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Spitting up in babies: What's normal, what's not
What you can do about it
Although it may be impossible to prevent spitting up entirely, these tips may help:
- Keep it calm. Make each feeding peaceful and relaxed. Feed your baby before he or she becomes frantic.
- Sit up. Feed your baby in an upright position. Follow each feeding with 15 to 30 minutes in a sitting position. Hold your baby in your arms, or try a front pack, backpack or infant seat. Avoid active play and infant swings while the food is settling.
- Try smaller, more frequent feedings. Feed your baby an ounce (about 30 milliliters) less than usual or limit nursing sessions to just one breast.
- Take time to burp. Frequent burps during each feeding — when your switch breasts or after every 2 to 3 ounces (about 60 to 90 milliliters) — can keep air from building up in your baby's stomach. Also burp your baby at the end of each feeding. Sit your baby upright, supporting his or her head with one hand while patting his or her back with your other hand.
- Check the nipple. If you're using a bottle, make sure the hole in the nipple is the right size. If it's too large, the milk will flow too fast. If it's too small, your baby may get frustrated and gulp air. A nipple that's the right size will allow a few drops of milk to fall out when you hold the bottle upside down.
- Thicken the formula or breast milk. If your baby's doctor approves, add a small amount of rice cereal to your baby's formula or expressed breast milk. You may need to enlarge the hole in the nipple to make sure your baby can drink the thickened liquid.
- Raise the head of the crib. To reduce the risk of sudden infant death syndrome, it's important to place your baby to sleep on his or her back. This position can aggravate reflux, however. It may help to slightly elevate the head of your baby's crib. Never prop your baby with pillows.
When it's something more serious
Normal spitting up doesn't interfere with a baby's growth or well-being. Contact your baby's doctor if your baby:
- Isn't gaining weight
- Spits up forcefully, so that stomach contents shoot out of his or her mouth
- Spits up more than a small amount at a time
- Spits up green or brown fluid
- Resists feedings
- Seems hungry between feedings
- Has fewer wet diapers than normal or appears lethargic
- Has other signs of illness, such as fever, diarrhea or difficulty breathing
Treatment depends on what's causing the problem. Special feeding techniques are often helpful. In other cases, the doctor may recommend medication to treat reflux or a procedure to loosen the pyloric sphincter — a valve at the bottom of the stomach.
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References
- Vomiting. American Academy of Pediatrics. http://www.aap.org/publiced/BK0_Vomiting.htm. Accessed Feb. 9, 2009.
- Burping, hiccups and spitting up. American Academy of Pediatrics. http://www.medem.com/medlib/article/ZZZA66L09EC. Accessed Feb. 9, 2009.
- Parent's take home guide to GERD (gastroesophageal reflux disease). North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Children's Digestive Health and Nutrition Foundation. http://www.naspghan.org/user-assets/Documents/pdf/diseaseInfo/GERD-E.pdf. Accessed Feb. 9, 2009.
- Gastroesophageal reflux in infants. National Digestive Diseases Information Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/gerdinfant/index.htm. Accessed Feb. 9, 2009.
- Winter HS. Gastroesophageal reflux in infants. http://www.uptodate.com/home/index.html. Accessed Feb. 9, 2009.
- Hoecker JL (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 9, 2009.
