Bringing a new baby home from the hospital is equal parts exciting and nerve-wracking. Thoughts of “he/she is so sweet, I’m already in love, I can’t wait to show him/her off to the world” mesh right in with “will I get any sleep, will he/she feed well?” With my first, I reacted to every little oddity, and I even recall my youngest making this arm-jerking motion to her side that freaked me out, which I of course brought right to my pediatrician’s attention. He chuckled as he explained how typical this was of newborns.

I also remember her early days being filled with difficult feeds, screaming fits accompanied by arching her back and tummy grumbles that just did not sound right. I had heard of babies having acid reflux, and I wondered if this was what my baby had.

What I found in my research, which my pediatrician confirmed, is that some babies have what people commonly refer to as reflux, a harmless tendency towards spitting up after feeds. In it’s harmless form, it doesn’t seem to cause baby discomfort, doesn’t cause additional medical problems, and seems to go away on it’s own. On the other end of the spectrum is gastroesophageal reflux disease (GERD) or “acid reflux” as it’s more commonly referred to. This is a medical condition in which your baby’s frequent spit up is causing pain and possibly other associated medical problems such as weight loss and apnea, and may require treatment. And because babies like to keep us guessing, your baby can also have “silent reflux” in which baby is indeed experiencing acid reflux, yet it’s not apparent since they may not spit up anything.

So how do you decipher whether or not your baby’s spit up is problematic?

1)     Mood. Is your baby a “happy spitter”? Chances are if she’s cooing and smiling while spitting up, she’s experiencing some innocent reflux and it will likely resolve on it’s own as her system matures. If your baby is arching her back and/or is screaming inconsolably after or during feeds, there is a likelihood she has GERD.

2)     Quantity. When our babies spit up, as moms, we are typically concerned that their weight gain is being compromised. How much actually comes up can be deceiving though. Take a tablespoon of water, and pour it on a surface. You’ll be surprised how much it appears to be. If your baby’s spit up seems to be much more than that, then it’s something you should bring to your pediatrician’s attention.

3)     Other issues accompany the spitting up. Other signs of GERD are chronic ear infections, chronic respiratory infections and/or pauses in breathing (apnea), and weight loss.

These are meant to be used as a guide, but remember there are always exceptions. For example, my youngest had GERD so severe that she required surgery, but all the while ranked very high on the growth chart. Likewise, as in silent reflux, your baby may scream and arch after feeds, but never actually spits up. Although this is not the typical case, it does happen, so be mindful that your baby may present with GERD without following all of the “rules.”

So you suspect your baby’s spit up is problematic, what can you do?
1) Document. Make note of your observations. Even take video if you can; my smartphone ended up being a useful tool in diagnosing some of my baby’s medical conditions, as babies don’t typically “perform” when brought in to the pediatrician’s office.

2) Consult. A trip to the pediatrician of course so he can review your observations and evaluate your baby for GERD and decide if he may need a study to look for an underlying cause of GERD, such as a hernia.

3) Position. Place your baby upright after feeds, and even while she sleeps. Fisher Price’s Rock and Play was a safe and simple solution to this problem for us, and it folds up easily and compactly so it came everywhere with us. You can also utilize the rollover technique to change diapers instead of lifting baby’s legs over her head, which can aggravate reflux.

3) Experiment. There is much to be said for natural therapies to treat tummy troubles including eliminating acidic foods (from your diet if you’re nursing) and feeding organically when possible, peppermint essential oil (used in a pure carrier oil) probiotics, and chiropractic care. I have safely used both with positive results. Although my youngest ultimately required surgery, it was due to other medical conditions complicating her GERD. Once her surgery was complete, she still went on to need a high dose of anti-reflux meds, which I was disappointed with, but I was able to get her off of these with the use of probiotics. My oldest daughter was well controlled with diet modifications, probiotics, and chiropractic care.

4) Medicate. Anti-reflux medication is another option and something your doctor may recommend if there is concern for your babies health.

Pay attention to your baby’s symptoms and trust your instincts. Many babies have harmless reflux; keep your eye on it until it settles down for your baby. If you are concerned your baby has GERD, educate yourself about treatment options, chat with other moms who have experienced it, and discuss with your pediatrician. Learning about natural therapies was a good place for me to start. I went down the line until I found an effective management plan.

However you decide to treat your baby’s GERD, you have your baby’s best interest in mind, and will make a decision that you are comfortable with. And the good news is GERD typically gets better as baby spends more time in the vertical position. So as the old saying goes, this too shall pass.

Michele Ogniewski is a mother of three, two of which were not happy spitters. She lives and writes in the Saratoga Springs area of New York.