Spitting up
Many newborn babies and young infants are prone to spitting up some of their breast milk or formula during or shortly after a feeding. Some newborn babies spit-up only occasionally, and others spit-up with every feeding. Spit-up effortlessly rolls out of the baby’s mouth, sometimes with a burp. The amount of spit-up can vary from feed to feed. Spitting up, also called gastroesophageal reflux, occurs when the ring of muscle at the top end of the stomach does not close properly. This ring is looser in infants than in older children.
Spitting up decreases as the baby gets older, and it generally goes away before the baby reaches one year of age.
Ways to help your baby
You can reduce the amount that your baby spits up by trying the following:
- Feed your baby before they become frantically hungry.
- If you are bottle feeding, feed them smaller amounts. Overfeeding can make spitting up worse. Your baby does not have to finish a bottle.
- If you are bottle feeding, make sure the nipple is neither too large nor too small. A nipple that is too large will cause the milk to flow too fast; a nipple that is too small will cause your baby to swallow a lot of air.
- Keep feeding times quiet and calm, and try to minimize distractions.
- Avoid tight diapers because they put pressure on the abdomen. Don’t put pressure on your baby’s tummy.
- Burp your baby a couple of times during feedings, to get rid of some of the air in their tummy. Don’t interrupt their feeding, but instead burp them when they take a break.
- Hold your baby upright after each feeding.
When to see a health-care provider
Usually spitting up is harmless; however, it can pose a problem if it leads to poor weight gain, choking, or pain from acid in the esophagus. If your baby experiences any of the following symptoms when they spit up, bring them to their health-care provider:
- streaks of blood in the spit-up
- spit-up that causes your baby to choke or gag
- spit-up that causes your baby to turn blue
- problems gaining weight
- vomiting or projectile vomiting
- your baby is refusing to drink or appears to be in pain
A note about sleeping position
Putting your newborn baby to sleep on their back is considered one of the best things you can do to help prevent sudden unexpected infant death (SUID). This is recommended by the Canadian Paediatric Society, the American Academy of Pediatrics, and many other paediatric societies around the world. Although you may be concerned about putting your newborn baby to sleep on their back if they are prone to spitting up, there is no need to worry. There is no increase in choking in newborn babies who are put to sleep on their backs.
Vomiting and projectile vomiting
Vomiting is more forceful than spitting up, and it involves more than just a couple of tablespoons of stomach contents. Vomiting can be a sign of an infection, a reaction to something the baby ate, or another gastrointestinal problem. Babies who vomit are at risk for dehydration.
Treatment for vomiting
Breastfed babies can continue to drink breastmilk. If your baby normally takes formula, then you can continue to offer their regular formula, starting with a small amount (5-10 mL or 1-2 teaspoons every five minutes) by syringe and then gradually increasing the amount offered if there is no vomiting. If the baby refuses, you can try to offer oral rehydration solution the same way and then switch back to formula when your baby is getting better. Do not give tea or plain water to babies. Use a teaspoon, syringe or medicine dropper to give the fluid to your baby if they are refusing to drink at the breast or from their bottle.
When vomiting becomes a concern
Because babies risk becoming dehydrated if they are vomiting, it is important to have your baby seen by a health-care provider. If there is a viral infection, vomiting is often accompanied by diarrhea and babies can become dehydrated more quickly if they have both vomiting and diarrhea. If there is green bile in the vomit or if your baby has projectile vomiting, it could be a sign of a blockage in the intestine, which requires immediate attention and possibly emergency surgery.
Projectile vomiting is when spit-up or vomit forcefully flies out of a baby’s mouth. If your baby begins projectile vomiting, contact their health-care provider immediately. It could be a sign of pyloric stenosis, which is a common condition in young infants. Pyloric stenosis occurs when there is a narrowing of the lower tubular portion of the stomach that prevents food from leaving the stomach. Surgery is used to correct this problem.
When to see a health-care provider
Bring your baby to a health-care provider immediately if:
- your baby seems dehydrated (no urine in 6 hours, sunken fontanelle, dry mouth, no tears, low energy or sunken eyes)
- your baby's vomit is green, bloody or dark brown (coffee colour)
- your baby has projectile vomiting
- your baby also has fever or diarrhea
- your baby is refusing to drink or drinking very little
- your child appears to be very sick
Your baby may show physical changes when their condition is serious or when their condition gets worse. Parents and caregivers can learn how to spot these signs in order to seek help from a health-care provider.
