Reflux & Spit-up

Newborn Spit-up / Newborn Reflux
By Michael Schoenwetter, MD

Newborn Care - SpitupMost newborns spit-up. I answer questions about newborn spit-up daily. Recurrent spit-up is called reflux and is very common in the newborn period. Some newborns spit up a little and some spit up a lot. I get a lot of concerned parents asking me if the spit up that comes out of their newborn’s nose is okay. The answer is yes. In the DVD I will speak more about newborn spit up.

Newborn vomiting is different. Some parents are nervous that they won’t be able to recognize the difference between vomiting and reflux. Even the inexperienced first time parents will be able to recognize the differences. Vomiting is the forceful evacuation of stomach contents. Any recurrent vomiting needs to be evaluated by your doctor as it could be a sign of serious illness in the newborn.

Reflux, in most cases, does not need intervention. There are a few scenarios where reflux is not considered normal. For these situations, multiple interventions are available. The newborn DVD will discuss when newborn spit-up and newborn Reflux are normal and the specific situations that might concern a pediatrician. The newborn DVD will also review the interventions for this very common concern.

Why do newborns spit-up?
Almost all newborns and babies spit-up. If the spit-up is recurrent, it is called reflux. Anatomically, there is an area between the esophagus and the stomach that acts like a door, called the Lower Esophageal Sphincter (LES). When your newborn has food in its esophagus, the “door” is open to let the food into the stomach. When the food has passed into the stomach, the door is supposed to close. Newborns and babies commonly have a “door” that doesn’t close tight, allowing the food to pass from the stomach up into the esophagus and sometimes out the mouth or nose. If the “door” is slightly open, there is a little reflux. If the door is not closing much at all, a lot of reflux can occur.

There are three scenarios where intervention is needed for newborn reflux. First, your child has to gain weight appropriately. If 60% of your newborn’s milk is on your shoulder instead of in his belly, he will not grow correctly and intervention needs to be done. Second, if your newborn is sickly. If the baby has a history of lung problems, such as wheezing or pneumonia, the doctor might be concerned that the refluxed food is getting into the newborn’s lungs and this would necessitate intervention as well. The third scenario, which is the most common that I intervene for, is if the newborn is an unhappy baby. If parents voice their concern regarding how unhappy their baby is- crying more than they think they should- in combination with their baby having reflux, it is possible that the reflux might be contributing to their newborn’s temperament. This can happen as acid might be refluxed from the stomach along with the food causing pain. The interventions most commonly done for these scenarios are medications and dietary changes. Sometimes, for severe reflux, a referral to a specialist is warranted for other management options.

A lot of the newborns and babies I see do not need intervention for their reflux. If the baby is healthy, happy and gaining weight, I call the reflux a laundry problem as the only thing that needs to be done is cleaning more spit-up! A point to remember is that reflux can peak between 3-5 months so symptoms that do not require intervention early might at a later time.

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