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Baby possetting, reflux and vomiting

Regurgitating food, or posseting, after eating at times is normal for babies and young children.

Reflux affects around 40% of babies, although it tends to happen less often with age.

It can be hard to distinguish the difference between normal episodes of food coming back up, or reflux, and the more serious GORD – gastro-oesophageal reflux disease.

What causes regurgitation in babies?

After your baby swallows milk it glides past the back of the throat into a muscular tube (the oesophagus), and from there into the stomach. At the junction of the oesophagus and the stomach is a ring of muscles (lower oesophageal sphincter) that acts like a valve. It opens to let the milk drop into the stomach and then tightens to prevent the milk (and the stomach contents) from moving back up into the oesophagus. If the stomach contents should happen to re-enter the oesophagus, this is called reflux, and if they rise back to the throat or mouth this is known as regurgitation. The irritation from reflux can sometimes trigger vomiting, and may cause other symptoms.

Infants are especially prone to this because:

  • Their stomachs are quite small (about the size of their fists or a golf ball), so they are easily distended by the milk.
  • The lower oesophageal sphincter may be immature and may not tighten when it should.

Is your baby simply regurgitating or possetting?

Every baby possets, or vomits, occasionally and some do quite often or even with every feed. Despite the possetting, is your baby:

  • Content?
  • In no discomfort?
  • Growing fine?
  • Experiencing no breathing problems from the vomiting?

If the answer to these questions is yes, they are likely to be a normal baby who possets and no treatment is needed. Typically, the lower oesophageal sphincter matures during the first year, usually around four to five months of age, at which time the possetting up may go away.

Could your baby have gastro-oesophageal reflux disease (GORD)?

Unlike with normal possetting, babies are diagnosed with GORD if reflux seems to be causing significant problems such as:

  • Discomfort and pain (presumably heartburn due to the acid-filled stomach contents irritating the oesophagus)
  • Breathing problems of any kind (gagging, choking, coughing, wheezing and, worst-case scenario, pneumonia due to inhalation of the stomach contents into the lungs, called aspiration).
  • Poor growth (due to the loss of so much nutrition from vomiting)

If your baby has any of the above GORD symptoms, talk to your doctor, who can arrange different tests to diagnose and treat it correctly.

Tips for concerned parents

For any baby who possets or regurgitates, there are a few things that might help:

  • Burp your baby often during a feed.
  • Keep your baby upright for a half hour or so after a feed (to let gravity help out).
  • Make sure there's no pressure on the stomach after a feed. For example, try to wait at least 30 minutes after feeding before putting a baby in a car seat.

Sometimes these simple manoeuvres help enough to overcome any problems. However, if they don't work your GP or paediatrician may suggest the mother avoids cow's milk and cow's milk products from her diet if she's breast-feeding, or if the child is bottle-fed then trying a hydrolysed milk formula. Antacid medications and/or other medications may be recommended by the paediatrician.

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