It is common for babies to spit up a few times a day. But if a child often vomits, it can lead to other problems or symptoms.
Frequent spitting up or vomiting in children is often due to acid reflux, also called gastroesophageal reflux disease (GERD). It can happen to infants as well as older children.
The esophagus connects the mouth, throat and stomach in humans. At the end of the esophagus, there is a muscle that contracts to prevent acid reflux, which is when food in the stomach goes back up the esophagus.
If your baby usually spits up after eating, acid reflux may be the reason. However, the condition is rarely serious when a baby gets older. Reflux occasionally causes babies to spit up throughout the day.
Although the symptoms may not be a concern if your baby is healthy and growing well, you should not take it for granted as the condition can indicate a medical issue such as respiratory problems, difficulty gaining weight and inflammation of the esophagus (esophagitis).
What causes acid reflux in children?
In children, the muscle at the end of the esophagus is often not strong yet. So acid reflux is more common in children than in adults. GERD is the most common acid reflux condition in children, but there are also other disorders such as food intolerance, eosinophilic esophagitis and pyloric stenosis. In older children, it can be from any pressure below the esophagus or from a relaxed esophagus muscle.
GERD is not a serious problem unless left untreated. To decide whether your child needs treatment, you should know the common symptoms. The most common symptoms of GERD in young children are refusing food and not gaining weight; spitting up forcefully, causing stomach contents to shoot out of their mouth (projectile vomiting); spitting up green or yellow fluid, blood or a material that looks like coffee grounds; having blood in the stool; having difficulty breathing; and beginning vomiting at six months or older.
While acid reflux and GERD can go away when a child gets older, the condition can still be harmful. You should take your child to the doctor if they experience the above symptoms.
GERD may be present in older children and adolescents if they have pain or burning in the upper chest (heartburn), have pain or discomfort when swallowing, frequently cough or wheeze or have hoarseness, belch excessively, have nausea, taste stomach acid in the throat, feel like food gets stuck in their throat or suffer from pain that is worse when lying down.
Who is at risk?
Sometimes, the factors that contribute to infant reflux cannot be avoided. The common risk factors include babies lying down most of the time, an almost completely liquid diet and prematurely born babies.
What treatments are available?
You can reduce the risk of GERD and acid reflux in your child simply by making changes to their lifestyle and diet. If these changes do not work, your doctor might recommend medication or surgery to treat GERD.
– Elevate the head of the baby’s crib or bassinet
– Hold the baby upright for 30 minutes after feeding
– Thicken bottle feedings with cereal (do not do this without your doctor’s approval)
– Feed your baby smaller amounts of food more often
– Try solid food (with your doctor’s approval)
For older children:
– Elevate the head of the child’s bed
– Keep the child upright for at least two hours after eating
– Serve several small meals throughout the day, rather than three large meals
– Make sure your child is not overeating
– Limit foods and beverages that seem to worsen your child’s reflux such as high-fat, fried or spicy foods, carbonated drinks and caffeine
– Encourage your child to get regular exercise
Medications used to treat GERD aim to reduce gas in the stomach or neutralize stomach acids, although there is no clear evidence that decreasing stomach acids can help GERD in children. These medications are considered quite safe for children, but antacid can lead to diarrhea.
– Medicines to lessen gas such as simethicon drugs (Mylicon, Gaviscon, etc)
– Medicines to neutralize or decrease stomach acid, including antacids such as Mylanta and Maalox, antihistamine H2 such as Axid, Pepcid, Tagamet or Zantac, proton-pump inhibitors such as Nexium, Prilosec, Prevacid, Aciphex and Protonix
Only cases of severe reflux need surgery to tighten the lower esophageal sphincter to prevent acid from flowing back into the esophagus. The procedure is usually effective, but it is not without risk. Discuss the potential risks and benefits of this operation with your child’s doctor.
Although less common in children with GERD compared to their adult counterparts, long-term acid reflux can lead to Barrett’s esophagus, a serious precancerous condition, and even cancer of the esophagus if the disease is not effectively controlled. You should seek immediate treatment for your child if symptoms continue to be serious. (kes)