This is a new phenomenon I’ve been hearing about. Apparently in my area, there are many doctors prescribing Zantac for breastfed babies because the baby spits up after feeding. It sounds as though some doctors and parents are concerned that spitting up after feeding means the baby has gastroesophageal reflux disease or GERD. GERD can be a big deal- but spitting up is normal. Because it’s such a misunderstood topic, I spent a whole section in my breastfeeding class dealing with it.

Now, I’ve met a few moms who have had babies with genuine GERD. Their babies were not gaining weight well, fussy all the time, arching the back, etc. For these moms and babies, a medication like Zantac can provide relief and allow the baby to take feedings without being in pain. But not all babies who spit up have GERD.

A few points to remember if you’re concerned about whether your baby has GERD:

  1. Breastfed babies are not at a higher risk of GERD. The actual incidence of GERD between formula fed and exclusively breastfed infants is about the same. However, breastfed babies tend to have fewer and shorter episodes of GERD.
  2. Happy Spitters vs. Scrawny Screamers. If your baby is spitting up but happy, gaining weight well and feeding well, it’s very unlikely that she has GERD (Happy Spitter). If your baby is frequently fussy and not gaining weight well, it’s quite possible your baby does have GERD and might need medicine to reduce the inflammation (Scrawny Screamer). Because their stomaches are so small, little babies often spit up if they get too much milk too quickly. It’s actually quite normal!
  3. Babies with GERD may not always spit up. “Silent reflux” is when the contents of the baby’s stomach come back up to the esophagus and are then re-swallowed- so there’s reflux but no spitting up or vomit. These babies are in pain and very fussy, but they’re not spitting up.
  4. An antacid is not the “first line” against GERD. Generally an antacid is only prescribed after you’ve tried sleeping and feeding changes with no success and/or the baby is not gaining weight well. (Disturbingly, the above link tells parents to thicken the baby’s feeds with cereal, a practice which is not backed up by evidence. At best, thickened feedings may be moderately helpful at reducing reflux in formula fed babies, but these thickened feeding studies have not used cereal.)
  5. It’s not a good idea to give babies a medication if they don’t have an actual need for it. Zantac is generally safe for babies, but like any medication it has side effects including headaches and malaise. It also means that you are changing your baby’s stomach acid ph when GERD may not be present.
  6. Signs of severe GERD include:
    • Severe fussiness associated with feeding
    • Baby taking too little or too much milk during feeding
    • Arching the back
    • Poor weight gain
    • Breathing problems
    • Weird spit up, i.e. with blood or greenish-yellowish fluids
    • Dehydration
    • Trouble swallowing
    • Frequent nasal congestion or sinus/ear infections
    • Refusing the breast or formula feedings.

Unless your baby is at the severe GERD stage, medication for GERD is probably not necessary.

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