Spitting up -- known medically as reflux -- affects more than two-thirds of all healthy infants, according to the American Academy of Pediatrics. While most infants outgrow reflux by age 1, some feel the lingering effects into their toddler years. In an infant, spitting up usually causes no discomfort, but reflux in a toddler can cause vomiting, tummy aches and refusal to eat. Because these symptoms occur with other conditions too, it's important to seek a professional diagnosis before setting out on a treatment plan. Some parents find that modifying their toddler's diet helps reduce acid reflux symptoms. Before starting a special diet, consult with your medical provider to ensure all nutritional needs will be met.
Healthy Eating for Toddlers
In general, a healthy diet for a growing toddler should include fruits, vegetables, whole grains, lean proteins and dairy. While there is not a specific diet for toddlers with acid reflux, there are some healthy habits to follow that may help ease symptoms. Eating smaller meals and feeding a toddler more often helps ensure the stomach does not become too full. This is important because overfilling the stomach increases the pressure inside, which can trigger reflux. For a picky eater, choosing nutrient-dense foods -- meaning they provide more healthy nutrients relative to their calorie amount -- is important. It may also be helpful to avoid straws when drinking to keep excess air from entering the tummy and causing bloating.
The 2009 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) practice guidelines for reflux treatment suggest avoiding common trigger foods such as chocolate, caffeine and spicy foods if they cause symptoms. Foods such as peppermint and fried or fatty foods may also provoke reflux because they can cause relaxation of the lower esophageal sphincter, the muscle that keeps food from flowing back into the esophagus. The 2013 American College of Gastroenterology practice guidelines and NASPGHAN do not recommend universal elimination of foods if they do not cause symptoms. If there is a food that seems bothersome for your toddler, you can remove it from the diet and reintroduce it later to see if symptoms return.
Parents can easily incorporate lifestyle modifications to help ease potential symptoms of reflux. Communication between a parent and toddler can be difficult when trying help ease symptoms. Keeping a daily food diary may help identify patterns and trends of which foods cause symptoms. It may also be helpful to avoid snacks or meals immediately before morning or afternoon naps and to ensure that the last meal or snack of the day is eaten a couple of hours before bedtime. These feeding changes help ensure the child's stomach is not full when lying down, which can help limit or ease reflux symptoms.
Allergies and Acid Reflux
A food allergy -- such as a reaction to cow's milk, eggs or soy -- is an uncommon but possible cause of reflux in a toddler. Cow's milk allergy, in particular, has been linked with acid reflux symptoms, including spitting up, vomiting and tummy aches. The connection between cow's milk allergy and reflux is more common in infants, and it typically decreases in severity as a child gets older. An April 2011 article in "Pediatric Clinics of North America" reports that cow's milk allergy affects 2 to 3 percent of young children. The allergy typically develops in infancy and can cause reflux, which is usually accompanied by other symptoms, such as a red rash or hives after eating. Medical evaluation is needed to determine whether food allergies may be causing acid reflux in a toddler.
Warnings, Precautions and Next Steps
An accurate diagnosis is crucial if a toddler experiences symptoms that may be related to acid reflux, as problems could result from untreated reflux. Seek medical help as soon as possible if your toddler:
-- Refuses to eat.
-- Has pain associated with eating.
-- Wheezes or experiences breathing problems after eating.
-- Vomits frequently or has bloody, yellow or foul-smelling vomit.
-- Passes bloody or black stools or has frequent diarrhea or constipation.
-- Loses weight or fails to gain weight as expected.
Speak with your medical provider before eliminating foods from your child's diet. You may be referred to a registered dietitian to evaluate the current diet, ensure that all nutritional needs are met and get advice on recommended food substitutions, if necessary. If lifestyle and dietary modifications are not working, your provider may recommend medication to help reduce symptoms.
- American Academy of Pediatrics: Gastroesophageal Reflux: Management Guidance for the Pediatrician
- North American Society for Pediatric Gastroenterology, Hepatology and Nutrition: Pediatric Gastroesophageal Reflux Clinical Practice Guidelines
- American Journal of Gastroenterology: Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease
- Pediatric Clinics of North America: Milk and Soy Allergy