What causes babies to spit up watery milk. How can you distinguish between normal and excessive spitting up. When should you be concerned about your baby’s spitting up habits. What are effective strategies to reduce spitting up in infants. How does spitting up affect a baby’s growth and development.

The Science Behind Baby Spitting Up

Spitting up is a common occurrence in infants, often causing concern for new parents. But what exactly causes this phenomenon? The primary reason lies in the underdeveloped digestive system of babies.

• Immature lower esophageal sphincter (LES)
• Overfeeding or feeding too quickly
• Swallowing air during feeding
• Lying flat after feeding

The lower esophageal sphincter, a muscle that acts as a valve between the esophagus and stomach, is often not fully developed in infants. This can lead to the backflow of stomach contents, resulting in spit-up. Additionally, when babies consume too much milk too quickly or swallow air during feeding, it can lead to regurgitation.

Is Watery Spit-Up Normal?

Many parents worry when they notice their baby spitting up watery milk. Is this a cause for concern? In most cases, watery spit-up is perfectly normal. The consistency of spit-up can vary, and it may appear watery due to the mixing of saliva with the regurgitated milk. As long as your baby is gaining weight and seems content, watery spit-up is typically not a cause for alarm.

Distinguishing Between Normal Spitting Up and Problematic Regurgitation

While spitting up is common, it’s essential to recognize when it might indicate a more serious issue. How can you tell the difference between normal spitting up and problematic regurgitation?

• Frequency and volume of spit-up
• Baby’s comfort level and overall mood
• Growth and weight gain patterns
• Presence of other symptoms (e.g., fever, diarrhea)

Normal spitting up typically occurs several times a day in small amounts. If your baby is spitting up excessively large volumes, showing signs of discomfort, or failing to gain weight, it may be time to consult a healthcare provider.

When Does Spitting Up Peak and Subside?

Understanding the typical timeline for spitting up can help alleviate parental concerns. On average, spitting up tends to peak around 4 months of age and usually resolves by 7 months. However, it’s important to note that this can vary from baby to baby, and some infants may continue to spit up beyond this timeframe.

Effective Strategies to Reduce Spitting Up in Infants

While spitting up is often a normal part of infancy, there are several strategies parents can employ to minimize its occurrence. What are some effective ways to reduce spitting up in babies?

1. Proper burping techniques
2. Feeding in an upright position
3. Avoiding overfeeding
4. Adjusting feeding patterns
5. Considering formula changes (if applicable)

One of the most effective methods is to burp your baby frequently during and after feeding. To do this, sit your baby upright, supporting the head, and allow them to lean forward slightly. This position helps move air to the top of the stomach, making it easier for the baby to burp.

The Importance of Proper Positioning

Positioning plays a crucial role in reducing spit-up. Keeping your baby in an upright position for 15-30 minutes after feeding can help prevent regurgitation. Additionally, slightly elevating the head of the baby’s crib can promote better digestion during sleep.

Understanding the Impact of Diet on Spitting Up

Diet can play a significant role in the frequency and severity of spitting up. For breastfed babies, could the mother’s diet be contributing to excessive spitting up? While it’s less common, some babies may be sensitive to certain foods in the mother’s diet, such as dairy products. If you suspect this might be the case, consult with a healthcare provider before making any significant dietary changes.

For formula-fed babies, the type of formula used can sometimes influence spitting up. Some infants may benefit from switching to a different formula, but this should always be done under the guidance of a pediatrician.

The Role of Feeding Techniques

How you feed your baby can significantly impact their likelihood of spitting up. For breastfed babies, trying to nurse from just one breast per feeding can sometimes help. For bottle-fed infants, ensure that the hole in the nipple isn’t too large, as this can lead to overfeeding and increased air intake.

When to Seek Medical Attention for Baby’s Spitting Up

While spitting up is usually harmless, there are instances where it may indicate a more serious condition. When should parents be concerned about their baby’s spitting up habits?

• Forceful or projectile vomiting
• Green or yellow vomit
• Signs of dehydration
• Poor weight gain or weight loss
• Refusing feeds or showing signs of discomfort during feeding
• Blood in the spit-up

If you observe any of these symptoms, it’s crucial to contact your pediatrician promptly. They may want to rule out conditions such as pyloric stenosis, a condition where the valve at the bottom of the stomach is too tight and requires medical intervention.

Differentiating Between Spit-Up and Vomit

It’s important for parents to understand the difference between spitting up and vomiting. Spitting up is generally effortless and doesn’t cause distress to the baby. Vomiting, on the other hand, is often forceful and may be accompanied by other symptoms such as fever or lethargy. If you’re unsure whether your baby is spitting up or vomiting, it’s best to consult with a healthcare provider.

The Connection Between Spitting Up and Reflux

Many parents wonder about the relationship between spitting up and gastroesophageal reflux (GER). Is all spitting up a sign of reflux? While spitting up can be a symptom of GER, not all babies who spit up have reflux. GER occurs when stomach contents flow back into the esophagus, and it’s a normal physiological process in infants. However, when it causes significant symptoms or complications, it may be diagnosed as gastroesophageal reflux disease (GERD).

Symptoms of GERD in infants may include:

• Frequent and forceful spitting up
• Irritability during or after feeding
• Refusing to eat or eating only small amounts
• Arching of the back during feeding
• Coughing or wheezing

If you suspect your baby may have GERD, it’s important to consult with a pediatrician. They can provide guidance on management strategies and determine if any medical interventions are necessary.

Managing Reflux in Infants

For babies with mild reflux, lifestyle modifications similar to those used to reduce spitting up can be helpful. These include keeping the baby upright after feeding, avoiding overfeeding, and burping frequently. In some cases, your doctor may recommend thickening feeds or prescribe medication to manage more severe reflux symptoms.

Long-Term Outlook: When Does Spitting Up Stop?

Parents often wonder when they can expect their baby to outgrow spitting up. What is the typical timeline for this developmental milestone? As mentioned earlier, spitting up usually peaks around 4 months of age and resolves by 7 months for many babies. However, it’s not uncommon for some infants to continue spitting up until they’re 12-18 months old.

Factors that influence when a baby stops spitting up include:

• Maturation of the digestive system
• Development of the lower esophageal sphincter
• Transition to solid foods
• Increased time spent in an upright position

It’s important to remember that every baby develops at their own pace. As long as your baby is growing well and not showing signs of discomfort, occasional spitting up beyond the typical timeline is usually not a cause for concern.

Transitioning to Solid Foods and Its Impact on Spitting Up

The introduction of solid foods can sometimes help reduce spitting up in babies. How does this transition affect spitting up patterns? As babies begin to eat more solid foods and rely less on milk, the frequency and volume of spit-up often decrease. The thicker consistency of solid foods can help keep stomach contents in place, reducing the likelihood of regurgitation.

Psychological Impact of Spitting Up on Parents and Caregivers

While spitting up is generally harmless for babies, it can cause significant stress and anxiety for parents and caregivers. How does frequent spitting up affect parental well-being? Many parents report feelings of frustration, worry, and even guilt when their baby frequently spits up. They may be concerned about whether their baby is getting enough nutrition or if they’re doing something wrong.

It’s important for parents to remember that spitting up is a normal part of infancy and doesn’t reflect on their parenting skills. However, if these feelings become overwhelming, it’s crucial to seek support. This could involve talking to a healthcare provider, joining a parent support group, or seeking counseling if needed.

Coping Strategies for Parents

Dealing with frequent spit-up can be challenging, but there are strategies that can help parents cope:

• Educate yourself about normal spitting up patterns
• Keep plenty of burp cloths and changes of clothes handy
• Practice self-care and stress management techniques
• Share feeding responsibilities with a partner or caregiver when possible
• Remember that this phase is temporary

By understanding that spitting up is a normal part of development and implementing strategies to manage it, parents can feel more confident in their ability to care for their baby.

Mythbusting: Common Misconceptions About Baby Spitting Up

There are many myths and misconceptions surrounding baby spit-up. Let’s address some of the most common ones:

1. Myth: Spitting up means the baby is allergic to their formula or breast milk.
2. Fact: While allergies can cause digestive issues, most cases of spitting up are not due to allergies.
3. Myth: Babies who spit up frequently aren’t getting enough nutrition.
4. Fact: As long as the baby is gaining weight appropriately, spitting up doesn’t typically affect their nutritional intake.
5. Myth: Switching to solid foods earlier will stop the spitting up.
6. Fact: Introducing solids too early can actually increase digestive issues and is not recommended.
7. Myth: All babies who spit up have reflux disease.
8. Fact: While spitting up can be a symptom of reflux, not all babies who spit up have reflux disease.

Understanding these facts can help parents feel more at ease about their baby’s spitting up habits and avoid unnecessary interventions or dietary changes.

The Role of Genetics in Spitting Up

Is there a genetic component to spitting up? While there isn’t strong evidence for a direct genetic link to spitting up, some studies suggest that certain genetic factors may influence a baby’s likelihood of experiencing reflux or frequent spitting up. For example, if a parent experienced reflux as an infant, their child may be more prone to it as well. However, environmental factors and individual physiology play a significant role in determining a baby’s spitting up patterns.

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.