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32 years
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My 8 weeks old baby starts by eating 30-50ml bottle formula.I stop him to burb,he occasionally spits like 20-30ml.He doesn't show discomfort and doesn't cry. After spitting he eats whole bottle.Why?
Oct 30, 2014
2nd opinion

Dr. Zakia Dimassi Pediatrics
Gastro-esophageal reflux (GER) is defined as the passage of the contents of the stomach into the lower esophagus. It is considered a physiologic (i.e., not due to disease) occurrence in healthy infants, and results from the immaturity of the muscle sphincter that separates the lower esophagus from the stomach and that usually prevents backward return of the stomach content into the esophagus. In the majority of instances episodes of reflux are brief and do not extend above the lower esophagus.
GER is particularly common in infancy and manifests most frequently as episodes of regurgitation or vomiting. The majority of cases of GER are harmless and self-limiting: 50% of infants vomit at least once per day in the first 3 months of life, the peak of GER occurs at the age of 4 months with as much as 67% of four-month-old infants having reflux, then drops to 21% by 7-9 months of age.
Uncomplicated GER is associated with the classic case scenario of a “happy spitter”, where a well-looking infant is noted to have effortless painless vomiting and otherwise normal growth parameters. Most babies would outgrow the problem and need no or very little intervention. The use of pharmacological therapy, like domperidone (Motilium) and proton-pump inhibitors (Nexium) is not supported by clinical evidence and is usually reserved to severe cases.
If symptoms worsen or do not improve by 18-24 months of age, then further evaluation could be in order, for possible etiologies as cow’s milk protein allergy (CPMA), which has been recognized as a possible underlying cause of GER symptoms in some infants: as many as 20- 30% of infants with GER symptoms are found to have CMPA. Often, CMPA cannot be clinically distinguished based on history and physical examination alone. In these instances a 2-week trial of hypoallergenic formula (with partially hydrolyzed cow milk proteins to facilitate digestion) is recommended.
Infant with recurrent vomiting and poor weight gain require further evaluation in terms of adequacy of calories offered and ingested by the infant:
- the way formula is prepared (or diluted),
- how the formula is fed to the infant and
- the presence of pain or difficulty associated with feeding.
A condition termed “nervous vomiting” results from poor maternal-infant interaction, leading to irritability, vomiting, feeding difficulties and failure to thrive in the infant. Maternal anxiety has been demonstrated to result in increased muscle tension, which is transmitted to the infant, as evidenced by increased muscle tone and heart rate.
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