When you have a newborn baby, it can be overwhelming to get yourself acquainted with this squirming new bundle. If your little one is struggling to feed, or spitting up after a feed, you may be getting worried.
Is spitting up just something babies do? Or does it signal a more serious problem?
It’s normal to be anxious about these things, especially for first-time parents. Let’s look into what causes reflux and spit up in babies, how to distinguish between spit up and vomit, and how to treat infant reflux.
Is Baby Spit Up Normal?
Spitting up is common in babies and, in most cases, is completely normal (1). It is most likely to happen right after feeding, though it may also occur up to one or two hours later. It’s more of a laundry problem than a medical one.
Most babies outgrow spitting up as they get older. The condition is typically at its worst when baby is around two to four months old.
By their first birthday, most babies stop spitting up altogether. So, don’t worry- it will get better!
Causes of Spit Up
Spit up most often happens because your little one’s digestive system is still developing. As they mature, babies will become much better at keeping their food down (2).
In addition to their developing digestive system, there may be a few other factors causing excessive spit-up. These include:
- Oversupply of breast milk: This may cause your baby to take too much milk or drink it too quickly. The result is reflux-like symptoms. Thankfully, it is easy to remedy (3).
- GERD: If your baby is spitting up a lot, it may be a sign of gastroesophageal reflux disease. We’ll talk more about GERD below.
- Food sensitivities: In breastfeeding moms, this could be from something you ate. If you are no longer breastfeeding, any new food could disagree with baby’s stomach.
The most common cause of food sensitivities in babies is an intolerance to cow’s milk. However, pay attention to whatever you feed them, especially if you’re introducing solids like baby cereals or soft foods.
If you are still breastfeeding, elements of your diet can also upset your baby’s stomach. Reflect on your food intake if they’re spitting up more than usual. You may have eaten something different, which has transferred to baby through your breast milk. (Allergy to something in your milk is typically accompanied by more than just spitting up, though.)
Medication and alcohol can also affect breast milk, so look into those factors too. However, neither of these are typically a cause for concern, as long as your little one is otherwise happy and gaining weight.
Identifying Spit Up
Spit up will usually look like what your baby has recently eaten. If they’ve just had a milk feed, it should be creamy and pale in color. It might be a thicker consistency if they ate solids, for example, baby cereal.
If their spit up is a different color, like green, think of their last meal. If they had pureed greens, then all is likely to be normal.
When to See a Doctor for Spit Up
Regular spit up is not forceful. Vomiting is normal once in a while. However, if your little one is repeatedly vomiting violently, then you should seek medical advice.
If baby’s spit up is green, yellow, or with traces of red, which isn’t from their last meal, consult a doctor immediately. Also, if baby is not gaining weight and is uncomfortable or distressed, seek medical advice.
Gastroesophageal Reflux Disease (GERD)
While spit up is normal, even expected in young babies, a small percentage of babies may experience extra discomfort.
GERD, or gastroesophageal reflux disease, is a more complicated form of spitting up. There are a few key indicators of reflux in your baby, but your doctor will need to diagnose this condition.
Symptoms of Baby Reflux
Most signs of GERD will be frequent and persistent. Monitor your baby closely and keep track of symptoms and potential triggers to avoid falsely assuming they have reflux disease (4).
Some indicators your little one may be suffering from reflux include:
- Feeding difficulties, including gagging, refusing feeds, or choking.
- Constantly spitting up milk during or after a feed, throughout the day.
- Regularly suffering from chest infections.
- Crying while feeding, or constantly crying.
- Constant hiccups or coughing.
Is Reflux Dangerous?
Generally speaking, reflux is not a major cause for concern. As long as your baby seems happy, healthy and is gaining weight, you don’t need to seek medical intervention.
However, if new symptoms appear after six months of age, you may want to contact your doctor for advice.
Speak to your doctor or pediatrician if you begin to grow concerned for any reason. Particularly if your little one is continuing to spit up past age one and has any of the following symptoms (5):
- Refusing to feed or spitting up frequently.
- Gagging or coughing during a feed.
- Irritability or crying more than usual.
- Yellow or green vomit.
- Frequent projectile vomiting.
- Blood in their vomit or stools.
- Tender or swollen stomach.
- Weight loss, or failure to gain weight.
- Fever or high temperature: 100.4 Fahrenheit or higher is a fever.
These symptoms can help the specialist diagnose the underlying cause. It is likely your baby will need tests or treatment if they have one or more of these symptoms, combined with spit up.
What About Silent Reflux?
This condition is more difficult to notice, as your baby will not spit up. With silent reflux, the stomach contents travel back up to the esophagus and are then re-swallowed. There is pain and discomfort, but no vomiting.
You may be able to identify silent reflux if baby frequently coughs or hiccups during feeds. They may also be particularly fussy or show discomfort when feeding.
How to Prevent Infant Reflux
If your baby is gaining weight at a healthy rate, reflux will not normally require any treatment. Still, it is important to provide relief where possible, or even prevent reflux altogether. Here are some remedies you can try to prevent reflux and spit up in your baby.
1. Adjust Your Feeding Technique
The way you feed your little one could be causing some problems. Babies shouldn’t be completely horizontal during a feed; elevate their head slightly. Even during bottle feeds, hold baby in the same position you would if you were breastfeeding.
Regularly burp your baby during and after every feed. This can be done by sitting them upright and gently rubbing their back. Hold them in an upright position for a short while after feeding to release any trapped gas.
Make sure baby also isn’t swallowing air during feeds. The nipple of a bottle should always be kept full, by holding the bottle at an angle, preventing air bubbles.
If breastfeeding, make sure baby is latched on correctly, and not gulping air as they suck.
If you are no longer breastfeeding, try a thicker milk formula. If the milk is thicker, it is less likely to be brought back up.
However, unless your baby has already been introduced to solid food, ask a doctor for advice specific to your baby. Some thicker formulas are only available on prescription and may cause baby to gain weight quickly.
2. Create a Structured Feeding Schedule
Changing baby’s feeding routine could reduce spit up and reflux. Try giving them smaller amounts more often. That way, it’s easier to digest and keep down.
Try to feed at the same times throughout the day to get your baby into a feeding routine. Also, make feeding times a quiet, nurturing, and relaxing experience.
Babies can sense it if you are tense. So while you may be concerned about your baby, try to relax. Give your little one time to feed at a slower pace.
3. Check Sleeping Position
Babies can find it difficult to settle if they are in pain following a feed. Adjusting their sleeping position may help ease these feelings.
Place a wedge beneath the head of the mattress to elevate their upper body. There are a variety of products for this, but be sure you are only using one on the advice of your baby’s doctor. The wedge should always go under the mattress, not directly under the baby or sheet.
4. Care and Comfort
It’s important your baby feels calm and cared for at all times, to prevent a negative association with feeding and sleeping. While you may be itching to get your little one into a regular routine, remember, reflux doesn’t last forever.
You may have to sacrifice a little more sleep during this period. However, as babies grow out of their reflux, they can establish a better sleep pattern.
5. Reduce Caffeine
If your baby has reflux, watch the amount of caffeine you consume while breastfeeding. If you have a high intake of caffeine in your diet, your little one may suffer.
The LES (lower esophageal sphincter) is a muscle that allows food to move from the esophagus to the stomach. In babies, this is not fully developed. Caffeine can relax this muscle and allow food to go in the opposite direction, causing spit up.
While you may be dependent on caffeine to get you through long days, and even longer sleepless nights, consider cutting back. Try to limit your intake to no more than two cups of tea or coffee a day, or — better still — switch to decaf.
6. Reduce Alcohol
Alcohol can also cause the LES to relax. Therefore, it carries the same risks as caffeine.
If possible, do not breastfeed for at least two hours after you have alcohol. If you’ve only had one drink, most of the alcohol will be out of your system by then. ‘Pumping and dumping’ will not eliminate alcohol from your milk any faster.
7. Quit Smoking
Smoking is another external factor that can cause reflux in breastfed babies. Nicotine in the cigarettes passes into the mother’s milk. It stimulates the production of gastric acid and, as with caffeine or alcohol, opens the LES.
Studies have revealed many other negative effects of nicotine on babies (6). The best way to avoid these problems when breastfeeding is to stop smoking. Even if you are not breastfeeding, secondhand smoke is dangerous for your baby and can make reflux symptoms worse for baby.
8. Test for Allergies
In cases where reflux is caused by an allergy to cow’s milk, your baby may also have diarrhea, blood or mucus in their stools, and a rash.
It’s common for babies to grow out of this allergy. However, the condition can also be treated by removing dairy products from their diet (7). Your doctor will recommend any relevant tests if they suspect a milk allergy.
If you recently introduced solid foods to baby’s diet, the reflux may be signs of intolerance to these foods. It’s a good idea to keep a diary of the food you introduce to your baby. This makes it easier to track their symptoms and reactions.
Treatments and Remedies for Infant GERD
It may feel like there’s no respite when it comes to your little one spitting up. Fear not, there are a few simple things that may work for you. Here are some solutions you can try:
1. Gripe Water
Whether you find success with gripe water depends on your baby. Some parents love it and find it helpful, whereas others have seen no change. Personally, it worked for my babies, so I love it!
Babies can use gripe water from month one of age and up. Although it is a natural treatment, carefully follow the instructions and dosage on the label. If you have any concerns about using gripe water, ask your doctor for more advice.
2. Baby Cereal
Thickening your baby’s feed may reduce spit up and reflux as it is easier to keep down. The option is worth looking into, as long as your baby is over three months of age. If you plan to do this, work closely with your baby’s healthcare provider.
To thicken your little one’s formula or expressed breastmilk, use up to one tablespoon of baby rice or cereal for every two ounces of formula. The thicker formula means you’ll need larger size nipples. Alternatively, cut a small ‘X’ into the end of the nipple (8).
Either way, ensure the mixture is flowing through smoothly. There are also pre-thickened formulas available to buy if you don’t want to mix your own.
Medication is rarely necessary to treat reflux, except in severe cases. Two common medications used to treat reflux are:
- Alginates: These create a protective barrier over the stomach and prevent anything from coming back up from the stomach. They also prevent irritation to the esophagus. You’ll receive alginates if you have already tried to change the way your baby feeds. If these changes have not relieved symptoms, alginates may be effective.
- H2-receptor antagonists and proton pump inhibitors: Both reduce the amount of acid within the stomach. This prevents the stomach contents from irritating the esophagus and stops any reflux or spit up. These medications are usually recommended to relieve discomfort. If your baby is refusing to feed or appears uncomfortable during a feed, they may help.
Will Spit Ups End?
Reflux and spitting up are most common within the first year of a baby’s life. Once they are one year old, they should have outgrown the condition. Otherwise, there are likely more serious underlying issues.
In some cases, reflux or spit up may need medical intervention. For example, if a child has an allergy, reflux will not end until the problem is identified and treated.
You may see quicker results if the issue is caused by simple issues, such as feeding position or routines. With proper burping and a change in feeding schedule, your little one could find relief immediately.