Spitting up is a common, albeit messy, part of being a baby. But some little ones have a harder time keeping their early diets down than others. So, infants these days are often prescribed medications to help keep their spit-ups — and the discomfort that can come with them — at bay. But now a new study is questioning whether many of the babies taking these drugs really need them.

Focusing on 44 infants with ongoing spitting up or vomiting problems, researchers used a test to measure the reflux (or regurgitation) of acid from the stomach into the esophagus. What they found: The vast majority of the babies couldn't technically be diagnosed with gastroesophageal reflux disease (GERD), a condition that's different from regular old reflux. Reflux is very common in infants, but it usually doesn't cause any health problems and stops before a baby's first birthday. Doctors diagnose GERD when a child's reflux is causing complications, like irritation of the esophagus due to refluxed stomach acid, poor weight gain, or breathing problems due to spit up spilling over into the child's lungs.

Although almost all of the 44 babies tested were on antireflux medications (42, in fact), only 8% of them could be considered to have GERD. And when the babies who didn't appear to have the condition after all were taken off the medications, the reflux symptoms in most of the babies improved or didn't get any worse.

So, why the large number of babies getting antireflux medications? The researchers say the high number of prescriptions could be because:

• Primary care doctors don't have a simple way to distinguish simple reflux from GERD, so they may prescribe the medication to see if it helps.
• Parents may become anxious and worried about their baby's ongoing problems and request a prescription. (The researchers note, though, that parents' reports of vomiting and spitting up are often highly exaggerated — often as much as five to six times more than the amount the baby is actually throwing up.)

Reflux vs. GERD

Reflux (also called gastroesophageal reflux) happens when acidic stomach contents move backward into the esophagus, which can cause babies (as well as older kids and adults) to burp, spit up, or have heartburn. If the muscle that connects the esophagus with the stomach (called the lower esophageal sphincter) is weak or relaxes, it can allow stomach contents to reflux.

It's perfectly normal for infants to be "happy spitters," bringing up small amounts of breast milk or formula after a feeding, especially when they're burped or are moving around.

But when this happens a lot or the infant has other symptoms like extreme fussiness or poor weight gain, it could be GERD. Although some will need treatment most babies will outgrow GERD without medication (usually around the time they turn 1 year old).

What This Means to You

It can definitely be upsetting to see your baby regularly spit-up or vomit. But medications usually aren't necessary, and they can have side effects. If you're concerned, it's a good idea to keep a log of your baby's spit up and vomiting — how often, when, and how much. Be as accurate and honest as possible.

Although some spitting up is normal for babies, make sure to tell the doctor if your newborn or young infant regularly has episodes of extremely forceful, or projectile, vomiting, which may be a sign of another condition called pyloric stenosis. Persistent vomiting can also be a symptom of a number of other conditions that your child's doctor may need to consider.

In addition to frequent spitting up and vomiting, other red flags for GERD include:

• poor weight gain
• excessive crying or irritability (especially after eating)
• feeding problems (like inability to eat certain foods and refusing food or accepting only a few bites despite hunger)
• frequent gagging or choking
• recurrent respiratory symptoms, like recurrent wheezing or pneumonia
• hoarseness
• chronic cough
• trouble sleeping soundly
• vomiting up blood

When babies spit up a lot but don't have any of these other symptoms, the doctor may want to skip the medications altogether and recommend:

• slightly thickening formula or breast milk with rice cereal (but you should never do this without getting the doctor's OK first)
• correct positioning — feeding babies in a vertical position, burping them frequently but not too forcefully, and keeping them in a seated position or held upright after meals (but NOT in an infant seat, which can make reflux worse)
• keeping the infant away from cigarette smoke
• a trial of hypoallergenic formula (if your child isn't breastfed) or eliminating dairy products from mom's diet if the baby is breastfed — some milk-allergic infants can develop symptoms resembling GERD

Of course, if you're still concerned and none of these things seems to help your little one, be sure to follow up with your doctor.

Reviewed by: Steven Dowshen, MD
Date reviewed: November 2007

Source: "Are We Overprescribing Antireflux Medications for Infants With Regurgitation?," Pediatrics, November 2007.