If you refer to your baby as "Old Faithful" because of his regular and impressive oral eruptions, he might have gastroesophageal reflux disease, often called GERD, a more severe form of acid reflux. Most babies spit up from time to time, but a baby with GERD spits up frequently enough and in quantities to interfere with good nutrition. He might lose weight or gain very slowly, a condition his pediatrician might call "failure to thrive." Frequent spitting up or vomiting that's affecting your baby's weight gain needs medical evaluation and treatment
Failure to Thrive
Doctors use the term "failure to thrive" to describe a group of symptoms rather than a disease. Your baby might fail to thrive from acid reflux if his weight falls below the third or fifth percentile for his height on two occasions, or if his weight is less than 80 percent of the expected norm for his age, according to the University of Chicago Comer Children's Hospital. Having his weight fall enough to cross two percentile lines can also lead to a diagnosis of failure to thrive, the same source reports. This is a scary diagnosis for parents, but in most cases, medication, lifestyle changes and, in severe cases, surgery can improve your baby's nutritional status when he has GERD.
Acid Reflux in Infants
It's a rare baby who never spits up; between 60 and 70 percent of babies age 3 to 4 months spit up at least once a day, pediatric gastroenterologist Dr. Steven Schwartz explains in a 2012 Medscape article. Frequent spitting up resolves in 80 percent of children by 18 months and in 98 percent by age 2, pediatrician Dr. Harland Winter reports on the Wolters Kluwer Health website. An immature or floppy valve between the stomach and esophagus, called the lower esophageal sphincter, allows stomach acid to enter the esophagus after eating. Severe acid reflux leads to GERD, which can cause burning pain, refusal to eat, arching of the back, coughing or aspiration, vomiting or poor weight gain. Both vomiting and refusing to eat contribute to poor weight gain.
As many as 80 percent of babies could show improvement with just simple measures, according to Dr. Winter. Between 15 and 40 percent of babies with reflux can't tolerate the proteins in milk, a condition called dietary protein-induced gastroenteropathy. Many of these babies also can't tolerate soy products. A two- to three-week trial of a non-milk, non-soy-based formula or cutting all soy and dairy from your diet if you're breastfeeding will tell you if you're on the right track. Keeping your baby upright for 20 to 30 minutes after feedings and thickening formula with cereal helps in some cases; if you're breastfeeding, don't switch to formula, since breastfeeding might protect against reflux.
Medications or Surgery
If simple measures don't work, medication or surgery might be necessary to get your baby's weight gain back in the normal range. Medications for reflux include drugs that block acid production in the stomach, or that neutralize stomach acid, negates the pain and damage done to the esophagus by reflux. While adults often take these medications over-the-counter, infants should take them only under their pediatrician's supervision; babies can have side effects that adults don't. If medications don't help and weight gain remains compromised, surgical repair, called fundoplication, tightens the lower esophagus so acid can't leave the stomach.