Reflux & posseting in babies

Spitting up or posseting is just part of life with a baby. Some do it more, some less, but it’s part of having an immature digestive system and it’s usually not a big deal. Acid reflux in babies, however, is an entirely different story. For babies with reflux, eating can become an uncomfortable and painful experience, making a new parent’s anxiety skyrocket. It’s not always easy to diagnose a baby with reflux, but here’s what you need to know to tell the difference between normal and concerning baby behaviour.

How do you know if your baby has acid reflux?

Non-acidic reflux in babies, also known as spitting up, is normal and expected. Babies do this because their gastrointestinal system is still developing. Sometimes they take in more formula or breastmilk than their system can handle, causing some of it to come back up. Many babies spit up every day for their first six months — or longer. Usually it’s just a little breastmilk or formula, but occasionally your baby may spit up curdled milk (this happens when the milk sits in the stomach acid for a bit). Babies usually take spitting up in stride. They’re often happy to eat immediately afterwards and might not seem to even notice that they’ve spit up.

Acid reflux in babies (aka gastroesophageal reflux) is different. This happens when stomach acid flows backwards from the stomach, up into the esophagus — the tube that carries food from the mouth to the stomach. In adults, you’d recognize the feeling as heartburn or acid reflux. This can be pretty uncomfortable for babies, and their behaviour reflects that — acid reflux in babies is usually diagnosed based on their behavioural symptoms.

Symptoms of acid reflux in babies

• Spitting up after each feed
• Arching their body during or after feeding
• Crying after or during feed
• Choking or gasping sounds during feeding
• Pulling off the breast or away from the bottle frequently
• Failure to gain weight or grow 

How to help a baby with reflux

While it’s tempting to ask your pediatrician for a prescription to fix your child’s reflux, this isn’t always the best course of action. The medications that treat reflux make the baby’s stomach acid less acidic, which can increase the baby’s risk of getting certain infections like lower respiratory tract infections. Because of this, doctors may suggest less interventionist methods like an elimination diet first. This involves eliminating many of the foods you eat (especially known irritants like caffeine and dairy) to see if that reduces symptoms.

There are a few other things you can also do to minimize and treat the symptoms of reflux in your baby. The first is to burp your baby more frequently. Try pausing their nursing session every 10-15 minutes for a burp. Feeding them smaller meals more frequently as opposed to one big one can also help. Especially important is to keep them upright for half an hour after nursing to minimize the opportunity for reflux. These methods are also helpful for treating babies with silent reflux, though this might be more difficult to diagnose as babies with silent reflux often swallow the spit up, so symptoms aren’t as obvious.

Is time the best cure for reflux in babies?

Reflux in babies is usually due to the immaturity of the esophagus and as your baby grows the esophagus will too. This means that most babies do grow out of their reflux when their esophagus matures a little, usually between six months to a year. 

Some doctors think that acid reflux is overdiagnosed in babies. Newborns cry a lot and newborns with colic cry even more. And the symptoms of colic (crying, arching the body, turning away from a feed) often look like acid reflux. This can make it seem like the baby has a painful digestive problem when they might “just” be colicky. And while colic is overwhelming and difficult, giving baby acid reflux medication doesn’t solve it.

Medication for reflux in babies

Finding a solution for your infant’s acid reflux should involve their doctor. While you can safely treat your heartburn with an over-the-counter (OTC) medication, the same can’t be said for babies. Many OTC acid reflux meds contain Aspirin, which isn’t safe to give to anyone under the age of 18. If your baby’s reflux is causing pain, or preventing them from growing and gaining weight, then medication is a great alternative. 

When to see a doctor

• Baby is vomiting blood or what looks like coffee grounds
• If baby vomits bile (a green or yellow liquid)
• Baby vomits after eating (as opposed to spitting up)
• If baby’s stool has blood in it
• Child seems to be in pain while eating or following a feed
• If baby is dehydrated
• If you’re concerned baby’s behaviour isn’t normal

Baby spit up is a pain to clean up, but in most cases it’s a normal part of your child’s development and they’ll likely grow out of it. But getting through the fourth trimester is difficult enough without having to worry that feeding your baby is causing them pain. If you’re concerned that your child’s spitting up is abnormal or that eating is causing them discomfort, speak to their doctor.