Parents contact me frequently to ask about their baby bringing up milk. While listening to their stories, I have noted that many confuse regurgitation, vomiting and reflux. I think it is essential to explain the differences.
Regurgitation is an overflow, a spontaneous return of undigested and odourless milk that, usually, is brought back up in the hour after feeding. In terms of scientific knowledge in 2020, it is said that regurgitation is in fact a normal physiological reflux in infants linked to the immaturity of the sphincter at the entrance to the stomach.
This frequently occurs in babies that drink quickly without taking a break, or when moved after feeding, especially during the day when awake and very little at night when sleeping. Gastric emptying (of the stomach) would be slower in these babies or delayed and influenced by food (caloric density).
Regurgitation is diagnosed if milk is regurgitated twice or more a day for at least three or more weeks and there is no digested milk (vomiting), no blood nor associated breathing difficulty (aspiration).
The latest studies have shown that regurgitation is the most frequent symptom in young babies and that 40% still regurgitate at 3-4 months of age, but this percentage drops to 5% when the baby eats solid foods and walks.
Note that the baby can regurgitate up to the age of 12 months without having an impact on his weight or development. It is time that will improve the situation and no medication can prevent regurgitation.
Vomiting is an upbringing of partially digested milk. It has curdled and has a stronger smell. Spray vomiting frequently occurs in very young babies, once or twice a day, due to the immaturity of the sphincter, a muscle located at the entry of the stomach. However, spray vomiting after every feeding is abnormal in a young baby and can lead to dehydration, less urine, drying of the skin, irritability, drowsiness – in short symptoms of pyloric stenosis, an illness that requires emergency care.
Reflux refers more to pathological regurgitation, that is to say, abnormal which causes inflammation which can lead to tissue damage. Reflux is seen in 5 to 9% of babies. When we talk about pathological regurgitation (reflux), the cause is also the relaxation of the lower esophageal sphincter (entrance to the stomach), but there is a component related to slower and delayed gastric emptying. The baby may always swallow after feeding, or swallow even if nothing is in their mouth. Frequent discomfort when the baby is lying down, and they may cry more during the two hours following feeding because, rather than travelling to the intestine, their milk, mixed with an acidic digestive enzyme, moves up from the stomach to the esophagus, which becomes irritated. Reflux is also caused by the immaturity of the sphincter at the entry to the stomach. However, in contrast to vomiting, reflux is more regular: it occurs after almost all feedings.
Again, it is the time that makes the difference, when your baby will mature but, if the baby has reflux which affects his growth or which causes respiratory problems, esophagitis, difficulty in breastfeeding, treatment is possible in these conditions.
Reflux peaks around four months and gradually dissipates and disappears around 8-12 months. As a reflex, babies will likely drink less per feeding, but more often to protect themselves from the pain and discomfort caused by the acidity that continually moves up from the stomach. When we look at family medical history, we often find parents or grandparents known to have been treated for reflux problems, even when adults. However, it is not a hereditary problem but more a family trait.
Reflux will not start at six months. If this seems to be happening, visit your doctor as it is symptomatic of other causes.
How can you comfort your baby? Here are a few ideas that can help:
- Feed more frequently but less each time;
- Avoid overfeeding;
- Burp them more often;
- Handle them carefully to avoid shaking them;
- Lay down your baby on their right side for 1 hour after feeding while watching them, then, on the left side for at least another hour while watching them. This follows the form of the stomach and avoids liquids coming up after feeding;
- Position them with the torso raised rather than lay them down flat;
- Avoid over-exciting them after feeding;
- Wait at least two hours after feeding before bathing them or lying them on their stomach to play;
- If they are covered in secretions, remove them before feeding;
- If you are breastfeeding and the ejection reflex is too strong, remove a bit of milk and/or give them just one breast at a time and/or position the baby straddling your leg facing the chest for feeding. They will be drinking in an anti-reflux position;
- If they are given formula, you may have to change it as it may be too difficult to digest, or use a thicker one;
- Acupuncture and osteopathy are alternative methods that can comfort them;
- Certain homeopathic or natural products can also reduce the discomfort caused by reflux;
- As a last resort, the doctor can prescribe an antacid for newborns to comfort them or help their growth. However, the medication can alter the baby’s intestinal microbiota, which will impact their defence and immunity.
Educational video from Marie
So, most of the time, there is nothing to worry about, parents! If your baby’s weight follows the normal growth curve, even if it regurgitates, vomits or has a reflux, it will not affect its development. It is a necessary passage, a transition.
The decision to consult a doctor comes to the experience and expectations of the parent(s), their perception of the symptom and their ability to cope with the symptom (their tolerance).
There is evidence that when parents understand the phenomen of reflux, and it is a question of maturity at the base, parents treat less their baby with medication.
Some babies who have less than expected normal growth could be hospitalized to be further investigated for their reflux through a test called “impedancemetry”. This test measure the resistance of certain biological tissues. A tube or a scope is installed in the baby’s stomach to measure the level of acidity and then provide the appropriate treatment.
To add to your preparation for birth and delivery, here are videos related to the adaptation to the arrival of a baby and to get to know them better :
- Adapting to the return home with a newborn
- Physical exam of a baby
- Newborn ailments
- Osteopathy and baby
- Baby massages
- Calming dance
- Naturopathy and baby
Also read those tickets that are related to baby care :
- When fungal infections arrive!
- Postnatal care for your baby
- Cradle cap
- Baby colic
- Baby and hiccup (French only)
- Babies crying at night
The Baby Expert
This post is also available in: Français