Everything You Need to Know About Baby Spit Up

Blog Submitted by Dr. Supriya Mishra

“Zainab, a mom of 21 days old baby boy remained anxious all the time regarding her baby spit up. She wondered why her baby spits up so often although she is exclusively breastfeeding and eating a simple homemade food devoid of spice and fats.”

Most of the new parents can relate to the story shared by Zainab as to why baby spit up so much during the early weeks or months of birth. No matter how much we get experienced in baby care and nourishment, the concern over a baby spit up never goes away. We often get stressed up with the situation, find it hard to differentiate whether the spit up is just a normal one or a not too ‘normal’ vomiting and don’t exactly know how to deal with it.

Being a mom of a six month old girl I definitely understand the feeling of helplessness as well as the fear that something might be wrong can make us extremely tense and anxious. Hence, in this article I have made an attempt to clear all the doubts regarding baby spit ups. 

# WHY MY BABY SPITS UP SO FREQUENTLY?

It is very common for the babies to ‘spit up’ after feeding especially in the early weeks of life. Some spit occasionally while some after every feed. Spitting up milk is more common in newborns and reduces as the baby grows. Normal spitting is also known as possetting. There are few reasons which can explain the phenomenon of possetting. They are:

1. Baby’s digestive system is not completely matured during the early weeks. There are valves surrounded by muscles between the mouth and food pipe and between the food pipe and stomach. Once the food enters the food pipe from the mouth and from the food pipe into the stomach these valves eventually close up that prevent the food from regurgitated back into the throat. In babies, these valves are not mature and strong enough to prevent the food from getting back into the baby’s mouth and hence babies spit. As the baby grows these valves get gradually matured. This is more common when the baby is overfed or baby’s tummy is unduly pressed upon.
2. Often during the feed baby swallows up the air along with the milk. This is more common in formula fed babies as compared to breastfed ones. The swallowed air sometimes gets trapped with the milk in such a way that the upper layer is formed by some amount of milk while the lower layer is made up of air. The entrapped air needs to come out and when it does as in after a burp the upper layer of milk too comes out along with the air. Hence it is absolutely normal when some amount of milk comes out with the burp. During breastfeeding it is more common when the mother has a strong let down or an oversupply of milk. This makes the baby gulp milk quickly and so the air also gets entrapped.
3. Babies can be allergic to certain foods or drinks that the mother takes in. the food can disagree with the baby and so the baby spit up.

# WHEN WILL MY BABY STOP SPITTING UP?

As the baby’s valve and muscle around it matures and gets strong, baby will gradually stop spitting u milk. This usually happens in and around 6-7 months of age. However, some may take almost a year to do so.

Note: spitting up or possetteing reaches its peak when the baby is 4 months of age.

# WHAT CAN BE DONE TO REDUCE SPITTING?

Some amount of spitting is unavoidable but frequent spitting up can be reduced to a certain level by taking the following measures:

1. Try to feed the baby in a favorably upright position or in a position such that the baby’s head is at a slightly raised level as compared to the baby’s tummy. This is done so that the milk gets a straight line pathway to the stomach.
2. I understand burping should be done as much as possible but just don’t burp the baby immediately after feed. Let the baby sit up and relax for a minute then burp the baby. Even after the baby has burped continue to keep the baby in an upright position for atleast 30 minutes. Remember to burp the baby in between feed also. For example when the baby pause for a minute or so during the feed u can use that time to make the baby burp and then again continue with the feed.
3. Whenever you feed the baby keep the environment quiet and calm. Remove all distracting elements and don’t let the baby be hungry for a long period of time. If the baby is very hungry, he/she may gulp down the milk too quickly and swallow excess amount of air.
4. When the mother has a fast let down of milk, the milk might be flowing faster than your baby can suck. Express some amount of milk before feeding so that the flow gets normalized.
5. Reduce the play time activities immediately after feed. Also don’t bathe or massage the baby immediately after feed. A gap of atleast 30-45 minutes should be there between the bathing/massaging process and feed.
6. Avoid overfeeding the baby. Baby’s stomach is very small in size. Whatever the excess amount has been taken in by the baby, it will most likely come out so that the baby gets more comfortable. Instead give small feeds more frequently.
7. Just see to it that baby’s tummy doesn’t get pressed too much during holding him/her. The diapers or clothes should not be tight at the tummy area.

 # HOW TO DIFFERENTIATE BETWEEN A NORMAL SPIT UP AND VOMITING

The basic difference between a normal spit and not so normal vomiting is whether it is forceful or not and whether the baby is in any discomfort after the spit up or not. In normal spit up there is no discomfort and baby is gaining weight properly while in vomiting baby has some sort of discomfort and is a poor weight gainer.

1. Normal Spit and happy baby: spit out milk is small to moderate in amount. Spitting is effortless and baby thinks nothing has happened. The spit up might be ‘curdled’ milk (digested milk) or somewhat like a freshly pumped milk. In any case, it is normal if the baby is not in any discomfort and is a happy weight gainer. Sometimes the baby might choke and some amount may come out from the nose also. The baby seems to be startled for few seconds in this case but he is not in pain.
2. Excessive spit and happy baby: baby spits up large amounts of milk and may be after every baby. However, as with the normal spit happy baby, this kind of baby also doesn’t seem to care much about it. The baby is gaining weight normally and such kind of milk spit up is most probably due to abundant milk supply which often leads to an overfed baby. The overfed baby then pukes a big amount and is comfortable again.
3. Excessive spit and unhappy baby: sometimes it happens that the baby spits up and cries and screams in pain. The baby would stop feeding and arches his back and start crying. Now this is the condition when it is something to worry about. Screaming in pain is the most important identifying factor of acid reflux. Mind the word, its acid reflux and not the mere reflux. Reflux is just the backward flow of milk when it goes up instead of going down like in possetteing while acid reflux is when the stomach acid flows back along with the milk causing burning and pain sensation. Apart from following the above mentioned measures you need to consult your pediatrician or gastroenterologist also as it might be GERD or gastroesophageal reflux disorder.
4. Projectile vomiting: it is a kind of forceful vomiting that comes out in a projectile manner. It shoots out travels certain distance and may wet the distant walls of the room too. This is seen in case of a medical condition known as Pyloric Stenosis. It is a rare condition often seen in babies of one month of age in which the valve leading the stomach into the intestines is thickened so much that it doesn’t allow the food to pass through it which causes the baby to vomit. He is a poor weight gainer or might even lose weight due to inadequate nutrition and dehydration. It requires immediate medical attention and can be cured by a simple surgical procedure.
5. Blood or bile in the vomit: seek immediate medical attention. It can be due to blockage in the intestines.
6. Gastroenteritis: it is a type of stomach infection in which there will be sudden onset of vomiting accompanied by dehydration (dry mouth, sunken fontanelles, less than 6 wet nappies a day, inactiveness) diarrhea and fever. Seek immediate medical attention.
7. Vomiting can also be a symptom of more serious disorders like meningitis, hernia, appendicitis, ear infection, urinary tract infection or pneumonia that require immediate medical help.

 Hope the article was helpful…

Dr Supriya Mishra – Hello all moms and moms to be! I am Dr Supriya Mishra, a Periodontist by profession, a postgraduate diploma in maternal and child health care and a mother of a six month old girl. I won’t say I am a perfect parent as I am still learning with my everyday experiences that I am getting while raising up my child and I am here to share those experiences with you all and the little piece of knowledge that I have gained would definitely help you in your baby’s everyday care.