Breastfeeding FAQs: Spitting Up, Gagging, and Biting (for Parents)

en español: Preguntas más frecuentes sobre la lactancia materna: regurgitación, arcadas y mordidas

Reviewed by: Jamila H. Richardson, BSN, RN, IBCLC

Breastfeeding is natural, but it takes practice to get it right. Here’s what you need to know about spitting up, gagging, and other concerns during breastfeeding.

Is it Normal for My Baby to Spit Up After Feedings?

Sometimes, babies spit up when they eat too much, or when they burp or drool. Many infants will spit up a little after some — or even all — feedings or during burping because their digestive systems are immature. That’s perfectly normal.

As long as your baby is growing and gaining weight and doesn’t seem uncomfortable with the spitting up, it’s OK. The amount of spit-up often looks like more than it actually is. But spitting up isn’t the same as forcefully vomiting all or most of a feeding.

What’s the Difference Between Spitting Up and Vomiting?

Vomiting is a forceful projection of stomach fluids. Spitting up is a more gentle “flow” of fluids that come up. Babies don’t usually react to spitting up, but a vomiting baby will usually look upset or cry.

If you’re concerned that your baby is vomiting, call your doctor. In rare cases, there may be an allergy, digestive problem, or other problem that needs medical care. It helps to keep track of how often and how much your baby is vomiting or spitting up.

How Can I Keep My Baby From Spitting Up?

If the doctor says your baby’s spitting up is normal, here are some things you can do to help lessen it:

• Burp your baby after each feed from each breast. Sometimes giving smaller feeds more often can help, rather than giving larger-volume feeds.
• Keep your baby upright after feedings for at least 30 minutes. Holding your baby is best, since the way your baby sits in an infant seat may actually make spitting up more likely.
• Don’t jiggle, bounce, or actively play with your baby right after feedings.
• Keep your baby’s head above the feet while feeding. Don’t hold your baby in a dipped-down position when feeding.
• Raise the head of your baby’s crib or bassinet. Roll up a few small hand towels or receiving blankets (or you can buy special wedges) to place under — not on top of — the mattress. Never use a pillow under your baby’s head. Make sure the mattress doesn’t fold in the middle, and that the incline is gentle enough that your baby doesn’t slide down.

If your baby also gets bottles of breast milk or infant formula supplements:

• Burp after your baby drinks 1–2 ounces from a bottle.
• Don’t give the bottle while your little one is lying down.
• Make sure the hole in the nipple is the right size and/or flow for your baby. For example, fast-flow nipples may cause babies to gag or may give them more milk than they can handle at once. Many breastfed babies do well with the slow-flow nipple until they are 3 months old, or even older.

Many babies outgrow spitting up by the time they’re sitting up.

How Can I Keep My Baby From Gagging?

Sometimes the force of your milk (especially when it “lets down”) is so strong that it can cause your baby to gag and pull off of the breast. If this happens during feeding:

• Try nursing your baby in a more upright position (head above the breast). This may ease the force of the milk.
• Nurse in a side-lying position, which also might help slow the flow of milk. 
• Make sure your breasts are not engorged or over-full. Nursing every 2–3 hours can help prevent engorgement. If your breasts are too full and you’re concerned about a forceful letdown, express or pump a little bit of milk a few minutes before feeding time to avoid a strong letdown.

If your baby is pulling off and gagging or coughing during feeding, sit your baby up in a seated burp position. Gently pat the back to help your baby calm down before continuing feeding. If you’ve tried the steps above and this continues to happen, talk to your doctor or lactation consultant. 

If your baby sometimes gags or chokes while taking a bottle of breast milk: 

• Try a different nipple with a slower flow.
• Practice “paced” bottle feeding. This is where you slow down the milk flow from the bottle by holding it at less of an angle and allowing your baby to pause for breaks.

My Baby Bites During Breastfeeding. What Can I Do?

Babies will often play with their mothers’ nipples with their gums, not meaning to cause any harm. But once they start teething, a baby might bite down, not knowing this is hurting mom.

Sometimes you can tell when your baby’s about ready to bite down — usually when satisfied and starting to pull away from the breast. When you sense that your baby is finished feeding and may be bored or feeling playful, end the feeding. Break the suction by slipping your finger into the corner of your baby’s mouth.

If your baby is already biting down, pull your baby closer to you to make it more difficult to pull off easily. Then, break the suction. React calmly without raising your voice. 

Here are more ways to make baby less likely to bite:

• Before a feed, give your baby something to chew on. Make sure it’s big enough that it can’t be swallowed or choked on and that it can’t break into small pieces. A wet washcloth placed in the freezer for 30 minutes makes a handy teething toy. Be sure to take it out of the freezer before it becomes rock hard — you don’t want to bruise those already swollen gums. Wash after each use.
• Say, “Mommy is not for biting. You can bite this.” Then, offer your little one a teething toy or ring.
• Praise your baby — with a hug, kiss, or cuddle — whenever they nurse without biting or trying to bite.

Usually this is enough to stop the biting, but if your baby continues, talk to your doctor or lactation consultant for advice.

Reviewed by: Jamila H. Richardson, BSN, RN, IBCLC

Date reviewed: January 2021

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Baby Spit-Up: How Much Is Too Much?

Parents of young infants know, or soon learn, that feeding and burping little ones can be a messy process. While burping can help infants expel excess air they take in during feeding, it often results in more than just air coming up. In fact, almost all babies will, at least occasionally, spit up some milk during and after feeding, sometimes even if they are not being actively burped.

In the majority of cases, spitting up is perfectly normal and harmless in otherwise healthy infants. It is simply the result of an immature digestive system and will usually occur less frequently as a baby grows. Typically, by the time a child is 9-12 months of age, spitting up will be a rare occurrence.

In the meantime, as long as your baby is growing, thriving, and isn’t having red flag symptoms such as frequent coughing or colicky behavior, spitting up is usually nothing to worry about.

Simple Remedies to Try at Home

Some of the more common reasons for excessive spit-up are overfeeding and swallowing too much air during feeding. The following tips may help reduce spit-up and make your baby more comfortable:

• Feed your baby before they get very hungry. If they are starving before a feed, they are more likely to take in more air as they gulp.
• Take frequent burp breaks during feedings.
• Maintain your baby in an upright position for at least 20 minutes after feeding.
• Avoid overfeeding. Try offering smaller amounts more frequently.
• If breastfeeding, experiment with your own diet. Cow’s milk and soy-based products eaten by the mother are the most likely to cause excessive spit-up in a breastfed baby.
• Pacifier use after feeding can be helpful if your baby will accept one.

When to See Your Pediatrician

As a parent, you are the best judge of what’s normal for your baby and what isn’t. “Trust your gut,” says Lauren Beene, MD, pediatrician at UH Rainbow Suburban Pediatrics. “If you’re concerned about your baby’s spit-up, or aren’t sure what’s normal, ask your pediatrician.”

If you notice any of the following changes in your baby’s feeding and spit-up habits, it is important to have them evaluated by your pediatrician. Although unlikely, some of the symptoms listed below may be a sign of a medical condition that requires treatment or dietary change, especially if the child isn’t gaining adequate weight.

• Regularly spits up more than 1 or 2 tablespoons at a time
• Spitting up is forceful, similar to projectile vomiting
• Baby experiences choking, coughing or wheezing
• Baby refuses to eat or is irritable while eating
• Baby arches their body after or during feeds
• Baby is colicky

If your baby’s spit-up is green or yellow, is bloody or contains a substance that looks like coffee grounds, they should be evaluated immediately.

Medical Conditions That Can Cause Excessive Spit-Up

Even though occasional spitting up is a normal and temporary occurrence in infancy, sometimes it may signal a medical condition that requires intervention. Possible conditions include:

Gastroesophageal Reflux Disease (GERD)

GERD is the medical term for problematic acid reflux. It is very common in young babies and occurs when formula or breast milk in the stomach backs up into the esophagus and into the mouth.

“All babies have some degree of reflux,” says Dr. Beene. “This is because the sphincter that keeps milk in a baby’s stomach does not close as tightly as in adults. In otherwise healthy babies, this problem will usually resolve without treatment as the digestive system matures. However, if babies start having red flag symptoms such as refusal to eat, crying or arching of the body during or after feeding, they should be evaluated by their pediatrician.”

“Management of GERD in babies varies by their symptoms and exam findings,” says Dr. Beene, “Some babies may have improved symptoms if they change formulas or, if breastfed, their mom avoids dairy and sometimes soy. Some babies may need a more extensive work-up or be started on medication to decrease symptoms. Every situation is different, so please call your pediatrician if you’re concerned your baby has GERD.”

This condition usually peaks at around four to six months of age and goes away between 12 and 18 months of age.

Esophagitis or Gastritis

Sometimes, inflammation of the esophagus and stomach can contribute to excessive spitting up and should be evaluated and treated by a pediatrician.

Pyloric Stenosis

The pylorus is a muscular valve located at the lower part of the stomach. When food in the stomach is ready to move into the small intestines for the next stage in digestion, the pylorus opens to allow it to pass through. In infants with pyloric stenosis, the pylorus muscle is enlarged, narrowing the opening and eventually preventing food from moving into the intestines. This rare condition is more common in boys than girls and occurs in babies between birth and six months of age.

The most common symptom of pyloric stenosis is forceful, projectile vomiting of large amounts of milk that will often have a curdled appearance because of prolonged exposure to stomach acids. Other symptoms may include:

• Weight loss
• Good appetite in spite of vomiting
• Lethargy
• Constipation
• Mucous in the stool

Because severe vomiting is the primary symptom, babies with pyloric stenosis are at high risk for dehydration which can be life-threatening. If your infant has symptoms of pyloric stenosis, they should be seen immediately by your pediatrician or in the emergency room.

A confirmed diagnosis of pyloric stenosis can only be treated with surgery, which most babies tolerate well and go on to thrive.

Related Links

University Hospitals Rainbow Babies & Children’s has a wide network of highly skilled pediatricians at convenient locations across the region. Our specialists have the advanced training and experience to care for children of all ages and provide parents with the support and encouragement they need.

Why does the baby spit up after feeding?

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Regurgitation is a common condition in newborns and infants and is most often a normal variant. However, it is not uncommon for parents to worry if their baby is spitting up frequently, believing that it is due to nutritional or health problems in general. Sometimes these fears are not unfounded, and regurgitation really has a pathological origin. What is its cause and when should you really consult a doctor about this?

Regurgitation – Return of a small amount of food (uncurdled or partially curdled milk) from the stomach up the digestive tract: into the esophagus and further into the oral cavity. According to statistics, at least 1 time during the day, at least 50% of babies from 0 to 3 months old can spit up, more than 60% of children 3-4 months old, and in 5% of children spit up continues up to the year ¹ .

Regurgitation in newborns is considered a physiological process. It is caused by a number of factors, including:

• Features of the structure of the upper digestive tract in babies
• In newborns and infants up to a year of life, the stomach has a spherical shape. It holds a small amount of food, besides, the release from it into the duodenum is slower in comparison with children after the year ² .
• Weakness of the lower esophageal sphincter that separates the esophagus from the stomach
• Normally, the lower esophageal sphincter should tightly “close” the esophagus, allowing food to pass into the stomach and not allowing it to enter back into the upper digestive tract. However, in young children (up to a year), the muscles of the esophageal sphincter are poorly developed, and it does not do its job very well ² .
• Slow movement of food through the gastrointestinal tract
• The neuromuscular system of newborns is immature. It does not ensure the proper movement of food through the esophagus, causing regurgitation.

One of the important risk factors contributing to regurgitation in newborns is aerophagia. This is the swallowing of large amounts of air during feedings. This happens when the baby is not properly attached to the breast, the mother has a lack of breast milk, or the bottle is in the wrong position in the child who receives the mixture. The size of the opening in the nipple also matters – if it is too large, the newborn swallows a lot of air ³ .

With aerophagia, the baby becomes capricious, restless immediately after feeding. Noticeable bloating. If the baby spits up immediately after a feed, the milk (or formula) remains practically fresh, uncurdled ³ .

Promotes regurgitation after feeding and a predominantly horizontal position of the baby during the day, combined with relatively high intra-abdominal pressure ⁴ . Therefore, the correct position of the baby after feeding is so important. To avoid regurgitation of an excessive amount of stomach contents, after feeding, it is necessary to hold the baby in an upright “column” position for some time (10-20 minutes), lightly patting on the back and allowing excess air to “exit”.

Regurgitation in many newborns can be provoked by other situations in which pressure in the abdominal cavity increases and stomach contents are thrown into the esophagus, in particular ³ :

• tight swaddling;
• stool disorders, in particular constipation;
• long, forced cry and some others.

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How can you tell the difference between normal spitting up and vomiting?

Sometimes regurgitation is considered a manifestation of disorders in the digestive tract of children. Due to the constant reflux of acidic stomach contents into the upper sections, inflammation and other complications may develop, including growth retardation, a decrease in hemoglobin levels, and others. Therefore, it is important for parents to understand where the line is between physiological and pathological regurgitation ¹ .

If the mother is worried that her baby is spitting up, keep track of when this happens and count the total number of spit ups per day. Normally, regurgitation usually occurs after eating (the child burps after each feeding), lasts no more than 20 seconds and repeats no more than 20-30 times a day. With pathology, the problem manifests itself at any time of the day, regardless of when the baby was fed. Their number can reach 50 per day, and sometimes more ¹ .

The amount of discharge during regurgitation also matters. With normal, physiological regurgitation, it is approximately 5 – 30 ml. If this volume fluctuates between 50 and 100 ml, it is already defined as profuse vomiting. When the range of the jet of vomit is up to 50 cm, doctors talk about “vomiting a fountain.” A variant of atonic vomiting is possible, when the contents of the stomach flow “sluggishly”. It occurs with atony of the stomach (decrease in muscle tone of the stomach wall) and disruption of the esophagus ¹ .

Vomiting in babies is a warning sign. Doctors are especially alarmed by repeated vomiting, a fountain, with an admixture of bile, in combination with constipation. Vomiting can lead to the development of dehydration, acid-base imbalance and other consequences, therefore, if it occurs, you should urgently contact a pediatrician to find out the cause and begin treatment. A doctor’s consultation is necessary if the child is spitting up a lot (more than 15-30 ml at a time), with a frequency of more than 50 episodes per day ^1.3 .

Physiological regurgitation: symptoms

Regurgitation in newborns, which is considered a normal variant and does not cause concern to pediatricians ³ :

• usually continues for a certain period of time;
• is characterized by slow, “passive” leakage; if the baby spits up a fountain, it is better to consult a doctor;
• has a sour smell of curdled milk;
• occurs without the participation of muscles – the baby does not strain during regurgitation;
• does not affect the general well-being of the baby.

How to help a newborn who spit up often?

If the baby is healthy, no medication is prescribed for spitting up. To help the child allow simple measures based on lifestyle changes and feeding.

• Frequent feeding of the baby
  It is known that the baby is more prone to spit up if his stomach is full. To improve the situation, it is recommended to feed the baby more often, avoiding oversaturation, best of all – on demand ⁵ .

• Correct feeding technique
  Every feeding, the mother must ensure that the baby does not swallow too much air during suckling. When sucking, there should be no loud, smacking, clicking sounds. You also need to control that the baby captures the nipple along with the areola.

• Choosing the right bottle and nipple
  If the newborn is bottle-fed and receiving formula, it is important to choose the right bottle and nipple. The hole in it should be such that the milk flows out in drops, and not in a stream. The nipple must not be filled with air ⁴ .

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Some bottles allow feeding newborn in an upright position. At the same time, due to gravity, the reverse reflux of the contents of the stomach up the esophagus does not occur.

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• Baby standing upright after eating

To allow air that has entered the digestive tract during meals to escape, it is important to keep the newborn upright for 10-20 minutes after feeding ⁴ .

• Ensure the correct position of the baby during sleep

To reduce the negative impact of the acidic contents of the stomach on the esophagus, it is necessary to put the baby to sleep in the supine position. The side or prone position, which many pediatricians used to recommend, is no longer recommended. It was found to be associated with an increased risk of sudden infant death syndrome ⁵ .

If parents notice alarming symptoms, such as spitting up too often or large volume, etc., it is important to consult a pediatrician without delay. This will allow you to identify the real problem in time and help the baby grow up healthy and happy.

References

¹ Zakharova I. N., Andryukhina E. N. Regurgitation and vomiting syndrome in young children // Pediatric pharmacology, 2010. V. 7. No. 4.

² Nagornaya N V., Limarenko M. P., Logvinenko N. G. Experience with the use of domperidone in suspension in young children with regurgitation syndrome // Child Health, 2013. No. 5 (48).

³ Zakharova IN Regurgitation and vomiting in children: what to do? //Pediatrics. Supplement to Consilium Medicum, 2009. No. 3. S. 58-67.

⁴ Zakharova I. N., Sugyan N. G., Pykov M. I. Regurgitation syndrome in young children: diagnosis and correction // Effective pharmacotherapy, 2014. No. 3. P. 18-28.

⁵ Vandenplas Y. et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) //Journal of pediatric gastroenterology and nutrition. 2009; 49(4): 498-547.

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Why does baby spit up after feeding

Why does the child spit up after feeding – Gazeta.Ru


May 25, 2022, 08:45
Family and Children

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Moderate regurgitation in children of the first year of life is not considered a pathology, but worries many parents. Olga Nikolaevna Glushko, a pediatric gastroenterologist at the Semeynaya clinic network, told Gazeta.Ru about the dangers and prevention of regurgitation.

When spitting up should alert

After feeding, one or sometimes several times a day, curdled breast milk or formula may leak from the baby’s mouth. This phenomenon is called regurgitation or regurgitation – involuntary reflux of stomach contents into the esophagus and mouth after eating.

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The reason for such regurgitation is the peculiarities of the structure of the gastrointestinal tract of babies in the first year of life. As a rule, it does not bother children, does not affect their well-being, appetite and weight gain. But there are situations when regurgitation should alert and cause a visit to the doctor. These include:

• Profuse regurgitation in large volume several times a day.

• Poor weight gain – the baby is not getting better or even losing weight.

• Fewer than six urination times per day – baby’s diaper is dry most of the time.

• High or low temperature, pale or bluish discoloration of the skin.

• Anxiety, refusal to breastfeed if baby is breastfed or bottle fed if baby is bottle fed.

• Vomiting in a fountain when there is no stool or after falling and hitting the head.

• Atypical color of contents when spitting up – yellow or bloody.

Regurgitation can be symptoms of diseases such as esophagitis (inflammation of the lining of the esophagus), anemia, diseases of the upper respiratory tract, aspiration pneumonia.

What is the rate of spitting up in an infant

The rate of spitting up in babies is about one to two tablespoons and from one to five times a day. Normally, regurgitation disappears by a year or earlier. If they become more frequent or suddenly begin in a child older than six months, this also requires contacting a pediatrician.

The dangers of spitting up in newborns and how to avoid it

If the baby is healthy, spitting up in itself is not dangerous to health, but if the baby is not in an upright position at the time of spitting up, he may choke. To prevent this from happening, take the following preventive measures:

• When feeding, hold your baby at a 45° angle to the breast or bottle. Breastfed babies should fully grasp the nipple and areola.

• Before feeding, lay the baby on his stomach, and after eating, hold the “column” for ten minutes – to release the air that he could swallow during feeding.

• Avoid tight swaddling, do not disturb the child in the first half hour after eating, do not play active games with him.

• Do not overfeed your baby or give him food or breasts as comfort.

• If you experience frequent spitting up, consult your doctor about anti-reflux mixtures.

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