Spitting Up
be describing gas-troesophageal reflux, in
Almost all infants spit up, although
formula-fed babies appear
to do it more than breastfed babies.
Parents who did not han-dle their infant
much in the health care facility where
their
child was born may discover spitting up
only after they take
the baby home. They may interpret this as
vomiting or think
an infant is developing an infection. Ask
them to describe
carefully what they mean by “spitting up.”
How long has the
baby been doing it? How frequently?
What is the appearance
of the spit-up milk? Almost all milk that is
spit up smells at
least faintly sour, but it should not contain
blood or bile.
A baby who spits up a mouthful of milk
(rolling down the
chin) two or three times a day (or
sometimes after every
meal) is experiencing normal, early-
infancy spitting up.
Associated signs such as diarrhea,
abdominal cramps, fever,
cough, cold, or loss of activity suggest
illness. If an infant is
spitting up so forcefully that milk is
projected 3 or 4 feet
away, it may be beginning pyloric stenosis
(an abnormally
tight valve between the stomach and
duodenum), which re-quires surgical
intervention. If the spitting up is a large
amount with each feeding, parents may
which a lax cardiac sphincter from
the stomach into the esophagus allows
regurgitation of gas-tric contents into the
esophagus. This also requires medical
attention (see Chapter 45).
Burping a baby thoroughly after a feeding
often limits
spitting up. Parents may try sitting an
infant in an infant
chair for half an hour after feeding.
Changing formulas gen-erally is of little
value. Reassure parents that spitting up
de-creases in amount as the baby
becomes better at coordinating
swallowing and digestive processes (the
cardiac sphincter ma-tures). In the
meantime, a bib can protect the baby’s
cloth-ing and the parent. After a few
months, the child will natu-rally stay in an
upright position longer, and gravity will
help
to correct the problem.
Diaper Dermatitis
Some infants have such sensitive skin that
diaper dermatitis
(diaper rash) is a problem from the first
few days of life. It oc-curs for several
reasons.
When parents do not change a child’s
diaper frequently,
feces is left in contact with skin, and
irritation may result in
the perianal area. Urine that is left in
diapers too long breaks
down into ammonia, a chemical that is
extremely irritating
to infant skin. Ammonia dermatitis of this
type is generally a
problem in the second half of the first
year of life, when an
infant is producing a larger quantity of
urine than before. For
some infants, however, it is a problem
from the first week.
Frequent diaper changing, applying A&D
or Desitin
ointment, and exposing the diaper area to
air may relieve the
problem. Some infants may have to sleep
without diapers at
weather or when babies are overdressed
or sleep in over-heated rooms. Clusters of
pinpoint, reddened papules with
occasional vesicles and pustules
surrounded by erythema usu-ally appear
on the neck first and may spread upward
to
around the ears and onto the face or
down onto the trunk.
Bathing an infant twice a day during hot
weather, partic-ularly if a small amount of
baking soda is added to the bath
water, may improve the rash. Eliminating
sweating by reduc-ing the amount of
clothing on an infant or lowering the

night to control the problem. room temperature should bring almost

immediate improve-ment and prevent
Whenever the entire diaper area is further eruptions.
erythematous and irri-tated so that the
outline of the diaper on the skin can be Infant Caries (Baby-Bottle Syndrome)

identified, one must suspect an allergy to Putting an infant to bed with a bottle of
the material in the formula, breast

diaper or to laundry products if a milk, orange juice, or glucose water can

commercially washed or result in aspiration.

home-washed diaper is being used. It also can lead to decay of all the upper
Changing the brand or teeth and the lower

type of diaper or washing solution usually posterior teeth

alleviates this

problem.

If a diaper area is covered with lesions

that are bright red,

with or without oozing, last longer than 3

days, and appear

as red pinpoint lesions, suspect a fungal

(monilial or can-didiasis) infection. This is
discussed in Chapter 43.

Miliaria

Miliaria, or prickly heat rash, occurs most

often in warm