What Are the Signs of Newborn Acid Reflux?

If your baby frequently spits up, you probably possess a stack of bibs and a good stain remover. Occasional spitting up, or reflux, is normal and occurs in nearly all babies. Normal reflux is not the same thing as gastrointestinal reflux disease, or GERD, which can lead to health complications. But it can sometimes be tricky to distinguish normal reflux from GERD or other medical conditions that cause similar symptoms. Colicky behaviors, poor weight gain or respiratory problems might be signs of GERD in infants -- but they are not diagnostic, since milk allergy or other health issues could also be the cause. Talk with your doctor if you are concerned about your baby's reflux.

Frequent Spitting Up

Spitting up is the easiest symptom of acid reflux to recognize, since the evidence is right in front of you -- and often on you. But spitting up doesn't necessarily mean your baby has GERD, since more than 66 percent of infants spit up, according to the American Academy of Pediatrics. Newborns spit up for a number of reasons. Small stomach size, frequent feedings, inexperience swallowing and being laid flat can all contribute. If your baby spits up frequently but is otherwise happy, healthy and gaining weight, there's generally no cause for concern. This type of spitting up generally begins improving around age 4 months and typically goes away completely about the time of the baby's first birthday. If your newborn spits up regularly, after nearly every feeding, vomits large amounts or seems uncomfortable after eating, these might be signs of GERD or another health problem.

Pain Reactions

Normal newborn spitting up doesn't cause your baby any discomfort. But GERD might cause pain because stomach contents and acid back up into the esophagus and out your baby's mouth. When this happens frequently, the esophagus can become irritated, and the stomach acid can cause a burning sensation. Unlike an adult, your newborn can't reach for the antacid tablets when this happens. Babies with GERD can display their discomfort as irritability, difficulty swallowing, frequent crying, arching the back, refusing to eat or just plain seeming miserable. However, colic, milk allergy and other health issues trigger similar signs and symptoms. It's important to discuss any symptoms or feeding difficulties with your doctor to determine what's making your baby unhappy -- especially if your baby is a newborn.

Upper Respiratory Symptoms

Because newborns are just learning to breathe, suck and swallow, a perfectly normal baby might occasionally seem to gag or cough a bit during or after a feeding. However, if your baby coughs frequently, seems to choke during or after most feedings, has noisy breathing or experiences frequent wheezing, there might be a problem such as GERD or another digestive condition. Coughing can occur if a small amount of milk or formula goes down the wrong way and gets into the respiratory tract during a reflux episode. This can irritate the lungs and possibly lead to pneumonia. If your newborn is having difficulty breathing, seek immediate emergency medical care.

Poor Weight Gain

Most babies who spit up from time to time gain weight normally. However, babies with GERD sometimes don't get weight as expected simply because they don't eat well. A baby with GERD might refuse feedings or feed poorly. Valuable calories might also be lost through frequent spitting up or vomiting of feedings. Keep your regularly scheduled doctor visits so that your baby's weight can be tracked. These visits also enable your baby's doctor to detect any early signs of poor weight gain quickly. Call your doctor right away if your newborn refuses to eat or eats very little for more than 2 feedings in a row.

When to Seek Help

An occasional bout of spitting up is generally normal, as long as your newborn is otherwise healthy. Simple measures, such as keeping your baby upright for 30 minutes after feedings and making sure the diaper is not too tight, might reduce the frequency of normal spitting up. But if you're concerned about your baby spitting up or other symptoms, talk with your doctor. Frequent vomiting, poor weight gain, recurrent respiratory problems and irritability are possible signs of GERD and should prompt a doctor's visit, according to he American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition 5.

Seek immediate medical attention if your baby experiences any of these symptoms: -- Forceful vomiting, or vomiting blood or bright yellow fluid. -- Noticeable increase in the size of the belly. -- Fever. -- No wet diaper for 3 or 4 hours. -- Crying without tears or a depressed soft spot of the head. -- Difficulty breathing.

Medical advisor: Jonathan E. Aviv, M.D., FACS