Spilling the Tea on Spit-Up

Any parent of an infant will tell you that spit-up or regurgitation is a common phenomenon. It is responsible for an industry that produces burp cloths, wipes and bibs. Recently, much attention has been paid to the diagnosis of gastroesophageal reflux disease. I often get asked by parents about the advisability of using medications for regurgitation. Protein pump inhibitors (PPIs) are a category of medications that are used in adults for gastroesophageal reflux disease (GERD). They are one of the most prescribed categories of medications in adults.  

Infants are also often prescribed PPI medications when the regurgitation is beyond a normal level. Most often they are prescribed when the amount of milk regurgitated is impacting growth by compromising nutritional intake. Growth of your child is perhaps the most important indicator of whether treatment is needed. If their growth is optimal, it is likely that the spit-up is more likely garden variety regurgitation rather than GERD.   

Parents often worry that regurgitation might affect the food pipe or cause heartburn in the way that adult GERD does. Fortunately, the acidity of regurgitation in infants is much less than that of adults so there is no harm of the regurgitation to the food pipe.   

PPI medications have side effects impacting absorption of nutrients and bone health. They have a role when needed, but should be otherwise avoided.  

There may be non-medication ways of lessening regurgitation. Burping infants after a feed and having baby stay upright for 20 minutes in an infant carrier or seat might lessen regurgitation. In the meantime let’s keep the burp cloth industry alive! 

 

Dr. Bhooma Bhayana is a family physician in London and the mother of two young men and proud grandmother of three! She continues to find wonder and enjoyment in family practice despite more than 30 years on the job!