Spit-Ups: Baby Problem or Laundry Problem?

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Title: Spit-Ups: Baby Problem or Laundry Problem?

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Author: Mike Jr, MD

Email: mike@...

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Spit-Ups: Baby Problem or Laundry Problem?

Copyright 2006 Mike Jr, MD

You've had your baby home a month or so, and he's a

cutie--no doubt about it. There's one problem though, a

problem you hadn't considered before he arrived: He pukes

all the time! And it's not just a little urp. We're talking

over your shoulder and through his nose kind of stuff.

You're embarrassed to let others hold him. Aunt Betty, the

one who always knows best, thinks your baby needs to see a

specialist right away, and your neighbor tells you she

knows someone who knows someone who had a spitty baby who

choked and died in her sleep.

You start making middle-of-the-night nursery runs to check

your baby's breathing. The baby monitor is turned up so

loud you can hear its electric hum, and you promise

yourself once more that in the morning you really are going

to call the doctor and ask to see a specialist. In the

meantime, your baby is asleep. There's no unusual sound on

the monitor, and no vomit in the crib. Your baby is fine,

but the situation is driving you crazy.

So is this spitting-up okay? Or is it a problem?

Most of the time, baby spit-up is a temporary form of

gastroesophageal reflux disease (GERD). It's a condition

caused by a loose valve on top of the stomach. From a

mechanical point of view, the stomach is pretty simple.

Food goes in, mixes with acidic digestive juice, and gets

churned. Then the stomach gives a great big squeeze,

forcing food into the small intestine.

For many, this is the problem stage. When the stomach

squeezes, the valve on the bottom is supposed to open, and

the valve on top is supposed to stay closed. But in babies

with GERD, the valve on top also pops open, so food goes

both ways--up and down.

Unfortunately, GERD is not the only cause of infant

vomiting. There are life threatening causes as well. Bowel

obstruction. Infection. Metabolic disease (such as PKU). So

how do you tell the difference? Well, you don't do it

alone. You find a doctor you trust and you let her decide.

Here are some questions she'll ask:

Is the spit-up projectile? Bowel obstructions create a

great deal of pressure. These babies have very forceful

vomiting, often across the room.

Is there blood or bile in the vomit? These are serious

signs. Blood may indicate erosions or high blood pressure

in the GI tract, and bile is common with obstruction.

Does your baby choke on the spit-ups? We're talking more

than a little red-in-the-face gag here. If your baby is

having pauses in breathing or is dusky blue in the face,

you should seek medical help immediately. While severe

reflux can cause this problem, heart defects, blood

infections and meningitis can too.

Is your baby gaining weight appropriately? Severe reflux

can cause weight loss, but your doctor will want to

eliminate other possibilities.

Your answers to these questions, along with physical exam

findings, will determine the next step. If there is a

reason to suspect a cause other than reflux, some testing

is likely. The most common test is the " upper GI. " Your

baby drinks a bottle of barium, and the radiologist takes

x-rays. The barium lights up, showing the structure of the

intestinal tract. If all goes well, your baby will have a

little spit-up action during the exam. The radiologist will

see the reflux as it occurs, and you'll have your culprit.

On the other hand, your baby might not cooperate. He might

not show any reflux during the test even when reflux really

is the cause of the problem. Don't worry; it won't be the

last time he refuses to show off for you.

Other tests are possible, but only a handful of babies need

them. For most, reflux can be diagnosed on the basis of the

history and physical alone. It's like my grandma used to

say: If it looks like a duck and walks like a duck and

quacks like a duck, it's probably a duck.

So let's say we establish that your baby has reflux. What's

next? How do you make it go away? After all, that's the

question that brought you in. Well, you might not like the

answer. The answer is you do nothing, unless the reflux is

causing a problem. Dirty laundry doesn't count here. We're

talking constant fussiness or breathing difficulty or

weight loss.

For fussiness, something to reduce stomach acid usually

does the trick--antacids and Zantac are good examples. Your

baby will still spit up, but at least he'll smile at Aunt

Betty as he soils her blouse. Babies with breathing

problems or weight loss are a more difficult bunch. They

need reduction of their vomiting.

You can start by decreasing feed volume. Refluxing infants

tolerate 2 ounces every 2 hours better than 4 ounces every

4 hours. Also, try to keep your baby upright during and

after feedings. This allows gravity to keep milk in the

bottom portion of the stomach. Your doctor may have you add

rice cereal to the milk. Not Rice Krispies. Rice baby

cereal. Don't laugh. I've seen it done. Thicker milk stays

down better, but it comes with a price--weight gain.

Sometimes these simple measures aren't enough. Your baby

may need medicine and possibly surgery to stop the

vomiting. This is reserved for the most severe cases of

reflux. Medicine and surgery may have side effects and

unexpected results, so it's best to make sure their

potential benefit outweighs the risk of consequences. Your

doctor will help you decide.

For most babies, reflux treatment is not necessary. These

are the babies without projectile vomiting. There is no

blood or bile in their spit-ups. They aren't choking. They

have no breathing difficulty. No weight loss. No extreme

fussiness. It's okay to let their milk fly over the

shoulder or out the nose. It's even okay if it soils Aunt

Betty's blouse. What you have there is not a baby problem.

It's a laundry problem--and that's something Aunt Betty

knows all about.

About the Author:

Mike is an American pediatrician. Read more at

http://www.pediascribe.com

COPYRIGHT 2006 Mike Jr, MD