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Spitting up is something that comes up a lot with newborns. It can be concerning to parents and sometimes, concerning to us as providers.
I want to preface this with, when I was a new mom, I was not yet a nurse practitioner and although I was an RN, I worked in the adult world. In hospice. I had not held a baby in some time and had no idea what I was doing. I was also crippled with anxiety, which did not help. I tell you this because I want you to know, I’ve been there. Most of us have. And it is nearly impossible to be objective and calm when evaluating your own child’s behaviors.
So let’s get into it.
Let’s talk about…
your couch.
Yes, your couch. You purchased it about a year before you decided to have a baby.
You love the look, the feel, the fabric. It’s now the perfect place to curl up with your nursing pillow and your newborn for cuddling and feeding sessions.
And then…
Blaaaaaahh... Erupting from that cute, tiny mouth is what looks like the entire contents of their most recent snack.
I also want to talk about …
your dog.
He’s been your “fur baby” for years and you are so happy he has taken to your human baby. He is sleeping at your feet while you are feeding your infant.
Blllllaaaaaaaaaaaah. Direct hit. Poor puppy.
Holy cow! Is this normal? How can baby Maddie possibly gain weight when she is throwing up every feed? Can she breathe when milk is coming out of her nose? Now she sounds congested, is she sick? For the life of you, you cannot suction anything out of that tiny nose.
So what in the world is going on???
While spit ups certainly can be normal, there also can be some signals that there is more to it. What’s the difference between normal reflux and reflux disease? When is this a problem? When should we worry? Follow your mom or dad “Spidey Sense” as I like to call it.
Physiologic Reflux (AKA the Happy Spitter)
This is normal infant reflux. A baby's esophagus is small and not really mature and the belly does not hold much volume. Also they sit reclined most of time. All reasons why food may come back up!
These babies will spit up and they are happy about it. It just dribbles out or plops onto your lap (or couch, or dog). They may spit up after every feed, sometimes even hours later. It looks like milk, maybe a little curdled.
Everything is connected, so reflux can also get up into those little noses giving them that “congested” sound. We are reassured as long as they are growing well and don't seem to be in significant discomfort. However, you may have a lot of extra laundry to do!!
Here are some helpful stats from the American Academy of Pediatrics (AAP):
• “50% of infants ages 0 to 3 months regurgitated at least once daily, 67% at 4 months” [1].
• Reflux symptoms are usually at their worst around 4 months of age and then gradually decrease, with most reflux resolving by age 12 months
GERD (AKA reflux disease):
The good news is that GERD is not as common as people may think.
Some things to keep in mind: Babies with untreated GERD may not gain weight appropriately. They seem to be in discomfort from the reflux events. They may eat smaller, more frequent feeds as this tends to briefly soothe their tummies. Speaking of tummies - they usually do not enjoy tummy time at first!
There are certainly other medical issues that may cause fussiness and spit ups. Projectile vomiting (where it shoots out an arm's length away) or spit up that doesn't look like milk or has green or has red in it are problems you should discuss with your pediatrician right away. Always check with your pediatrician when you have concerns and you're not sure if the spit ups are normal. You don't even have to wait for your baby's next well visit!
Okay, so you have seen your pediatrician and they have ruled out the scary problems, how do we help baby (and save said couch, carpet, bedding, canine)?? Oh and I am sorry about your clothing, that’s just a parenting thing. Prepare to have stains for about 16+ years...
Normal reflux treatments:
Reflux precautions:
Give baby smaller, more frequent feeds
Hold baby more upright during feeds and keep upright for at least 20 minutes afterwards
Burp frequently, after every ounce or so with formula or expressed breastmilk
If exclusively breast feeding (EBF):
Try slowing your let-down, some moms (lucky ladies) have a strong ‘let down” or initial flow of breast milk. You can do this several ways. You can manually start the flow of milk by massaging your breast from the areas furthest from the nipple, down to the nipple.
You can pump some initial milk
You can also recline slightly back so gravity will provide less “assistance”.
If bottle feeding:
Try using a slower flow nipple
Your pediatrician may recommend trying a different formula or thickening it. Please don't add cereal to your baby's bottle without a specific plan from your pediatrician though.
Abnormal reflux (GERD):
This will be managed by your child’s pediatrician. Medications may be recommended.
Remember, there are a lot of reasons babies have lots of spit ups or vomiting, and sometimes these can be very serious.
You always want to check in with your pediatrician if you have concerns or your baby develops problems feeding.
1. Sullivan, J.S & Sundaram S. S. Pediatrics in Review June 2012, 33 (6) 243-254; DOI: https://doi.org/10.1542/pir.33-6-243
