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Everything You Need to Know About Regurgitation in Infants


Infant regurgitation, also known as gastroesophageal reflux (GER), occurs when contents in the stomach move up through the esophagus and into the mouth or nose. Regurgitation is common among infants and oftentimes occurs daily. It usually resolves within the first year and a half of life. As long as a baby is healthy and growing, infant regurgitation is not a concern.

Regurgitation usually presents at around 3-6 months of age and will resolve in over 50% of infants by 10 months. Almost all babies stop having reflux by 2 years of age. Some babies have more severe reflux that can result in complications and warrants further testing and diagnosis.

Why does regurgitation happen?

After a baby breastfeeds or bottle feeds, the liquid goes down the esophagus (the narrow tube-like passageway connecting the mouth to the stomach) and through the lower esophageal sphincter, a ring-like muscle that helps prevent food and liquids from going back up into the esophagus. The contents in the stomach will then begin to break down and exit the stomach into the small intestine.

Due to babies having a shorter, smaller esophagus and an underdeveloped sphincter, food more easily backs up into the esophagus and out of the mouth or nose. As babies grow, they will begin drinking larger quantities of breastmilk/formula, which will fill the stomach and more than likely result in reflux. If babies swallow a lot of air during feedings, reflux may occur before or during burping.

Systems of regurgitation/reflux

The most common symptoms in infants with GER are seeing stomach contents (spit up) coming out of the mouth or nose and coughing or hiccuping after feedings. Gastroesophageal reflux disease (GERD), on the other hand, is a more severe type of reflux that can cause the baby to be irritable, have a decreased appetite, and even experience weight loss.

Diagnosis

If a baby spits up food out of the mouth or nose, that is considered regurgitation/reflux/GER. Further testing may be required if GERD is suspected, and this may include:

  • Ph testing in the stomach - A small tube is placed down the nose and into the esophagus to test stomach acid levels.
  • Upper gastroesophageal endoscopy (upper GI) - A scope placed down the throat and into the stomach that visualizes the anatomy and allows for biopsies to be taken.
  • Gastrointestinal X-rays (upper GI series) - The baby will drink a fluid called barium that is used to help visualize the body more clearly on X-rays and can show problems with anatomy that causes reflux.

Treatments

Usually, infant regurgitation does not need treatment and will eventually self-resolve. If a baby is fussy, eating less, and losing weight, a doctor may conclude that a baby has a more severe case of regurgitation (GERD). There are several treatment options available:

  • Thickened liquids - Adding a thickening agent like rice or oat cereal to a baby’s bottle will make the fluid denser and help reduce how easily the fluid can back up and out of the stomach.
  • Smaller, more frequent mealtimes - Reducing the amount of fluid that is taken in can help minimize reflux. The amount of meals must be increased in frequency to prevent weight loss and malnourishment.
  • Burping - Adequate burping following feedings helps to remove excessive swallowed air from the stomach.
  • Positioning - Keeping the baby in an upright position after feedings and avoiding feedings right before bedtime helps reduce the backflow of food into the esophagus.
  • Smoking - Maternal smoking and second-hand smoke may result in an increased risk of reflux in babies.
  • Diet - Breastfed babies may have a sensitivity to the foods their mom eats, and dairy products are a common cause of food allergies. Bottle-fed babies may have an allergy or sensitivity to their current formula, so changing formulas may be necessary.
  • Medications - There are several types of medications available to help reduce gastric acid secretion or improve gastric motility. Some examples include omeprazole (Prilosec), famotidine (Pepcid), metoclopramide (Reglan).

Conclusion

While infant regurgitation may be concerning, it is common and often resolves on its own within the first couple of years of life. If a baby with reflux becomes overly irritable, starts eating less, and begins to lose weight, it is important to notify the pediatrician. Some measures can be taken to decrease reflux, and several testing and treatment options are available if needed.

Key takeaways

Infant regurgitation is common among children under two and usually resolves on its own, with more than half resolving before 10 months of age.

Infant regurgitation is also known as reflux, spitting up, or gastroesophageal reflux (GER). Common symptoms are stomach contents coming up into the mouth or nose and/or coughing and hiccuping.

A more severe form of reflux that may require treatment or interventions is called gastroesophageal reflux disease (GERD). It can cause babies to have increased irritability.

To help minimize regurgitation, avoid overfeeding and feeding right before bedtime, keep the baby in an upright position and burp the baby during and after feedings, and avoid smoking.

Resources:

UpToDate. (2021). Patient education: Acid reflux (gastroesophageal reflux) in infants (Beyond the Basics).

SpringerLink. (2017). The Management of Infant Regurgitation.

National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Acid Reflux (GER & GERD) in Infants.

National Library of Medicine. (2019). Gastroesophageal reflux in children: an updated review.

American Academy of Pediatrics. (2018). Diagnosis and Management of Gastroesophageal Reflux in Preterm Infants.

National Library of Medicine. (2020). Natural history of gastroesophageal reflux in infancy: new data from a prospective cohort.

National Library of Medicine. (2004). Maternal smoking and infantile gastrointestinal dysregulation: the case of colic.

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