Infant Reflux: What’s Normal, What’s Not and How to Manage
Spit-up/reflux in newborns is very normal and tends to peak around 4 mo and improve by 6 mo. Almost all babies have reflux to some extent due to immature GI systems but it becomes something that requires more intervention if it is causing difficulty gaining weight, a lot of discomfort/pain, and difficulty feeding. Quantity of spitup often looks like much more than it actually is and can be scary to see but is usually not a concern.
While prescription medications can help with symptoms, they don't address the underlying issues and just work by reducing stomach acid, so I do not recommend them as a first line of treatment if just experiencing spit up and all else is normal. Majority of babies are "happy spitters" but if they are otherwise growing well and functionally feeding there is no reason to intervene and it will resolve with time.
A few strategies to reduce reflux:
Keep baby upright after feeds for ~20 minutes.
Feed baby more frequently (every 2-3 hours) with smaller volumes.
If bottle feeding, use a slow flow nipple like Dr. Brown's preemie or Pigeon SS and use responsive feeding to avoid overfeeding.
If formula feeding, consider switching formulas to a type with a protein that is more fully broken down (partially hydrolyzed) to see if that would improve digestion (they are sometimes called gentle formulas). Some options are Enfamil Gentlease, Bobbie Gentle, or Similac Total Comfort. Discuss these options with your ped and they may also have samples available to try.
Avoid excessive use of swing, car seat, or bouncer.
Consider probiotic supplement like Mary Ruth's or Smidge.
Practice coregulation with skin to skin, infant massage, babywearing.
If your baby is overly uncomfortable during feeds, forcefully spits up multiple times/day, and/or they are not growing on their curve, my first recommendation is to schedule a consultation to go over maternal and infant health history, evaluate oral function, and observe a breast and/or bottle feed. We will work together to create a care plan to address symptoms and refer out for further support as needed.
Sources:
https://www.seattlechildrens.org/conditions/a-z/reflux-spitting-up/