Infant vomiting.....What is normal?

When babies are born almost all of them have "spit up."  You carry around your burp cloth and make sure your visitors have the cloth when they hold the baby.  It's embarrassing when your baby spits up on the lady down the street who just dropped by to see the new little one.  Baby spit up seems to be the norm, something we all expect and plan for.

A GI doctor once told me it IS normal for babies to have reflux, no not just the spit up, but reflux.  Why?  Babies have small stomachs and eat frequently.  Some babies love to eat and overfill.  Also, babies' esophageal sphincter, (the opening into the stomach from the esophagus that controls food getting into the stomach and staying there) may not fully be developed completely yet.  Babies muscle tone is low compared to adults, so sitting up straight and core control is not developed and therefore leads to reflux and vomit.  Take assurance parents, it is very normal for your baby to spit up.

So when does vomiting and reflux go from normal to a problem?  There are three things to look for that will indicate a problem:
   
                 1. The baby is not gaining weight.

                 2. The baby is in pain.

                 3. The baby begins to refuse food.

1. If the baby frequently vomits during feeds, or if the baby vomits all the feeds given at most feeding times, he or she will not gain appropriate weight.  That is why if you notice too much vomit, I suggest you go to pediatrician and have your baby weighed and talk openly about your worries.  Something underlying may be going on and should be addressed, especially if the baby is not gaining weight.  If the baby vomits a lot but continues to gain weight, there is not cause for concern.

2. If you notice your baby crying a lot after spiting up, if you notice the baby retching in pain, if you notice your baby arc his or her back, you can suspect your infant is in pain. Sometimes there is more reflux than what you notice.  You may only be seeing the baby vomit some of what is coming up into his or her esophagus.  There is acid in the stomach and when it is constantly refluxing silently or with vomiting into the esophagus it will begin causing irritation and many times pain in the infant.  This is a problem because you do not want your baby to be in pain and also it can lead to food refusal.  You should talk to your doctor if your baby seems to be in pain and ask the doctor about acid blocker medications.  These medications do not prevent reflux or vomiting, but it will neutralize the acid so your baby's esophagus is protected and has less irritation.

3. A baby may begin to reject feeds for a many reasons, but the most common reasons are pain associated with reflux and vomiting,  sensory issues, or breathing/aspirating issues when feeding.  Many times the baby is refusing consistently because there is an underlying issue.  If your child refuses food consistently you need to make an appointment to talk to your child's pediatrician.

Above all, always trust yourself and your child.  If you feel the baby is vomiting too much for any reason, please talk to your doctor.  However, always remember reflux and vomiting in infancy is the norm so try not to get too worried.