When Is My Baby's Reflux A Problem?

“My baby spits up all the time.”

“My baby never spits up, but seems like they are fussy all the time."

I know this sounds like reflux, but the truth is spitting up can be normal. Even if it’s with every feed, even if it seems really bad.

Maybe you just have a happy spitter.

I call babies who spit up a lot but still gain weight and who aren't fussy with feeds “happy spitters.” They present more of a laundry problem (their clothes, your clothes, sheets, burp cloths, couch cushions…) than a medical problem.

The passage of milk and stomach contents into a baby’s esophagus is a normal process and can even result in VERY frequent, VERY large amount of spitting up and still be normal. It happens because the muscle that sits on top of the stomach is relaxing off and on all day long. If the pressure inside the stomach is higher than the resistance provided by that muscle, the baby can spit up.

But when is it a problem?

I consider reflux a problem if one of two things are happening:

1. The baby seems fussy after feeds or they are fussy when they spit up.
2. The baby is having significant spit up and is not growing well.

Fussiness after feeds is particularly concerning for reflux if the baby is arching their back or starting to refuse their feeds once they start. 

Because pressure is a big player in the spit-up/reflux process, there are some simple things you can do:

1. Make sure you are not overfeeding the baby. Babies who are overfed and spit up can seem hungry after, but that only makes the problem worse.
2. Avoid laying the baby down immediately after feeds when possible. Keeping a baby upright 20 minutes after feeds can help the milk to move further down and be less likely to come back up.

So when do we need to consider medication for reflux?

When the fussiness symptoms are severe and consistent with reflux or the baby is not gaining weight well, despite limiting overfeeding and keeping the baby upright, we consider treatment with an acid reduction medication.

One common medication is a group of acid reducers known as H2-blockers, the most common example is ranitidine. Another group of acid reducers are known as PPIs, such as lansoprazole.

It’s important to keep in mind that the medications don’t do anything to keep the milk down, so it’s likely that the baby will continue to spit up hopefully without being fussy and gaining weight (and another good reason not to treat a “happy spitter”).