, especially those like expensive specialized formulas that you'll see on the shelf at the store. They're usually not necessary, but something that you can certainly talk to your pediatrician about and see if they want to do a trial of it.
And then thickening feeds again, you should talk to your pediatrician about, you know, when and how, and sometimes you have to adjust the nipple flow with those thickened feeds. But there are certainly treatment options, but sometimes you just do extra laundry and that's that.
Scott Webb: Good to know that there are options. And as you say, it's just maybe, you know, mom and dad doing more laundry. And then, you know, usually it stops. For us, it was around six, seven months, something like that. If an infant has reflux, can that be an indication that they're going to have reflux for the rest of their lives? How does that work exactly?
Dr. Aubrey Bonhivert: So usually not is the good news. As you mentioned, most babies grow out of their reflux by around six months. There's several reasons for that actually. So one is that babies just have more muscle tone by then. They're also sitting up on their own by then. So they're spending more time upright and they're also starting to take solid foods. And so that helps keep things down in the stomach as well.
Some babies will have reflux until 12, maybe 18 months of age, and that still can be considered normal. But usually if it's persisting beyond a year and a half of age is when a pediatrician might get a GI or gastroenterology specialist involved to make sure there's not something else going on. It's really rare occasion that a baby or a child will need surgery to help them with their reflux.
And I typically don't think of, you know, babies with normal baby reflux being at increased risk for heartburn or, you know, child or adult reflux later on in life. But in those situations where it's something more than just normal baby reflux. Certainly, I would consider those folks at increased risk.
Scott Webb: Yeah, that's good to know. And as you say, the pediatricians, they're just the best and they're such a great resource and we just want parents to, you know, reach out with any questions or concerns. And I'm sure this has helped today. It certainly helped me and allowed me to kind of reflect and smile a little bit about those first six months with our daughter. Doctor, as we wrap up today, anything else you want to tell parents about infant reflux?
Dr. Aubrey Bonhivert: Well, I would just say that the majority of the time, as I've mentioned, several times that infant reflux is completely normal, nothing to worry about. But of course, always talk to your doctor about it and make sure that any of your concerns are being addressed. And there are resources online through the AAP or there's this association called NASPGHAN, which is the pediatric GI organization for America. And they have a good slogan that I like, and they say, "Spit happens."
Scott Webb: Yes. It most definitely does. And many of us parents have been there, done that, as you say, usually it just goes away and it just means a little extra laundry along the way. So this has been so fun today, doctor. And great to put a smile on my face and hear a smile in your voice. And, you know, it's just good to know that, it's not really a serious problem and it will tend to go away and that our kiddos are going to be fine. So doctor, thanks so much today and you stay well.
Dr. Aubrey Bonhivert: Thank you. Thank you for having me.
Scott Webb: For more information, visit FranciscanHealth.org and search pediatric medicine. And we hope you found this podcast to be helpful and informative. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well. And we'll talk again next time.
Scott Webb: Commonly known as spitting up happens when food moves back into the esophagus from a baby's stomach. It happens in healthy infants and is usually not a cause for alarm and it usually stops after 18 months of age. Reflux can be exacerbated when baby's life flat for much of their day. Premature birth and consumption of an almost completely liquid diet can also contribute. There are some ways to minimize reflux, such as feeding the baby in an upright position, trying smaller and more frequent feedings, taking time to burp the baby during feedings and putting the baby to sleep on his or her back. And joining me today to discuss all of this is Dr. Aubrey Bonhivert. She's a board certified pediatrician with the Franciscan Physician Network.
This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, thanks so much for your time today. We were just talking, you know, my daughter had infant reflux when she was little. So everything I owned for the first six months had spit-up down the left shoulder and many family members just thought she was cute, but really didn't want to hold her until the reflux stopped. But for all of our listeners, please explain what is infant reflux?
Dr. Aubrey Bonhivert: Yes. I can tell you infant reflux also commonly known as spit-ups is when breast milk or formula moves from the stomach up into the esophagus or the food pipe. And oftentimes, it's coming out of the baby's mouth and sometimes even their nose.
Scott Webb: Yeah, that's exactly the way I remember it. And I guess I'm wondering, do we know what causes spit-up or infant reflux?
Dr. Aubrey Bonhivert: The reason that babies are so prone to reflux, especially at first is that there's this ring of muscle. It helps keep food or, in a baby's case, milk in the stomach. And that ring separates the esophagus from the stomach. And in babies, that ring of muscle is not fully developed and so it's just not as strong. And so it makes it pretty easy for the breast milk or formula to just come back up from the stomach. But luckily over time, as that muscle gets stronger, the spitting up tends to improve.
Scott Webb: Yeah, definitely. And as you and I were talking about it, it was just like one day I noticed, and I didn't want to jinx it, but after it had been about a week or so, I said to my wife, I'm like, "Have you noticed that she's not spitting up anymore? "And she's like, "I have," and it was the best day.
So are otherwise healthy infants at risk for reflux or are they just all sort of generally at risk simply because they're all still developing?
Dr. Aubrey Bonhivert: Otherwise healthy babies commonly have issues with spit-ups. We know that up to two-thirds of normal healthy babies will have a spit-up at least once a day, actually. And the way that I think about reflux, there are two important distinctions to make.
And so one is that spit-ups are not the same as vomiting. Spit-ups are usually kind of quiet. They appear effortless when it happens. And the spit-up doesn't really travel very far. You know, it gets all over their clothes, but it's not like it's projectile by any means. Whereas vomiting is actually, you know, forceful and that's because it's associated with contraction of the abdominal muscles. And so usually that appears a lot more dramatic and uncomfortable to the baby. And you kind of know it when you see it. So whereas spit-ups are usually nothing really to think about, actual vomiting in a young baby would be pretty worrisome.
And then the second distinction I always explain to families is that there's a difference between reflux and GERD, which is G-E-R-D. So a lot of people will be familiar with the term GERD, stands for gastroesophageal reflux disease. Many babies have reflux, so they have the G-E-R part of it, but not necessarily the disease associated with their reflux.
So we consider a baby to have GERD with a D when their reflux or spit-ups are causing problems. So poor weight gain, significant pain, or sometimes even breathing problems. So those two distinctions being made, basically otherwise healthy babies certainly can develop GERD with a D, but it's much more common for them to just have simple reflux and we call those babies happy spitters and explain that it's really more of like laundry problem than a problem with your baby. So that's the way I usually explain it.
Scott Webb: That is a great explanation. And, yeah, I see what you're saying. It's sort of the GERD without the D so they just have the GER and that the GER is pretty common. And you're absolutely right. You're so right. It really was more of a laundry problem, mom and dad just keeping their clothes clean. And over time, I felt like I could see sort of a look on her face. Somehow I could just sort of sense, maybe it was just my spidey sense, but I could sort of tell, I'm like, "Uh-oh. Here it comes." Are there any other symptoms? Are there things that parents can be on the lookout for?
Dr. Aubrey Bonhivert: So usually, it's just the spit-ups themselves. As I mentioned, babies, where it becomes more of a problem or the GERD with a D will have problems where they seem like they're having a lot of pain or irritability. They might have trouble feeding where they seem like they don't want to feed because they know that it's going to be painful for them.
Some babies will arch their backs. Other babies will develop problems with like wheezing or coughing from their reflux because they're kind of aspirating a little bit of that reflux into their lungs. So, again, this is definitely the rare case. But those are things that they can look out for to know that it's more of a problem.
Scott Webb: Yeah. And in our case, as I said that one day she just stopped and it was great. It was a glorious day, so much less laundry to do. But are there medications that you use to treat reflux?
Dr. Aubrey Bonhivert: So there are medications available. It's something that parents will want to talk to their pediatrician about. It's certainly not the first line of treatment for reflux though. Typically, there are a few things that I recommend parents try first. These things won't necessarily eliminate spit-ups, but they can help minimize it so it's at least a little bit less of a problem until the baby grows out of it. So that includes burping the baby. I usually recommend parents burp a baby halfway through the feed. And then also again at the end of the feed. And that just helps prevent them from kind of swallowing extra air and helps the babies release that extra air. Parents can also keep their baby upright after a feed for a good 20 minutes, can be helpful.
Scott Webb: Or hours.
Dr. Aubrey Bonhivert: Yeah, sometimes it takes a while
Scott Webb: Or just never put them down, you know? Yep.
Dr. Aubrey Bonhivert: Yeah. And sometimes no matter what you do, the reflux is going to happen sometimes and that's okay too. But these things, at least you can feel like you're doing something and sometimes they help. So yeah, you don't want to bounce the baby or do tummy time right after a feed because that makes it much more likely that that milk is going to come back up. So really it's just giving gravity a little bit of time to let the milk go through the stomach. And then, you know, if the baby is bottle fed, you can try different positioning or a different nipple flow to try to prevent the baby from swallowing extra air.
And then sometimes parents will actually accidentally overfeed their baby. Babies' stomachs are only a certain size. And so if you give them too much milk, some of it's just going to come back up. So one thing that sometimes can be helpful is giving the baby a smaller feed and then just feed the baby more frequently so that the baby is still getting enough throughout the day to grow, but not so much that the tummy's overfilled basically.
So it's these things that I just described are not helping and the reflux is a problem, there are a few other things that parents can talk to their pediatrician about. One as you mentioned is medication. That's usually actually the last resort that we go to just because medications are not without side effects. And they aren't usually super helpful, but in some babies, it's necessary. And so the babies that are considered for those medications are, again, the ones that have GERD with a D. So the reflux is associated with poor weight gain or extreme irritability or breathing problems. And again, that's something that they'll want to talk to their pediatrician about.
The other two things are trying different formulas or thickening feeds. And so as far as the formulas, it is quite rare that a baby needs a change in the formula, especially those like expensive specialized formulas that you'll see on the shelf at the store. They're usually not necessary, but something that you can certainly talk to your pediatrician about and see if they want to do a trial of it.
And then thickening feeds again, you should talk to your pediatrician about, you know, when and how, and sometimes you have to adjust the nipple flow with those thickened feeds. But there are certainly treatment options, but sometimes you just do extra laundry and that's that.
Scott Webb: Good to know that there are options. And as you say, it's just maybe, you know, mom and dad doing more laundry. And then, you know, usually it stops. For us, it was around six, seven months, something like that. If an infant has reflux, can that be an indication that they're going to have reflux for the rest of their lives? How does that work exactly?
Dr. Aubrey Bonhivert: So usually not is the good news. As you mentioned, most babies grow out of their reflux by around six months. There's several reasons for that actually. So one is that babies just have more muscle tone by then. They're also sitting up on their own by then. So they're spending more time upright and they're also starting to take solid foods. And so that helps keep things down in the stomach as well.
Some babies will have reflux until 12, maybe 18 months of age, and that still can be considered normal. But usually if it's persisting beyond a year and a half of age is when a pediatrician might get a GI or gastroenterology specialist involved to make sure there's not something else going on. It's really rare occasion that a baby or a child will need surgery to help them with their reflux.
And I typically don't think of, you know, babies with normal baby reflux being at increased risk for heartburn or, you know, child or adult reflux later on in life. But in those situations where it's something more than just normal baby reflux. Certainly, I would consider those folks at increased risk.
Scott Webb: Yeah, that's good to know. And as you say, the pediatricians, they're just the best and they're such a great resource and we just want parents to, you know, reach out with any questions or concerns. And I'm sure this has helped today. It certainly helped me and allowed me to kind of reflect and smile a little bit about those first six months with our daughter. Doctor, as we wrap up today, anything else you want to tell parents about infant reflux?
Dr. Aubrey Bonhivert: Well, I would just say that the majority of the time, as I've mentioned, several times that infant reflux is completely normal, nothing to worry about. But of course, always talk to your doctor about it and make sure that any of your concerns are being addressed. And there are resources online through the AAP or there's this association called NASPGHAN, which is the pediatric GI organization for America. And they have a good slogan that I like, and they say, "Spit happens."
Scott Webb: Yes. It most definitely does. And many of us parents have been there, done that, as you say, usually it just goes away and it just means a little extra laundry along the way. So this has been so fun today, doctor. And great to put a smile on my face and hear a smile in your voice. And, you know, it's just good to know that, it's not really a serious problem and it will tend to go away and that our kiddos are going to be fine. So doctor, thanks so much today and you stay well.
Dr. Aubrey Bonhivert: Thank you. Thank you for having me.
Scott Webb: For more information, visit FranciscanHealth.org and search pediatric medicine. And we hope you found this podcast to be helpful and informative. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well. And we'll talk again next time.