I cannot tell you how often I hear this question. Almost all babies spit up at one time or another and parents worry how much is too much and whether or not we need to do something about it. So, here s the lowdown on babies and spit up. The first thing to know is we pediatricians refer to baby spit up as reflux. When parents first hear that term (reflux) they automatically think acid reflux and are confused because isn t that an adult condition? Let s talk about reflux in babies Reflux in babies is physiologic and presents as spit up. It is extremely common in newborns, particularly in premature infants. About half of all newborns up to the age of 4 months will have reflux and the numbers are higher in premature babies. This is simply a БmechanicalБ issue in babies where the lower muscle of the esophagus is БrelaxedБ and allows a backflow of breastmilk and/or formula. Most babies will grow and thrive throughout it all and will outgrow this Бspitting upБ phase by the time they reach 1 year (itБs much sooner for most babies). We refer to babies who grow, thrive, and are otherwise unruffled by this spitting up as happy spitters. Taking some Бreflux precautionsБ such as keeping baby upright for 20-30 minutes after feeding, offering baby smaller and more frequent feeds, and burping often will ease this reflux. Ultimately, time is the best treatment for these happy spitters as the muscles of the lower esophagus strengthen and mature. When itБs more than just spit up Some babies will have more severe reflux. They may cry and grimace with the spit up and/or they may not be gaining weight. In these babies, an evaluation of the degree of reflux and/or a trial of anti-reflux medication may be in order.
If your baby is formula feeding, her pediatrician may even recommend thickened formula to reduce the amount of spit-up. Another red flag is if your babyБs spit-up is projectile or forceful. If this forceful spit-up (vomiting) occurs frequently after feeding, your babyБs pediatrician will want to rule out a condition known as
Although rare, pyloric stenosis will not go away on its own. If your babyБs pediatrician suspects this, an abdominal ultrasound will be ordered. If present, surgery is needed to correct this thickened muscle at the junction of the stomach and small intestine. A word on colic and reflux Oftentimes an infant who presents with symptoms of may also have significant reflux exacerbating those crying jags. Be sure to mention any spit-up to your childБs doctor if youБre in the throes of colic. Treating and relieving moderate to severe reflux may improve the symptoms of colic greatly. Bottom line : Most babies will have some degree of reflux. The good news is, most of them are happy and thrive throughout it all. For these babies, time is the best treatment. Did or does your baby spit up frequently? What questions do you have about babies and reflux? Q. I know it\’s typical for babies to spit up sometimes, but with my 6-week-old it happens all the time! She\’s still gaining weight, but is there some way to know if this isn\’t normal? A. Spitting upa common nuisance of infancyis usually more of a problem than a medical one. (Do you know any new parents who don\’t have spitup stains on their shirts? ) Most babies spit up due to their immature suck/swallow mechanisms and digestive systems. As these mature, regurgitation usually subsides. Picture what happens when babies eat and you\’ll better understand why they spit up: While sucking milk, a hungry baby often gulps down air.
The air settles beneath the milk in the stomach; when the stomach contracts, the air acts like a pneumatic pump, shooting the milk back up the esophagus. A basic remedy for minimizing regurgitation is to allow less air and milk to gather in the stomach and to let gravity do its part in keeping the milk down. Here\’s how to know when to worry and when not to worry, plus tricks for keeping baby\’s meals in her tummy where they belong. There are several signs that your baby\’s spitup is not something to stress about. First of all, she is gaining the normal amount of weight, which indicates that she\’s not spitting up excessively. What may look like a cupful of spitup is probably less than a tablespoon. Second, she doesn\’t seem to be suffering from colic or abdominal pain during the episodes (if she were, you would note her facial grimaces and the drawing up of her legs). As a general rule of thumb: If your baby\’s pediatrician isn\’t worried, then you don\’t need to worry. The most common medical cause of persistent regurgitation is gastroesophageal reflux (GER): The stomach acids are regurgitated up into the esophagus, irritating the lining and causing \”baby heartburn. \” Some babies with mild GER may still show reasonable weight gain. The main characteristic is abdominal pain, which is why GER is often misdiagnosed as colic. Another possible medical reason for spitup is pyloric stenosis, a condition in which the muscle at the end of the stomach is too large to let stomach contents pass easily. As a result, when the stomach contracts, the milk forcefully shoots up and out. Symptoms of pyloric stenosis include projectile vomiting (during or immediately after a feeding) and poor weight gain.
Yet another possibility is an allergy to formula or to dairy products or wheat in the mother\’s milk. Key allergy clues: abdominal bloating, gassiness, diarrhea, and a red rash around the anus. If you notice any of these symptoms, or if your baby has painful night-waking, there\’s cause for concern. Your pediatrician has likely considered all these medical possibilities, but it\’s still worth discussing on your next visit. * Feed your baby twice as often and half as much. This is my general rule for any digestive disturbance. Naturally, if the stomach is less full, the milk will be digested sooner, reducing spitup. * Burp your baby well during and after a feeding. moms: Burp before you switch breasts. Formula-feeding moms: Burp halfway through the bottle. * Keep your baby upright and quiet for 20 to 30 minutes after a feeding. Gravity will hold the food down. Jostling or laying your baby flat right after a feeding encourages spitup. One of the best ways to monitor a health concern and to differentiate between a nuisance and a medical problem is to keep a running diary. List the frequency and amount of spitup, and whether it\’s associated with any symptoms, such as abdominal pain or poor weight gain. If your diary reveals the occurrence of these or other worrying clues, report these to your baby\’s doctor. If, on the other than, your diary shows that her spitup episodes gradually decrease in frequency and volume, you have reason to relax. Fortunately there is an end in sight. You can expect the last spate of spitup between 6 and 8 months, when baby spends most of her time upright and her digestive system has matured.