Have Pediatric Questions? Ask a Pediatrician.
Is your baby prone to spitups or has s/he been diagnosed with gastroesophageal reflux (GER)? GER involves vomiting of stomach contents due to incomplete closure of the lower esophageal sphincter (LES), the muscular valve that connects the esophagus to the stomach. You might think of the stomach as a fluid-filled balloon and the esophagus as a tube connected to the balloon. When the stomach "balloon" squeezes and churns formula during digestion, the formula may easily squirt up the esophagus "tube" if the LES remains open, especially when the child is lying down. Such reflux may be visible upon reaching the mouth and/or nose versus concealed (not going high enough to be seen) but causing stiffening, grunting, crying, etc. As the baby matures, the LES also matures in function, usually closing normally with digestion by age 6-18 months. If the GER does not involve complications of (1) weight loss or poor weight gain, (2) frequent "heartburn" irritability and crying due to esophageal exposure to acidic stomach contents, or (3) aspiration (accidental inhalation of vomited stomach contents) with possible respiratory symptoms or pneumonia as a result, then treatment (e.g., medication or, rarely, surgery) is usually not required because most cases resolve at the age mentioned above. The following general measures may help to lessen your baby's symptoms if GER is the cause: give smaller-volume, more frequent feeds; burp the baby after every 1-2 ounces; keep the baby upright during and until 30 minutes after feeds; consider a wedge under the crib mattress to raise the sleeping angle to 30 degrees. Consider a discussion of the symptoms with your pediatrician, who may consider a trial of anti-reflux medication.