Reflux 101 – When Baby Cries Too Much

Baby with spitup or vomit

So your baby cries. What baby doesn’t? What, he spits up a lot too? Welcome to life with babies. Crying and spitup is not a problem. Unless it is.

Happy Spitters

Babies spit up. Some even spit up with such force that it flies across the room. They may spitup so much that it can feel like each feeding is an effort in futility. Big spitters will mark every piece of furniture you own, every carpet, ever piece of clothing with baby vomit. Sometimes they will choke and cough on their own vomit so much that you keep the phone ready with your fingers on 9-1-1. Even the term, spitup, seems too petite and cute for what your baby does. Your baby VOMITS. Often and with great gusto.

Is this OK? Probably.

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  • Is your baby gaining weight?
  • Is he happy?

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If your baby is reasonably happy and growing at a pace that keeps your pediatrician happy, then regardless of how much the spitup bothers YOU, it’s not a problem. The choking, the projectile vomit, soaking his clothes after every feeding, etc. is not a medical concern. Buy some carpet cleaner. Do lots of laundry. And relax. Your baby is fine.

But how do you know if your baby is happy? Newborn babies cry. A lot.

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The average newborn cries for a total of 3 hours throughout the day. Crying and/or fussiness peaks at 6-weeks of age. Typically crying drops to about 1 hour a day by 3 months.
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It is almost impossible to really measure how much your newborn baby cries throughout the day. For starters, you’re probably too busy trying to soothe him to really keep track. Secondly, when they do cry it seems like an eternity. Parents are notoriously bad at actually knowing how much their babies cry because 15 minutes can seem like hours.

But lets assume that your baby cries a lot. Maybe more than average. Enough that you’re starting to have concerns that he may have some contributing medical factor like reflux or colic (this post won’t get into colic but it will be covered in the future – use the subscription options on the right if you want to get updates on future postings). Maybe your baby cries a lot and NEVER spits up.

But the bottom line is that you have a really unhappy baby and you’re starting to wonder why he’s so unhappy.

Reflux Defined:

We all have a valve at the top of the stomach that lets food go IN but keeps food from coming back OUT. In most newborns this valve is not fully developed and stomach contents are pushed back up the esophagus and come out of the baby’s mouth. This is called spitup or baby vomit. Over time, this valve matures and the stomach contents stay IN the stomach.

For some babies, having stomach contents pushed up into the esophagus can cause irritation which is just like an adult who suffers from heartburn. So the problem is not the spitup, the problem is discomfort. Most babies will spitup. Only a small number of babies will suffer from reflux related discomfort.

Some babies will have discomfort without visible spitup. These babies are called “silent refluxers.” The stomach acid is being pushed up into their esophagus, causing discomfort, but without enough force to make it all the way up to come out as spitup.

So again, spitup by itself is nothing to worry about.

How Do You Know if Your Baby Has Reflux?

Ultimately this is a determination that you and your pediatrician will need to make together. Unfortunately there aren’t any non-invasive medical tests to make a diagnosis so generally you observe your baby, make an educated guess, and discuss lifestyle & drug treatments with your Dr. If your baby has more than a few symptoms listed below, its time to make an appointment:
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  • Cries a LOT (substantially over 3 hours a day)
  • May cry excessively after feedings or while/after spitting up
  • Is irritable/fussy/crying due to PAIN
  • Seems to cry even more when placed on back or in a car seat
  • Has frequent hiccups
  • Coughs often
  • Seems hungry but then refuses breast/bottle after eating very little (but then may want to eat 2 minutes later just to repeat the same process)
  • Has chronic ear infections
  • Sleeps poorly, especially during the day (although it’s not uncommon for refluxing babies to sleep well at night out of sheer exhaustion)
  • Chronic wheezing
  • Arching back after feeding
  • Your parenting instinct tells you your baby’s tummy hurts

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Other factors to consider when considering the possibility of infant reflux:
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  • Many babies with reflux don’t show any symptoms until they are 3 months old. Presumably this is because it takes time for the stomach acid to result in significant discomfort.
  • Reflux is hereditary. If you, your partner, or immediate family members suffer from heartburn, your baby is at greater risk.
  • Reflux is more common in premature babies.

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Reflux can be a frustrating and difficult problem to diagnose. According to Dr. Harvy Karp over 25% of all babies in the US are treated for reflux when less than 2% actually have it.  As a culture we are running to medicate babies who are simply fussy, crying, and spitting up BECAUSE they are babies. You need to listen to your heart. Trust your gut. Talk to your pediatrician. And work with lifestyle remedies (discussed further in a future post). If things don’t improve, it may be time to look into medications or possibly an evaluation with a pediatric GI specialist.

Further reading on Infant Reflux:

Crying Over Spilt Milk – Another highly credible site on reflux, symptoms, treatment, etc. however this one comes out of New Zealand. Use the menu on the left for helpful information on symptoms, diagnosis, and treatment. Some of the vernacular is going to be unusual to Americans (“happy chucker” = baby who spits up a lot but doesn’t seem uncomfortable).

Infant Reflux Disease – Good site with general reflux information and a parent forum. Parent forums can be really helpful resources if you can put in the time to wade through them. Especially if you are looking for lifestyle management solutions for reflux (read: non-medical solutions to keep your unhappy spitter happy).

Reflux Rebels – A good source of information and a good parent forum. I particularly like this article on common infant reflux myths.

Infant Reflux – Another good forum (although most of the site content outside of the forum is out of date or contains broken links).
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