Case Scenario

A two-month-old full-term, formula-fed infant presents for the first well-child examination since the newborn period. The child’s parents are concerned because the infant spits up at least four times per day. The contents resemble curdled milk (nonbloody, nonbilious), and the spit-up is non-projectile. The infant is gaining weight and following the 75% weight curve for age. The parents report that the infant gets fussy every day around 5:00 p.m. The mother has a 10-year-old child who was prescribed antireflux medications around this age and is wondering if these medications should be prescribed for her infant.

Clinical Commentary

Gastroesophageal reflux, or the regurgitation of gastric contents, occurs in up to two-thirds of healthy infants.¹ Gastroesophageal reflux begins approximately two to three weeks after birth and peaks between four and five months of age. Physiologic reasons for increased reflux in infants include an underdeveloped angle of His (the angle between the greater curvature of the stomach and esophagus), inadequate gastric accommodation, prolonged supine positioning, and a liquid diet. Symptoms usually resolve completely by one year of age.² By one year of age, muscles in the lower esophagus strengthen, the esophagus lengthens, and esophageal and intestinal motility coordination improves. Normal developmental milestones, such as head control, sitting up, and the introduction of solid food, help improve gastroesophageal reflux symptoms. Infants who experience reflux without discomfort or other problems are sometimes referred to as “happy spitters.”