My baby is spitting up: is this normal?

As a pediatric resident I get to see many newborn babies, and I often continue to care for them in our outpatient clinic as they grow. In my experience, spitting up is among the top concerns for mothers within the first few months of their babies’ lives. And why shouldn’t it be? More than half of all infants spit up daily. Well, before I give you some tips to help you manage this at home, I’d love to review some information that we as pediatricians keep in mind when we hear the words “spit up.”

What is reflux and when is it a problem? 

When a child is spitting up, your pediatrician may refer to this as gastroesophageal reflux or GER. This simply means that the contents of the stomach flow back from the stomach into the esophagus. GER or “spit up” can occur in more than two-thirds of otherwise healthy infants. This can be completely normal. Infants not only have small stomachs but a muscle located between the esophagus and stomach that is not always strong enough to keep the stomach contents in the stomach. The muscle needs to grow just like the rest of them. This is not a disease, and the best way to help is to provide comfort while their little ‘sphincters’ or muscles grow to prevent formula or breast milk coming up as easily. 

However, some infants will develop troublesome symptoms or complications associated with GER, and that’s when we refer to the problem as gastroesophageal reflux disease or GERD. These symptoms may include pain, crying, refusal to eat, arching their back, recurrent vomiting, poor weight gain, chronic cough and others. If you think your baby is having some problematic symptoms, talk to your pediatrician and let him or her help you figure out if your baby has GER or GER+Disease.

What you can do to help your baby

The first things we like parents to try, whether their baby has GER or GERD, are some simple changes to the way they are feeding their baby. 

If you have a “Happy Spitter” on your hands, or in other words a baby that spits up with many feeds without any other symptoms and generally good overall feeding, you can try some of the recommendations below or keep many bibs and washcloths around until they simply grow out of it. 

Even if your child is found to have GERD (not completely normal spit up), there is no need to be alarmed because they can grow out of this. Only 5 to 10% of babies still have it it once they reach 12 months of age. 

Be sure to chat with your doctor before considering any major dietary changes if you are breast feeding or most definitely before considering antacids or any medical treatment. However, these are some things you can try at home, starting now! 

Here are some changes you can make:

• Give smaller, more frequent feedings so you don’t overfill their extremely small stomachs. Keep in mind that a newborn’s stomach is about the size of a cherry. At one month of age, their stomach may be the size of an egg. Remember, they often cannot handle more than this amount during one feeding. 
• Burp frequently during feeds, to allow that muscle to contract and pass contents. 
• Hold infant’s head up for a minimum of 15 to 20 minutes after feeding to allow milk to pass. 
• It may also be helpful to note that infants who are breast fed experience less spitting up and reflux compared to formula fed infants 
• Remember, spitting up is common, often not requiring any major changes or medications.

However, it is important to seek medical care as soon as possible with the following signs or symptoms:

•  Coughing, choking, severe breathing problems, or color change
•  Bloody or green spit up, projectile spit up
•  Back arching or significant restlessness after feeds 
•  Excessive spitting up, that may result in not gaining weight or difficulty feeding 
•  Prolonged feedings, not feeding as well as the infant had before 
•  Or, of course, if you as the caretaker are concerned that something is not right!