Regurgitation and Gastroesophageal Reflux in Infants

Regurgitation, also known as spitting up, is quite common in infants. It is usually caused by immature muscles in the digestive tract. Spitting up is not painful and does not have any repercussions on the child's health, unlike gastroesophageal reflux (GER), which can be or become a health problem.

How do they differ?

When infants regurgitate, they usually spit up a small amount of milk. In spite of spitting up, babies remain happy and continue to gain weight. Regurgitation in infants is very common and often occurs after feeding. Unlike simple regurgitation, infants with GER experience discomfort when spitting up. Here are some signs that may indicate a child suffers from GER:

• Weight loss or very slow weight gain
• Refusing to eat or agitated while feeding
• Persistent cough
• Respiratory problems

Unlike GER, simple regurgitation does not have any serious consequences on the child's overall health. If left untreated, GER may lead to other complications including:

• Aspiration of stomach contents into the lungs which may lead to more frequent respiratory problems (bronchitis, laryngitis, otitis, persistent cough, etc.)
• Poor growth
• Esophagitis (irritation of the esophagus)

Causes and triggers

In infants, the esophageal sphincter is not completely formed. Located between the stomach and the throat, that valve-like sphincter prevents food from flowing back up towards the mouth. Furthermore, the mechanism involved in transferring the stomach contents to the intestines is not fully developed either. Both regurgitations and GER gradually disappear during the child's first year as the digestive tract matures and the child begins to stand upright more consistently.

Premature babies and infants who lack muscle tone and have other developmental problems (Down syndrome, for example) are most at risk for regurgitation and GER. The presence of tobacco smoke is also an aggravating factor.

Treatment and Prevention

A few simple measures can be taken to reduce spitting up:

• Avoid tight clothes and diapers;
• Offer smaller amounts more frequently.
• Burp the baby several times during feeding by holding the child upright against yourself and gently rubbing or patting their back.
• Keep the child in an upright position for a while after each feeding - in other words, wait before laying the child down and avoid vigorous play.
• Avoid sitting the child in their car seat after feeding. Sitting puts pressure on the stomach and can aggravate the problem.
• Do not incline the child for sleep, except otherwise advised by your health care professional.
• Ask your health care professional before changing or thickening the child's formula, and if you are breastfeeding, before excluding food from your diet.
• Provide the child with a smoke-free environment.
• Never lay a child on their side or stomach unless otherwise directed by your health care professional, as it increases the risk for sudden infant death syndrome.

Medications are usually not necessary for the treatment of GER. However, your health care provider might suggest some in severe cases, such as when the baby doesn't eat enough. In exceptionally rare situations, surgery may be required.

When should I see a health care professional?

Consult your health care provider if your child has regurgitation or reflux symptoms in addition of the following:

• Recurrent vomiting
• Blood in regurgitation
• Severe diarrhea, bloody stools
• Poor growth
• Refusing to eat or drink anything for a prolonged period
• Infant under three months of age who has forceful vomiting after each feed
• Behaviour changes (lethargic or decreased responsiveness)