Spitting up – self-care Information | Mount Sinai

Spitting up is common and occurs frequently during infancy. Spitting up does not indicate a problem unless the baby is choking on the food, or is spitting up excessively large amounts of food.

To reduce spitting up, burp the baby several times during and after feeding. One technique is to sit the baby upright, with your hand supporting the head. Let the baby lean over slightly, bending at the waist. The upright posture moves air to the top of the stomach, and the forward lean puts a little pressure on the stomach to eject the air, helping the baby to burp.

Babies commonly spit up since the sphincter at the top of the stomach is often loose. In healthy babies who are growing well, the spit-up is mostly milk, rather than stomach acid. On average spitting up peaks at 4 months and is over by about 7 months of age, though it can take longer. To help reduce spitting up, burp the baby several times during and after feeding.

Why Babies Spit up

Your baby is spitting up because:

• The muscle at the top of your baby’s stomach may not be fully developed. So your baby’s stomach cannot hold in all that they eat.
• The valve at the bottom of the stomach may be too tight. So the stomach gets too full, milk travels backward, and it comes out.
• Your baby may drink too much milk too fast, and take in a lot of air in the process. These air bubbles fill up the stomach and milk comes out.
• Overfeeding causes your baby to get too full, so milk comes up.

Spitting up is not often due to a formula intolerance or an allergy to something in the nursing mother’s diet.

Spitting up is Often Normal

If your baby is healthy, happy, and growing well, you don’t need to worry. Babies that are growing well often gain at least 6 ounces (170 grams) a week and have wet diapers at least every 6 hours.

How to Reduce Spitting up

To reduce spitting up you can:

• Burp your baby several times during and after feeding. To do so sit your baby upright with your hand supporting the head. Let your baby lean forward slightly, bending at the waist. Gently pat your baby’s back. (Burping your baby over your shoulder puts pressure on the stomach. This might cause more spitting up.)
• Try nursing with just one breast per feeding while breastfeeding.
• Feed smaller amounts of formula more frequently. Avoid large amounts at one time. Be sure that the hole in the nipple is not too large while bottle feeding.
• Hold your baby upright for 15 to 30 minutes after feeding.
• Avoid a lot of movement during and immediately after feeding.
• Slightly elevate the head of babies’ cribs so babies can sleep with their heads slightly up.
• Talk to your baby’s health care provider about trying a different formula or removing certain foods from the mother’s diet (often cow’s milk).

When to Call the Doctor

If your baby’s spit up is forceful, call your baby’s provider. You want to make sure your baby does not have pyloric stenosis, a problem where the valve at the bottom of the stomach is too tight and needs to be fixed.

Also, call your provider if your baby often cries during or after feedings or often cannot be soothed after feedings.

Bora G, Kovacic K. Vomiting and regurgitation. In: Kliegman RM, Toth H, Bordini BJ, Basel D, eds. Nelson Pediatric Symptom-Based Diagnosis. 2nd ed. Philadelphia, PA: Elsevier; 2023:chap 15.

Hibbs AM. Gastrointestinal reflux and motility in the neonate. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin’s Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 82.

Maqbool A, Liacouras CA. Normal digestive tract phenomena. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 331.

Last reviewed on: 7/3/2022

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Newborn 101 – Baby Spit Up – Tiger Pediatrics

What causes spitting up during different stages of your baby’s growth? How much is normal? When should a doctor be contacted about spit up? These are all good questions for parents of newborns to consider. Let’s get the conversation started.  

First Things First, What’s the Difference Between Spit Up And Vomit? 

Both spit up and vomit are messy and involve the contents of a baby’s stomach ending up on clothes, furniture, and whatever else may be nearby!!  But what it basically comes down to is how this happens. Spitting up is the easy flow of a baby’s stomach contents through his or her mouth. This often happens when the baby burps. Vomiting occurs when the flow is forceful and shoots out inches rather than dribbling from the mouth. The act of spitting up typically looks effortless, doesn’t cause pain, and isn’t forcefully done. Babies usually don’t seem to mind or notice spit up. 

What’s Going On With Newborn Spit Up?

Whether breastfed or bottle-fed, the first few days after birth babies will often be spitting up amniotic fluid along with their meal. Because newborns’ stomachs are still quite small, an influx of liquid can be a lot to handle. As their stomach is expanding they will gradually be able to hold more milk. Technically, spit up is also referred to as reflux. No medication is needed to control this, and it’s not an allergic reaction, it’s totally normal. 

How Much Baby Spit Up Is Normal?

There is very little cause for concern as long as spitting up doesn’t interfere with a baby’s well-being. If they seem comfortable, are eating well, and gaining weight, everything is most likely quite normal. It’s easy to overestimate the amount your baby has spit up. Remember, if your baby is gaining weight then they aren’t being harmed by the calories lost through spitting up. 

When Do Babies Stop Spitting Up?

​​Expect spit up to get more frequent until about 3 months of age, and then gradually start to slow down as baby gets stronger and can sit up on their own. Most babies stop spitting up by 12 months. 

Reflux (Infant GERD) 

Some babies continue to have severe reflux as they get older. If this is accompanied by other symptoms or poor weight gain, spit up might indicate that your baby has a condition called gastroesophageal reflux disease, also known as infant GERD. If you notice excessive drooling, uncontrollable crying, poor sleep, and erratic feeding patterns, then you should talk to your child’s pediatrician.

Tips to Reduce Spitting Up 

• Feed your baby in a more upright position and follow each feeding with 30 minutes in an upright position.  
• Let your baby’s stomach settle by avoiding immediate active play or the use of an infant swing.
• Avoid overfeeding by feeding your baby smaller amounts, more frequently.
• Try burping your baby. Frequent burps during and after each feeding can keep air from building up in your baby’s stomach.
• If you’re breastfeeding, experiment with your own diet. Your baby’s doctor might suggest that you eliminate dairy products or certain other foods from your diet.

Ask us Anything! If you have questions about spit up or newborn care contact us at 573-777-7627. The Tiger Pediatrics team is here to provide the education and support necessary for new and growing families.

First digestive problems while breastfeeding

How often can you hear from young mothers: “My baby often spit up. Is he sick or is it supposed to be like this? “My daughter is spitting up a lot, it seems to me that she is not getting enough food. ” “My baby has not had a stool for two days – what should I do?” “My daughter grunts and pushes every time she has a stool.” Peculiarities of digestion in babies is one of the first problems faced by young parents.

What is the norm, and what should be alarming?

Regurgitation

Some time after eating or between feedings, semi-digested milk flows down your chin, and sometimes the contents of the stomach come out of the mouth with great force, do not be alarmed, this is natural. The child may burp when dressed, turned over, and even during feeding: he sucks, turns away. burps and takes the breast again. All this is the result of the immaturity of the nervous system and the weakness of the sphincter of the muscular valve, which is located in the upper part of the stomach and does not yet hold its contents too well. The milk regurgitated by the baby will almost not differ in appearance from the one that got into his mouth, if it only reached the esophagus. But if the milk has gone down to the stomach, it will curdle and have a sour smell.

Noticeable regurgitation appears after the arrival of mature milk – by about 14-30 days after birth. They become more abundant and frequent from the 20-30th day. As a rule, by the age of six months, regurgitation stops or greatly decreases.

When a child begins to spit up often, count how many times a day he pees. If 12 or more times, then the baby has enough milk, and he spits up the excess.

How much regurgitation is natural? The norm for the age of 1 to 4 months is considered to be regurgitation after each feeding in the amount of 1-2 tablespoons and once a day with a “fountain” (more than 3 spoons). Such vomiting is not dangerous if it occurs rarely and no other alarming symptoms are added to it. To check how much milk your baby has spit up, pour 1 tablespoon of water onto a diaper and compare the water stain to the size of the spit up stain.

Do not be afraid that everything eaten came back and the baby was left hungry. The volume of milk splashed out always seems large, but in reality it will be no more than 2 tablespoons. Often, mothers lift the baby vertically so that he burps AIR. In fact, this is true for a child who captures air during feeding. This is one of the signs of incorrect attachment. Teach your baby how to properly latch on!

If your baby is properly attached to the breast, does not make any sounds when sucking and does not capture air, do not put him in a “column” after each feeding. While eating, the baby often falls asleep. Try to imagine how you, sleepy, are lifted out of bed and put in a “pillar”. Moreover, a child spitting up in an upright position may begin to choke. If your baby starts spitting up while in your arms, turn him over onto his stomach. If you need to shift the child to bed for a while, it is better to put him on the side.

So, if your baby spit up often and profusely, but at the same time he pees often, feels good and gains weight normally, this is the norm. If there is frequent spitting up accompanied by poor weight gain and infrequent urination, or if every spitting up of the child is a “fountain” vomiting, immediately take the baby to the doctor.

Constipation

How often does a child have to “do it big”? Some parents believe that if the baby does not have a chair every day, the baby is sick. But in breastfed babies, stool frequency is very different. A baby soils diapers more often than an artificial one, because mother’s milk has all the nutrients a child needs, it is quickly and easily absorbed due to special enzymes that break down the main ingredients of milk. However, by the 4th month of life, the frequency of stools decreases and amounts to 2-4 times a day. It also happens that the child defecates every other day, or even less often – once every 2-7 days. If the baby poops rarely, but at the same time does not show anxiety, he has no difficulty with defecation and the stool remains soft, there is nothing to worry about. This is not constipation, but evidence that breast milk is an excellent food for a child, which is almost completely absorbed in his body and practically does not produce waste. However, if your baby poops rarely and is not gaining weight well, it may be that he has too little milk, and the body simply has nothing to bring out. Signs of a lack of milk are a decrease in the number of wet diapers during the day and a decrease in weight gain or a halt in weight gain.

Often mothers complain that their child desperately groans and pushes. But they say that the baby’s stool is soft and watery. So there is no constipation. All newborns grunt and push: they do not have such strong abdominal muscles as adults, and therefore they have to work hard … This is completely normal, babies do not need help, they do not need enemas and laxatives.

The chair in a child who is breastfed can range from 10 times a day to 1 time in several days. With a good weight gain, this is the norm.

Closer to 1 year, when the baby begins to eat a fairly significant amount of food from the general table, the situation changes and the baby poops once a day or every other day. Hard stools in a breastfed baby are rare. True constipation with hard stools is more common in artificial children, in which case a doctor should be consulted. But even artificial children are given an enema only on the third day.

Natalya Kudryashova, psychologist, breastfeeding consultant

Magazine “Lisa. My child” No. 10, 2002

Lactose deficiency: how to diagnose

Often, parents of children in the first months of life complain that their child behaves restlessly during or immediately after feeding (crying, throwing the “breast”). Also worried about the appearance of frequent foamy stools, regurgitation and poor weight gain. All of these symptoms are a manifestation of lactase deficiency, a diagnosis that has become very common in recent times.

Let’s try to understand the causes of lactase deficiency and ways to overcome it.

So, lactase deficiency is a condition in which the activity of the lactase enzyme is reduced or absent. The main function of lactase is cleavage of lactose – the main component of any milk (cow, goat, female). With a reduced activity of lactase in the intestine, there is no breakdown of lactose to simpler sugars: glucose and galactose. As a result, lactose in an unsplit form enters the large intestine, where, under the influence of microorganisms, fermentation processes occur, increased gas formation occurs and a large amount of water is formed (which causes the stool to become watery and foamy). Further, in the process of fermentation in the intestine, a violation of the microflora occurs with an increase in opportunistic bacteria, which aggravates the course of lactase deficiency.

Lactase deficiency is primary and secondary . Primary lactase deficiency is a very rare hereditary disease. It is found in 6-10% of the population of the entire Earth. It proceeds very hard, manifested by prolonged loose stools and a lag in physical development. Secondary lactase deficiency is associated with damage to intestinal cells as a result of allergies to cow’s milk proteins, various intestinal infections, and inflammatory bowel diseases. This variant of lactase deficiency is temporary and disappears 1-2 months after the treatment of the underlying disease.

Normally, children in the first months of life cannot break down as much lactose as they receive with breast milk due to a temporary deficiency of lactase. It is also known that premature babies have very little lactase, so they are more likely to have signs of lactase deficiency.

How to diagnose lactase deficiency? Most often, the diagnosis is made on the basis of clinical symptoms. There are also additional tests: feces for carbohydrates and a test for the study of hydrogen in exhaled air. However, these two tests often give a false positive result. The most accurate test is endoscopic with taking a biopsy of the villi of the small intestine. It is carried out very rarely, mainly for health reasons.

If symptoms of lactase deficiency are detected or suspected, the child’s parents must consult a pediatrician who will select the correct corrective therapy option.

Currently, the treatment of lactase deficiency in breastfed children consists in prescribing the lactase enzyme, which will help the baby digest milk. The following preparations containing the lactase enzyme are presented on the domestic market: Lactase Baby, Lactazar – preparations that have long been presented on the Russian market and Kolif, which has been registered in the Russian Federation only since November 2017, the main difference of which is that it is produced in the form of drops.

The treatment of artificially fed children with manifestations of lactase deficiency consists in prescribing a special mixture with a low lactose content based on partially hydrolyzed protein.