Dr. Jacqueline Gerhart: Does My Grandson Have Reflux Or Is He Just Spitting Up?
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that usually appears weekly on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Dr. Gerhart: My grandson is spitting up his food with every feeding regardless of what food it is. It looks like he is uncomfortable. Does he have baby reflux? How do I know if he needs medication?
Dear Reader: When patients come in asking if their baby has reflux, their symptoms can span anywhere from normal spit up to serious projectile vomiting. The key is to get a good history. Things your doctor will want to know include: what he eats, how often he is fed, how much he eats at a time, what position he feeds in, how frequently he urinates and stools, and what the spit up and stools look like.
Then at the office visit, the physician will assess if the child has lost any weight, or is "falling off of the growth curve." For example, if he was previously in the 50th percentile compared to the weight of other U.S. children, is he dropping off to the 25th and then to the 5th percentile over the last few months. We also will likely want to see you feed your grandson to get a sense of what the spit up looks like, how forceful it is and at what time it happens (during or after the meal).
We will also look for aspiration, which means that the food is going "down the wrong pipe" and possibly into the lungs. And we will assess the mouth for sores or infection that is causing spit up due to painful swallowing.
In most cases, when parents feel that their child has reflux, the child is usually "normal," and the spit up can be cured by lifestyle changes. Some examples include proper "burping" after feeding, being consistent in quantity and frequency of feeds, and being open to trying different formulas or foods. About 90 percent of babies will respond to lifestyle changes like these. Some physicians call these babies "happy spitters," because the spit up doesn't cause pain or damage and can be fixed relatively easily and without medications.
The other 10 percent of babies may have a true medical concern. Many of these babies have GER, which stands for Gastro Esophageal Reflux. This means that stomach acid goes up to the esophagus and causes "heartburn" symptoms. In those cases, a prescription acid controlling medication can be helpful. One commonly used is called ranitidine – the same medicine in Zantac. If uncontrolled, GER can progress to GERD – which is Gastro Esophageal Reflux Disease. It is considered a disease if there is significant weight loss, symptoms of aspiration or clear injury to the baby's stomach or intestines.
Finally, there are a small percentage of children who have more severe gastrointestinal issues and may require further testing. For example, many parents read about "projectile vomiting" indicating a disorder called pyloric stenosis, in which the opening from the stomach to the intestines is smaller and food can't get through as well.
So, please keep notice of when your grandson spits up, and then make an appointment with his primary care physician to discuss his symptoms.
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 11/19/2013