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Regurgitation and vomiting are among the most common symptoms encountered in newborns and infants and are the most common symptoms of gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is defined as the involuntary reflux of stomach contents into the esophagus and pharynx with or without regurgitation and vomiting. It is a common normal phenomenon that occurs several times a day, mainly after meals, and does not cause symptoms (happy spitters). Approximately 70-85% of infants experience regurgitation (spitting) within the first two months of life, which resolves spontaneously before the age of one year.

GERD occurs when reflux of gastric contents causes symptoms that affect quality of life or complications such as poor weight gain, feeding and sleeping problems, chronic respiratory distress, esophagitis (inflammation of the esophagus), hematemesis (vomiting blood), apneas, apparent life threatening events. The most common mechanism of GERD is transient relaxation of the lower esophageal sphincter.

A careful history and physical examination, with attention to warning signs that point to other causes, are usually sufficient to make the diagnosis of uncomplicated GERD. Onset of GERD symptoms after 6 months of age or persistence of symptoms after one year of age increases the likelihood of other diagnoses.

Symptoms such as weight loss, choking, lethargy, intense irritability with or without combined with repetitive neck movements with stretching backwards like an arch, persistent intense vomiting like a rocket, hematemesis or blood loss from the colon are some of the symptoms that may be associated with other pathological conditions. Because these symptoms do not occur exclusively in GERD, evaluation by a specialist Pediatric Gastroenterologist is recommended.

The purpose of further investigation is to exclude conditions that mimic GERD or to diagnose complications of the disease from GERD. The investigation may include blood tests, radiological examination of the upper digestive tract with contrast, gastroscopy with/or measurement of the pH of the esophagus depending on the symptoms.

When the reductions are not accompanied by complications, some modifications to the baby’s diet and feeding method may help. In breastfed infants, frequent interruption of meals in order for the infant to “regurgitate” is helpful.

In children who are not breastfed, small and frequent meals are preferable. A specially processed milk (thicker) or hypoallergenic milk may be recommended in cases where allergy to cow’s milk protein may coexist and worsen GERD. Regarding body posture during feeding, it is recommended to elevate the head at 20 to 30 degrees in relation to the rest of the body.

If deemed necessary, medication may be recommended in cases of esophagitis.

In conclusion, regurgitation is a benign phenomenon that occurs involuntarily and subsides over time. In regurgitation, the milk expelled is of small quantity, unlike vomiting where larger quantities of milk are expelled and it is a more active process.

However, if the clinical picture persists and other symptoms are added, as mentioned above, an assessment by a specialist Pediatric Gastroenterologist is deemed necessary.