Description
Regurgitation or reflux is the effortless spitting up of one or two mouthfuls of stomach contents. Formula or breast milk rolls out of the mouth, often with a burp. It usually occurs shortly after feedings. Reflux is most common in children under one year of age and begins in the first weeks of life. More than half of all infants have reflux to some degree.

Cause
A lack of closure of the protective one-way valve at the upper end of the stomach (known as the Lower Esophageal Sphincter) is responsible for regurgitation. This condition is also called gastroesophageal reflux (GER) or chalasia.

Expected Course
Reflux improves with age. By the time your baby has been walking for three months it usually is completely cleared up. Many babies get over reflux even sooner.

Symptoms and Treatment
Regurgitation can cause symptoms such as heartburn, arching, fussiness, coughing & wheezing, or decreased appetite. Sometimes when this regurgitation causes pain or the infant not to eat, we use medications to help decrease the acidity of the stomach contents, increase the tone of the valve, and help the stomach empty. These medications do not ”cure” the problem, but control the symptoms until such time that the infant “outgrows” the condition. Rarely, if the infant does not respond to medications, and the symptoms are severe enough, surgery may be indicated.

Medications
When basic measures fail to control symptoms, medication may be indicated. Usually, two types of medication are used. Acid-blocking medications (famotidine/Pepcid, ranitidine/Zantac, cimetidine/Tagamet, omeprazole/Prilosec and lansoprazole/ Prevacid) suppress stomach acid and prevent it from doing damage to the esophagus and lungs. Pro-motility agents (bethanechol, metoclopramide/Reglan, cisapride/ Propulsid) help to strengthen the tone of the lower sphincter and increase gastric emptying. For children these medications are by prescription only.

All of these medications are safe in infants and children and have only minor side effects. If your child experiences side effects, we will adjust the dose or change medication.

Home Care
1. Feed smaller amounts
Overfeeding always makes spitting up worse. If the stomach is filled to capacity, spitting up is more likely. Give your baby smaller amounts (at least 1-ounce less than you have been giving). Your baby doesn't have to finish a bottle. Wait at least 2-3 hours between feedings because it takes that long for the stomach to empty itself.

2. Burp your infant to prevent spitting up
Burp your baby several times during each feeding if possible. Don't interrupt his feeding rhythm in order to burp him. Keep in mind that burping is less important than giving smaller feedings.

3. Positioning
After meals, try to hold your baby in an upright position, using a frontpack, backpack, or swing, for at least 30 minutes. Avoid infant seats because they increase the contact of stomach acid with the lower esophagus. When your infant is in a crib, elevate the head of the bed a bit by putting blocks under the mattress. After your child is over six months old, a walker can be helpful for maintaining an upright posture after meals. To make the walker safe, you should remove the wheels and make sure stairways are closed off securely.

4. Avoid pressure on the abdomen
Avoid tight diapers and clothes, as they put added pressure on the stomach. Don't let people hug your child or play vigorously with him right after meals.

5. Cleaning up
One of the worst aspects of spitting up in the past was the odor. This was caused by the effect of stomach acid on the butterfat in cow's milk. The odor is not present with commercial formulas because they contain vegetable oils. A more common concern is clothing stains from milk spots. Use the powdered formulas; they stain the least.

Adapted from B.D. Schmitt, MD, author of "Your Child's Health," Bantam Books.