Spitting up a lot in the healthy, happy baby is a non-issue. Yes, it is evidence of reflux, but it isn't bothering anyone so doesn't need treatment. Painful reflux (silent -- without spitting or reflux with emesis) is an important cause of failure to thrive in some infants, and contributes to a lot of familial stress. I think it is different from colic (which tends to be observed in well-growing babies -- both breast and bottle-fed -- who have some period of episodic crying each day.) Refluxing babies tend to be unhappy all the time, to not grow well, and to have crying that is not confined to a specific time each day. Poorly designed car seats cause babies to slump, thereby increasing abdominal pressure. They may well make reflux worse. It's better to use open seating and burping positions (not bending baby over diaper waistbands) to prevent increased abdominal pressure during or after feeds. Long feed intervals probably also make reflux worse. These long intervals promote frantically hungry babies who feed by gulping lots of foremilk, and end up over-feeding. Feed frequently, thus insuring creamier feeds, smaller vols at each feed and a baby who is less likely to cry a lot and gulp air and milk. Additionally, sometimes stressful deliveries (really rapid or very long deliveries) can cause painful gastric ulcers in infants. I lectured recently with Maryelle Vonlanthen, MD (the pedi GI) and she mentioned this. She emphasized that so many of these "mystery" disorders, from suspicion of food allergy, blood in the stools, and things like suspicion of esophageal damage from GERD can all be readily identified by scoping the babies. During these proceedures, a specialist can visualize the rectum or the throat and see if there is erosion, eosinophils (as allergy markers), or infection. Endoscopy involves looking down the throat, and a rectal scope is a quick peak up the bottom. These proceedures are momentarily invasive, but are very brief. Once you actually look, you know what you are dealing w ith and the correct treatment or management can be then instituted with way less trial and error and stress to the family. I appreciate that some families want to avoid tests, but face it, the easy fixes prob. don't have much going on, and the persistantly crying, poorly growing baby with the totally stressed family deserves a diagnosis rather than months of inaccurate guess work. I worked with a mom whose baby dropped over 4 months from the 75th to below the 5th percentile in weight due to GER. By the time investigatory tests were finally performed, the baby had esophageal ulcers and such an oral aversion due to her association of pain with eating that (even with meds) she needed 3 months of fairly intense Occupational Therapy in order to manage solids. I think the overuse of meds and unnecessarily restrictive maternal diets to treat these kids would be reduced if the diagnoses were more accurate. Breastmilk feeds are always best, but management of overactive letdown, oversupply, and foreign proteins in the milk provoking food intolerance sx may be needed. Barbara Wilson-Clay, BS, IBCLC Austin Lactation Associates LactNews Press www.lactnews.com *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html