Reflux in newborns

Reflux in newborns: Why does the baby spit up?

Spitting up, or gastroesophageal reflux (GER), is the involuntary return of a small amount of stomach contents back into the esophagus and oral cavity. This is an extremely common phenomenon in infants during the first months of life. If your baby is gaining weight well, generally calm, and spits up only a small amount of milk, this condition is considered physiological and does not require treatment.

Causes of physiological reflux

The newborn's digestive system is still immature, which is the main cause of spitting up:

• Weak sphincter. The muscular valve (sphincter) between the esophagus and stomach, which should keep food inside, is still weak in infants and does not always close tightly.
• Horizontal position. Infants spend most of their time lying down, which facilitates the return of milk from the stomach.
• Liquid diet. The child's diet consists exclusively of liquid milk or formula.
• Swallowing air. During feeding or crying the baby may swallow air, which then comes out together with a small amount of milk.

Usually physiological reflux peaks at around 4 months and resolves on its own by the end of the first year, when the baby spends more time in an upright position and the sphincter strengthens.

When is reflux a disease? (GERD)

Sometimes reflux can be pathological and cause complications. This condition is called gastroesophageal reflux disease (GERD). Concerning symptoms that require a doctor's consultation:

• Poor weight gain or weight loss.
• Intense crying and arching of the back during or after feeding, indicating pain.
• Refusal to eat or feeding difficulties.
• Frequent vomiting "projectile".
• Respiratory problems: chronic cough, wheezing, frequent bronchitis due to stomach contents entering the airways.

Distinguishing physiological spitting up from GERD can only be done by a pediatrician or a pediatric gastroenterologist.