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Why does my baby spit up after burping: Spitting up in babies: What’s normal, what’s not

Why Babies Spit Up – HealthyChildren.org



By: Alejandro Velez, MD, FAAP & Christine Waasdorp Hurtado, MD, FAAP

All babies spit up. Some babies spit up more than others, or at certain times.

Typically, babies spit up after they gulp down some air with breastmilk or formula. A baby’s stomach is small and can’t hold a lot, after all. Milk and air can fill it up quickly.

With a full stomach, any change in position such as bouncing or sitting up can force the flap between the esophagus (food pipe) and stomach to open. And when that flap (the esophageal sphincter) opens, that’s when some of what your baby just ate can make a return appearance.

So, what can you do―if anything―to reduce the amount of your baby’s spit up? How do you know if your baby’s symptoms are part of a larger problem? Read on to learn more.

Common concerns parents have about spit up

My baby spits up a little after most feedings.


  • Possible cause:
    Gastroesophageal reflux (normal if mild)


  • Action to take: None. The spitting up will grow less frequent and stop as your baby’s muscles mature—especially that flap we talked about earlier. It often just takes time.

My baby gulps their feedings and seems to have a lot of gas.


  • Possible cause: Aerophagia (swallowing more air than usual)


  • Action to take: Make sure your baby is positioned properly during feeds. Also be sure to burp the baby during and after feeds. Consider trying a different bottle to decrease your baby’s ability to suck in air.

My baby spits up when you bounce them or play with them after meals.

My baby’s spitting up has changed to vomiting with muscle contractions that occur after every feeding. The vomit shoots out with force.

I found blood in my baby’s spit-up or vomit.




  • Possible cause: Swelling of the esophagus or stomach (esophagitis or gastritis), or another health problem that requires diagnosis and treatment.


  • Action to take: Call you pediatrician right away so they can examine your baby.

Remedies for spitty babies

Regardless of whether or not your baby’s spit up warrants watchful waiting or medical intervention, there are some simple feeding suggestions that can help you deal with the situation at hand.

5 tips to reduce your baby’s spit up


  • Avoid overfeeding. Like a gas tank, fill baby’s stomach it too full (or too fast) and it’s going to spurt right back out at you. To help reduce the likelihood of overfeeding, feed your baby smaller amounts more frequently.


  • Burp your baby more frequently. Extra gas in your baby’s stomach has a way of stirring up trouble. As gas bubbles escape, they have an annoying tendency to bring the rest of the stomach’s contents up with them. To minimize the chances of this happening, burp not only after, but also during meals.


  • Limit active play after meals and hold your baby upright. Pressing on a baby’s belly right after eating can up the odds that anything in their stomach will be forced into action. While
    tummy time is important for babies, postponing it for a while after meals can serve as an easy and effective avoidance technique.


  • Consider the formula. If your baby is
    formula feeding, there’s a possibility that their formula could be contributing to their spitting up. While some babies simply seem to fare better with one formula over another without having a true
    allergy or intolerance, an estimated 5% of babies are genuinely unable to handle the proteins found in milk or soy formula―a condition called Cow Milk Protein Intolerance/Allery (CMPI and CMPA). In either case, spitting up may serve as one of several cues your baby may give you that it’s time to discuss alternative formulas with your pediatrician. If your baby does have a true intolerance, a 1- or 2-week trial of hypoallergenic (hydrolyzed) formula designed to be better tolerated might be recommended by your baby’s provider.


  • If breastfeeding, consider your diet. Cow’s milk and soy in your diet can worsen spit up in infants with Cow Milk Protein Intolerance/Allergy (CMPI and CMPA). Removing these proteins can help to reduce or eliminate spit up.


  • Try a little oatmeal. Giving babies cereal before 6 months is generally not recommended—with one possible exception. Babies and children with dysphagia or reflux, for example, may need their food to be thicker in order to swallow safely or reduce reflux. In response to concerns over
    arsenic in rice, the American Academy of Pediatrics (AAP) now recommends parents of children with these conditions use of oatmeal instead of rice cereal.
    See

    Oatmeal: The Safer Alternative for Infants & Children Who Need Thicker Food for more information.

Vomit vs. spit up: what’s the difference?

There is a big difference between vomiting and spitting up:


Vomiting is the forceful throwing up of stomach contents through the mouth. This typically involves using the abdominal muscles and is often uncomfortable, leaving you with a crying child.


Spitting up is the easy flow of stomach contents out of the mouth, frequently with a burp. Spitting up doesn’t involve forceful muscle contractions, brings up only small amounts of milk, and doesn’t distress your baby or make them uncomfortable.

What causes vomiting?

Vomiting occurs when the abdominal muscles and diaphragm contract vigorously while the stomach is relaxed. This reflex action is triggered by the “vomiting center” in the brain after it has been stimulated by:

  • Nerves from the stomach and intestine when the gastrointestinal tract is either irritated or swollen by an infection or blockage (as in the stomach bug)

  • Chemicals in the blood such as drugs

  • Psychological stimuli from disturbing sights or smells

  • Stimuli from the middle ear (as in vomiting caused by motion sickness)


Always contact your pediatrician if your baby vomits forcefully after every feeding or if there is ever blood in your baby’s vomit.

Remember

The best way to reduce spit up is to feed your baby before they get very hungry. Gently burp your baby when they take breaks during feedings. Limit active play after meals and hold your baby in an upright position for at least 20 minutes. Always closely supervise your baby during this time.

More information


  • How to Keep Your Sleeping Baby Safe: AAP Policy Explained

  • Gastroesophageal Reflux & Gastroesophageal Reflux Disease: Parent FAQs

  • How Much and How Often Should Your Baby Eat

About Dr. Velez


Alejandro Velez, MD, FAAP is a second-year gastroenterology fellow at Cincinnati Children’s Hospital who is interested in practicing general gastroenterology with a focus in motility and functional GI disorders, has a love for medical education at all levels, and harbors a passion for supporting and uplifting those that identify as unrepresented minorities in medicine.

About Dr. Waasdorp


Christine Waasdorp Hurtado, MD, MSCS, FAAP is a member of the American Academy of Pediatrics and the North American Society of Pediatric Gastroenterology Hepatology and Nutrition. She is an Associate Professor of Pediatrics at the University of Colorado School of Medicine and practices in Colorado Springs.

Last Updated

10/5/2022

Source

American Academy of Pediatrics Section on Gastroenterology, Hepatology and Nutrition (Copyright © 2022)


The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Spitting Up – Reflux

Is this your child’s symptom?

  • Spitting up small amounts of breastmilk or formula. Also called reflux.
  • Spitting up 1 or 2 mouthfuls of milk at a time
  • No effort or crying
  • Normal symptom in half of young babies

Symptoms of Normal Spitting Up

  • Smaller amounts often occur with burping (“wet burps”)
  • Larger amounts can occur after overfeeding
  • Most often seen during or shortly after feedings
  • Occurs mainly in children under 1 year of age
  • Begins in the first weeks of life
  • Caution: normal reflux does not cause any crying

Complications of Spitting Up (GERD)

  • Most infants are “happy spitters.” Normal spitting up (normal reflux) occurs in half of babies. It does not cause crying or colic.
  • Normal crying occurs in all babies. Frequent crying (called colic) occurs in 15% of babies. Crying and colic are not helped by heartburn meds. These meds also have side effects.
  • If they develop complications, it’s called GERD (gastro-esophageal reflux disease). This occurs in less than 1% of babies.

Symptoms of GERD

GERD problems occur in less than 1% of infants:

  • Choking on spit up milk
  • Heartburn from acid on lower esophagus. Infants with this problem cry numerous times per day. They also act very unhappy when they are not crying. They are in almost constant discomfort.
  • Poor Weight Gain

Cause

  • Poor closure of the valve at the upper end of the stomach (weak valve)
  • Main trigger: overfeeding of formula or breastmilk
  • More than half of all infants have occasional spitting up (“happy spitters”)

Reflux Versus Vomiting: How to Tell

  • During the first month of life, newborns with true vomiting need to be seen quickly. The causes of vomiting in this age group can be serious. Therefore, it’s important to tell the difference between reflux and true vomiting.

Reflux

The following suggests reflux (normal spitting up):

  • You’ve been told by a doctor your baby has reflux
  • Onset early in life (85% by 7 days of life)
  • Present for several days or weeks
  • No pain or crying during reflux
  • No effort with spitting up
  • No diarrhea
  • Your baby acts hungry, looks well and acts happy.

Vomiting

The following suggests vomiting:

  • Uncomfortable during vomiting
  • New symptom starting today or yesterday
  • Forceful vomiting
  • Contains bile (green color)
  • Diarrhea is also present or
  • Your baby looks or acts sick.

Pyloric Stenosis (Serious Cause)

  • This is the most common cause of true vomiting in young babies.
  • Onset of vomiting age 2 weeks to 2 months
  • Vomiting is forceful. It shoots out of the baby’s mouth. This is called projectile vomiting.
  • Right after vomiting, the baby is hungry and wants to feed. (“hungry vomiter”)
  • Cause: the pylorus is the channel between the stomach and the gut. In these babies, it becomes narrow and tight.
  • Risk: weight loss or dehydration
  • Treatment: cured by surgery.

When to Call for Spitting Up – Reflux

Call Doctor or Seek Care Now

  • Blood in the spit up
  • Choked on milk and turned blue or went limp
  • Age less than 12 weeks and spitting up changes to vomiting (forceful or projectile)
  • Age less than 1 month old and looks or acts abnormal in any way
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Chokes a lot on milk
  • Poor weight gain
  • Frequent crying
  • Spitting up is getting worse
  • Age more than 12 months old
  • Spitting up does not get better with this advice
  • You have other questions or concerns

Self Care at Home

  • Normal reflux (spitting up) with no problems

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.






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  • Everett







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  • Virtual Urgent Care


Care Advice for Spitting Up (Reflux)

  1. What You Should Know About Spitting Up:
    • Spitting up occurs in most infants (50%).
    • Almost always doesn’t cause any pain or crying.
    • Spitting up does not interfere with normal weight gain.
    • Infants with normal reflux do not need any tests or medicines.
    • Reflux improves with age.
    • Here is some care advice that should help.
  2. Feed Smaller Amounts:
    • Skip this advice if age less than 1 month or not gaining weight well.
    • Bottlefed Babies. Give smaller amounts per feeding (1 ounce or 30 mL less than you have been). Keep the total feeding time to less than 20 minutes. Reason: Overfeeding or completely filling the stomach always makes spitting up worse.
    • Breastfed Babies. If you have a good milk supply, try nursing on 1 side per feeding. Pump the other side. Switch sides you start on at each feeding.
  3. Longer Time Between Feedings:
    • Formula. Wait at least 2½ hours between feedings.
    • Breastmilk. Wait at least 2 hours between feedings.
    • Reason: It takes that long for the stomach to empty itself. Don’t add more milk to a full stomach.
  4. Loose Diapers:
    • Do not put the diaper on too tight. It puts added pressure on the stomach.
    • Don’t put pressure on the stomach right after meals.
    • Also, do not play too hard with your baby during this time.
  5. Upright Position:
    • After meals, try to hold your baby in the upright (vertical) position.
    • Use a front-pack, backpack, or swing for 30 to 60 minutes after feedings.
    • Decrease the time in a sitting position (such as infant seats).
    • After 6 months of age, a jumpy seat is helpful. The newer ones are stable.
    • During breast or bottle feeds, hold your baby at a slant. Try to keep your baby’s head higher than the stomach.
  6. Less Pacifier Time:
    • Frequent sucking on a pacifier can pump the stomach up with swallowed air.
    • So can sucking on a bottle with too small a nipple hole.
    • The formula should drip 1 drop per second when held upside down. If it doesn’t, the nipple hole may be clogged. Clean the nipple better. You can also make the nipple hole slightly bigger.
  7. Burping:
    • Burping is less important than giving smaller feedings. You can burp your baby 2 or 3 times during each feeding.
    • Do it when he pauses and looks around. Don’t interrupt his feeding rhythm in order to burp him.
    • Burp each time for less than a minute. Stop even if no burp occurs. Some babies don’t need to burp.
  8. Add Rice Cereal to Formula:
    • If your baby still spits up large amounts, try thickening the formula. Mix it with rice cereal.
    • Start with 1 level teaspoon of rice cereal to each ounce of formula.
  9. Acid Blocking Medicines:
    • Prescription medicines that block acid production are not helpful for normal reflux.
    • These medicines also can have side effects.
    • They do not reduce excessive crying from colic.
    • They are only useful for symptoms of heartburn.
  10. What to Expect:
    • Reflux gets better with age.
    • After learning to sit well, many babies are better by 7 months of age.
  11. Call Your Doctor If:
    • Spitting up changes to vomiting (forceful or projectile)
    • Poor weight gain
    • Your baby does not get better with this advice
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 07/12/2023

Last Revised: 12/30/2022

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.

Reflux and belching | Nestlé Health Science

  1. Nestlé Health Science
  2. health care
  3. Reflux and belching

Regurgitation is the flow of milk from the stomach into the mouth, which is often ‘spit out’ by the baby. Spitting up is not the same as vomiting , which forces milk out of the baby’s stomach. Symptoms of infantile reflux and regurgitation are typical and usually subside by 12 months of age.

Why is my baby refluxing or spitting up?
Occasionally, infantile reflux and regurgitation can be caused by a food allergy , such as cow’s milk protein allergy (CMP) . An immature gastrointestinal tract, lying down most of the time, and eating almost entirely liquid food can also lead to infantile reflux and regurgitation.

Can my child be allergic to cow’s milk protein?

Infantile reflux and regurgitation are typical symptoms in infants with CMPA.
Children with CMPA usually have more than one symptom, and these symptoms can be very different from each other.

If you think your child has symptoms of reflux or regurgitation , it could be CMPA.
You may have noticed other symptoms (besides reflux or regurgitation) that may affect other parts of your baby’s body.

For a simple and easy way to check for typical symptoms associated with CMPA, you can use our Symptom Checker.

Symptom Analysis

This will allow you to select all cow’s milk related symptoms your baby may have. You can then discuss this with your doctor.

In any case, if you have any doubts or concerns about the health of your child, you should consult with a healthcare professional as soon as possible

Other symptoms of cow’s milk protein allergy

ANAPHILACTIC SHOCK

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CRYING AND COLIC

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CONSTIPATION

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COUGH

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DIARRHEA

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ECZEMA

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GROWTH DISTURBANCE

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urticaria

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REFUSAL TO FOOD

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RASH

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Runny nose and sneezing

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EDITEC

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VOMITING

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HRIP

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IMPORTANT NOTE: : It is possible to continue breastfeeding if the infant is allergic to cow’s milk protein. To do this, the mother needs a special diet with the exclusion of all sources of cow’s milk protein. Only if these measures do not bring the desired effect, the doctor recommends the use of a special therapeutic mixture intended for children from 0 to 1 year old.
It is important to follow the correct methods of preparing the mixture: using boiled water, sterilized bottles and following the rules for diluting the mixture. Medicinal mixtures intended for diet therapy of CMPA should be used under the supervision of a physician.

Regurgitation in newborns – when to see a doctor?

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