Why do babies spit up milk? Should I be concerned?

Why do babies spit up milk? Should I be concerned?

Gastroesophageal reflux, infant reflux or infant acid reflux. OMG!! What do these terms even mean? And why are these terms being used in relation to infant spiting up?

First, let us understand the meanings of these terms. Reflux means the flowing back of liquid. Gastroesophageal reflux or acid reflux means the flowing back of stomach acid along with the milk or other food content due to poor closure of the esophageal sphincter causing heartburn like pain or discomfort. Oh, this seems scary to read!! But moms, please be assured that this is not alarming if it is happening to infants. So, nothing to worry.

Spitting up is mild vomiting or regurgitation of milk and saliva that can occur in most of the infants at least occasionally. Spitting may not contain large amounts of food and fluids. The fluid may look just like the milk that was just fed or may appear slightly curdled.

What causes spiting of milk or curdled milk?

When we eat or drink, the food passes down the feeding tube called the esophagus and then into the stomach. In the stomach, the food mixes with acids and passes slowly further into the intestines for digestion.

There is a valve between the esophagus and the stomach that helps prevent the food from coming back up and out of the stomach. In infants, this valve is not well developed and so can allow the liquid to go back up the feeding tube more easily. Since the infant’s stomach is small, overfeeding or gulping too much air while feeding can cause the milk to regurgitate past the valve. That is why spitting up will usually occur right after feeding or burping. As the baby grows and the organs develop, milk is less likely to pass this valve and travel up the esophagus. Also, after 4 to 6 months as the baby begins to take solid foods and is also able to sit with or without support in an upright position, the spitting up usually decreases. 

When not to worry?

The amount of fluid spit up may either be just a small portion of the feeding which is normal or it may even seem excessive sometimes. In both the cases the baby will seem unaffected and be happy still.

The normal spitting baby has a small to moderate amount of milk regurgitating. This will not affect the baby much and the baby seems to think nothing has happened at all. He may have a mouth dripping with spit up on his cute face and still smiling. Sometimes the baby may choke on his puke a little and it might come out of his nose too. So, don’t worry! It will bother the baby for a minute just because of the discomfort of not being able to breathe for a second.  The normal spit may be chunky “curdled” looking milk or it may look exactly like freshly pumped milk. It really does not mean anything concerning. It’s just that the curdled milk was just in his tummy a little longer than the other. The baby may or may not be hungry after throwing up.  More often they will not be hungry. This may be surprising for you since it looked like the baby threw up his entire feed!  The spitting up bothers you more than it bothers your baby.

Some babies spit up ridiculous amounts all the time but still seem to be happy.

Causes of concern?

So, what is it that you should look for to know if it is concerning?

  • If you have a happy spitting baby with well gaining weight, then you have nothing to worry about. But if the baby is not gaining or losing weight on the other hand then a visit to a doctor is warranted.
  • Only a reflux due to overfeeding or due to air getting trapped will not cause disturbed sleep in the babies. But if the baby has gastroesophageal reflux i.e. stomach acid too coming out along with milk it may need some meds prescribed by a doctor to keep it down.
  • If the infant stops breathing, becomes limp, or has any blue color change during a spitting up episode then immediate medical attention is required. With normal spitting up the child should not stop breathing or turn blue.
  • If the color of the spit is green or brown, then it may be a sign of intestinal blockage and requires medical attention.

Some tips to help with spitting

  • Handle the baby gently after feeding. Try to avoid significant activity immediately after feeds. Agitation of the stomach contents may result in more spitting up.
  • Burping the infant frequently in between the feed and compulsorily after the feed to prevent the build-up of air in the stomach.
  • Feed the baby more slowly if your milk flows with force to allow the baby to gulp easily and not gag or choke during the feed.
  • Be careful not to feed too much at a time. Smaller, more frequent feeds are easier to digest.
  • Do not pacify or start feeding the baby immediately after the spitting episode thinking that the baby is hungry. This way they may end up overfeeding again.
  • Keep the infant in the upright position after feeding for at least 10-15 minutes. This allows gravity to help prevent the stomach contents from coming up.
  • Keep clean up supplies likea cloth napkin to put it over your shoulder and a change of clothes nearby if required.
  • If the baby is on supplemental vitamins, iron or other multivitamins try to discontinue them for a while to see if it makes a difference.
  • Be watchful of your diet. Avoid eating spicy foods and foods that cause bloating. Cut down on too much of dairy products and food like eggs or wheat.

If your baby has reflux and you seem to be fed up, just try to keep a positive attitude. No matter how cliché this phrase seems, but still, “its’s a phase which will pass” and remember that in almost all cases, spitting up and reflux occurs in healthy babies who just need a little more time to grow.

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