Are Your Baby’s Spit-Ups Concerning?

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All babies have episodes of reflux intermittently without implying a medical condition. Acid reflux (technically called gastroesophageal reflux) is a common finding in infants and refers to the flow of contents from the stomach back into the esophagus. It can present itself with episodes of spit-ups or vomiting, with larger amounts of stomach contents being released. Reflux can also be "silent," implying that the stomach contents don't make it all the way to the upper esophagus and mouth.

However, reflux episodes can be a sign of several medical conditions. Therefore, it is important to differentiate between a "happy spitter" and a baby with one of these medical conditions. If the baby is content, happy, feeding well and growing adequately, then there is likely no need for concern.

Signs of concern include:

  • Pain or discomfort with spitting/vomiting
  • Pain or discomfort with feedings
  • Recurrent forceful vomiting
  • Refusal to feedings
  • Poor growth/weight gain
  • Recurrent significant respiratory issues
  • Blood-stained contents in spitting/vomiting
  • Bile-stained contents in spitting/vomiting (yellow or green vomiting)

What causes reflux?

Infant reflux is related to multiple factors, often in combination.

In babies, the ring of muscle between the esophagus and the stomach — the lower esophageal sphincter (LES) — is not yet fully mature, allowing the contents of the stomach to flow back into the esophagus. With time, this sphincter's function improves and keeps this from happening.

Lying flat on their backs makes reflux more likely in babies. Also, because young babies have a diet that is completely liquid, this may favor reflux, as well as air swallowing that can increase the pressure in the stomach allowing some of the contents to go to the esophagus with burping. Although infant reflux most often occurs after a feeding, it can happen anytime your baby coughs, cries or strains.

What medical conditions can be present with reflux?

  1. Gastroesophageal reflux disease (GERD): This is the condition where the episodes of reflux are common or severe, allowing acidic contents from the stomach to cause injury to the lining of the esophagus.
  2. Intolerance to food: Babies that cannot tolerate cow's milk protein or soy protein can have episodes of reflux/vomiting.
  3. Eosinophilic esophagitis: Certain blood cells (eosinophils) that migrate to the lining of the esophagus can cause inflammation of the esophagus and symptoms.
  4. Structural problems: Blockages or anatomic conditions can prevent the normal passage of feedings/gastric secretions through to the lower gastrointestinal tract.

If there is any sign of concern or family history of any of the above medical conditions, you should relay this information to your doctor for further evaluation. To schedule an appointment with a pediatrician, click here.

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