What is spitting up?
The medical term for "spitting up" is gastroesophageal reflux. It is the spitting up of milk after feeding. It is not the same as vomiting, which is the forceful expulsion of food from the stomach. Spitting up is common and occurs frequently during infancy. Spitting up does not indicate a problem unless the baby is choking on the food, is spitting up excessively large amounts of milk or there is failure to gain weight.
What causes spitting up?
It happens when milk or solid food in the stomach comes back up into the oesophagus. The oesophagus is the tube from the mouth to the stomach.
In older children
and adults, an elastic-like muscle at the entry of the oesophagus to the stomach closes like a valve to prevent liquids from being pushed back up. In babies, however, this valve or sphincter isn't fully effective until between 6 and 12 months of age. Since it is not fully developed yet, the valve is easily pushed back by the contents of the stomach - resulting in regurgitation or spitting up. Regurgitation often occurs after overfeeding, or with burping. Consequently, breastfed babies tend to spit up less than bottle-fed babies, because they usually take in only as much milk as they need, and because they tend to swallow less air. Regurgitation is not caused by allergy
or food intolerance, and should not be confused with vomiting.
What are the symptoms?
- Effortless spitting up or reflux of 1 or 2 mouthfuls of stomach contents.
- Smaller amounts often occur with burping ("wet burps").
- Larger amounts can occur after overfeeding.
- Usually seen during or shortly after feedings.
- Occurs mainly in children under 1 year of age and begins in the first weeks of life.
What are the ways to reduce spitting up?
- Burp your baby several times during and after feeding by sitting him upright (with your hand supporting his head). This allows air bubbles to rise to the top of his stomach and bending at the waist encourages burping of the air.
- Avoid pressure on the full abdomen, which often occurs when holding your baby over your shoulder. This "standard" procedure causes more expulsion of stomach contents rather than just expelling gas or air.
- Avoid excessive movements during and immediately after feeding.
- Avoid feeding large amounts. Instead, feed smaller amounts more frequently.
- Lay your baby down on his right side with the head of his crib slightly elevated.
- Check for dribbling during sleep. The constant moisture in the corners of the mouth, chin, and neck can result in skin irritations.
- Be sure he is getting adequate fluids by checking for dehydration.
- Is the inside of his mouth moist?
- Is he urinating adequately? Wetting 6 to 8 diapers each day?
- Does his skin look pink and full instead of dull and loose?
- Ensure that the baby has a normal weight gain
Can spitting up affect the baby's health?
Usually, the vast majority of babies outgrow this problem by 12 months or earlier and their growth and development is not affected at all. However, a small proportion of babies regurgitate so much that they do not grow properly. For this reason, babies who spit up frequently should be weighed regularly. If very large amounts of milk are being thrown up, or if regurgitation is forceful, a doctor should be consulted. Fortunately, even if the baby spits up frequently but is growing normally, there is probably no cause for alarm.Tips for feeding the baby:
- Feed smaller amounts:
- Bottlefed: Give smaller amounts per feeding. Keep the total feeding time to less than 20 minutes (as overfeeding or filling the stomach to capacity always makes spitting up worse).
- Breastfed: If the mother has a plentiful milk supply, try nursing on 1 side per feeding and pumping the other side.
- Longer feeding intervals: Wait at least 2 hours between feedings, because it takes that long for the stomach to empty itself.
- Loose diapers: Avoid tight diapers. It puts added pressure on the stomach. Do not let people put pressure on the abdomen or play vigorously with your child right after meals.
- Vertical position: After meals, try to hold your baby in the upright (vertical) position
- Expected course: Reflux improves with age. Many babies are better by 7 months of age, after learning to sit well.