What Causes Baby to Spit Up Breast Milk

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My baby spits up – is this a problem?

Spitting up, sometimes called physiological or elementary reflux, is common in babies and is usually (but not always) normal. Well-nigh young babies spit up sometimes, since their digestive systems are immature, making it easier for the stomach contents to flow dorsum upwardly into the esophagus (the tube connecting mouth to stomach).

Babies often spit up when they get too much milk too fast. This may happen when babe feeds very quickly or aggressively, or when mom's breasts are overfull. The amount of spitup typically appears to be much more than it really is. If baby is very distractible (pulling off the breast to await around) or fussy at the breast, he may swallow air and spit up more often. Some babies spit upwards more than when they are teething, starting to crawl, or starting solid foods.

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A few statistics (for all babies, not merely breastfed babies):

• Spitting up normally occurs correct after babe eats, but it may as well occur i-two hours after a feeding.
• Half of all 0-3 calendar month old babies spit up at least once per day.
• Spitting upwards unremarkably peaks at 2-4 months.
• Many babies outgrow spitting upwardly by 7-8 months.
• Most babies have stopped spitting up by 12 months.

If your baby is a 'Happy Spitter' –gaining weight well, spitting upward without discomfort and content near of the time — spitting upward is a laundry & social problem rather than a medical issue.

Some causes of excessive spitting up

• Breastmilk oversupply or forceful allow-down (milk ejection reflex) tin cause reflux-like symptoms, and ordinarily can be remedied with uncomplicated measures.

• Food sensitivities can cause excessive spitting. The most likely offender is cow'southward milk products (in baby'southward or mom's diet). Other things to inquire yourself: is baby getting anything other than breastmilk – formula, solids (including cereal), vitamins (fluoride, iron, etc.), medications, herbal preparations? Is mom taking any medications, herbs, vitamins, iron, etc.?

• Babies with Gastroesophageal Reflux Affliction (GERD) usually spit up a lot (come across below).

• Although seldom seen in breastfed babies, regular projectile vomiting in a newborn can exist a sign of pyloric stenosis, a stomach problem requiring surgery. It occurs 4 times more often in boys than in girls, and symptoms usually announced between iii and 5 weeks of age. Newborns who projectile vomit at least once a 24-hour interval should be checked out by their doctor.

My older baby just started spitting upwardly more – what'southward up?

Some older babies will start spitting up more after a menstruum of time with picayune or no spitting upwards. Information technology's not unusual to hear of this happening around vi months, though you also run across it at other ages. If the spitting up is very frequent (particularly if baby does not seem well), consider the possibility of a GI affliction.

If baby does not seem sick, then here are some possible causes:

• It's unlikely that your babe has suddenly developed a sensitivity to something in your milk, unless in that location's something actually new in your nutrition or you're eaten LOTS of a item nutrient very recently. Any foods that babe eats are more likely than mom's foods to crusade the spitting upwardly. Has babe started solids recently or tried a new food? Are you or baby taking any new medications? Have yous or baby started taking vitamins or changed your vitamins?
• Has infant been fussier than normal, and/or crying more lately? If and then, he is probably swallowing more air than usual, which tin can cause the spitting up.
• Spitting up can be caused past teething. When teething, babies tend to drool more and often swallow a lot of that extra saliva – this tin can cause actress spitting upward.
• A cold or allergies can result in baby swallowing mucus and spitting upward more.
• Baby may be striking a growth spurt and swallowing more air when he nurses, especially if he's been "guzzling" lately.
• If yous tend to have oversupply or a fast let-downwardly, some moms run into renewed symptoms (which can include spitting up) after a growth spurt.

Essentially, though, if your babe is healthy and doing well despite the spitting up — gaining well, having enough moisture/dirty diapers — then this is a laundry problem rather than a medical issue.

Gastroesophageal Reflux Disease (GERD)

A small percentage of babies experience discomfort and other complications due to reflux – this is called Gastroesophageal Reflux Affliction. These babies have been termed past some as 'Scrawny Screamers' (equally compared to the Happy Spitters). There seems to be a family unit tendency toward reflux. GERD is particularly mutual in preemies (due to their immaturity) and in babies with other health problems. GERD commonly improves past 12-24 months.

Following are symptoms of GERD — in that location are varying degrees and need your doctor's involvement to diagnose:

• Frequent spitting upwardly or vomiting; discomfort when spitting upwardly. Some babies with GERD do non spit up – silent reflux occurs when the stomach contents but go every bit far as the esophagus and are then re-swallowed, causing hurting but no spitting up.
• Gagging, choking, frequent burping or hiccoughing, bad breath.
• Baby may be fussy and sleep less due to discomfort.

Warning signs of severe reflux:

• Inconsolable or severe fussiness or crying associated with feedings.
• Poor weight gain, weight loss, or failure to thrive. Difficulty eating. Chest/food refusal.
• Difficulty swallowing, sore throat, hoarseness, chronic nasal/sinus congestion, chronic sinus/ear infections.
• Spitting upwards claret or green/yellowish fluid.
• Sandifer'due south syndrome: Baby may 'posture' and arch the neck & dorsum to relieve reflux pain–this lengthens the esophagus and reduces discomfort.
• Breathing problems: bronchitis, wheezing, chronic cough, pneumonia, asthma, aspiration, apnea, cyanosis.

GERD may cause babies to either undereat (if they acquaintance feeding with the after-feeding hurting, or if information technology hurts to swallow) or overeat (because sucking keeps the stomach contents down in the stomach and because mother'south milk is a natural antacid).

Current data on reflux indicates that testing or treatment for reflux in babies younger than 12 months should be considered just if spitting upwardly is accompanied by poor weight gain or weight loss, severe choking, lung disease or other complications. Per Donna Secker, MS, RD in the article Gastroesophageal Reflux Disease, "The infant with significant reflux who seems to exist growing well and has no other significant health problems benefits most from little or no therapy."

When GERD is suspected, many doctors commencement attempt a trial of various reflux medications (without running tests), to come across if the medications better babe's symptoms. If testing is washed, a 24-60 minutes pH probe report () is the current "gold standard" for reflux testing in babies; this is a process where a tube is placed downwardly infant's throat to measure the acid level at the lesser of the esophagus. A barium consume (upper GI) is not so invasive (baby swallows a barium mixture, so an ten-ray is taken) only is not really constructive for diagnosing reflux in babies, since most babies volition reflux when given barium. An upper GI will not identify whether baby's stomach contents are college in acid or if there has been any esophagus impairment due to reflux, but it volition show if at that place are any blockages or narrowing of the stomach valves that may be causing or aggravating the reflux. Boosted tests may exist recommended in sure circumstances (see the links below for additional information). In rare cases, when baby has very severe reflux that is non relieved by medication, surgery may be recommended.

Breastfeeding Tips

• Aim for frequent breastfeeding, whenever baby cues to feed. These smaller, more frequent feedings tin be easier to assimilate.
• Try positioning baby in a semi-upright or sitting position when breastfeeding, or recline back so that baby is above and tummy-to-tummy with mom. See this information on upright nursing positions.
• For fussy, reluctant feeders, try lots of skin to skin contact, breastfeeding in move (rocking, walking), in the bath or when babe is sleepy.
• Ensure good latch to minimize air swallowing.
• Allow infant to completely end one chest (by waiting until baby pulls off or goes to sleep) before you offer the other. Don't interrupt agile suckling only to switch sides. Switching sides too soon or also frequently can cause excessive spitting up (see Besides Much Milk?). For babies who want to breastfeed very frequently, try switching sides every few hours instead of at every feed.
• Encourage non-nutritive/comfort sucking at the breast, since non-nutritive sucking reduces irritation and speeds gastric emptying.
• Avoid rough or fast move or unnecessary jostling or handling of your baby right after feeding. Baby may be more than comfortable when help upright much of the time. Information technology is often helpful to burp often.
• Every bit always, picket your baby and follow his cues to determine what works best to ease the reflux symptoms.

What tin can I do to minimize spitting upward/reflux?

• Breastfeed! Reflux is less common in breastfed babies. In addition, breastfed babies with reflux have been shown to accept shorter and fewer reflux episodes and less astringent reflux at night than formula-fed babies [Heacock 1992]. Breastfeeding is also best for babies with reflux considering breastmilk leaves the breadbasket much faster [Ewer 1994] (then at that place's less time for information technology to back up into the esophagus) and is probably less irritating when it does come support.
• The more relaxed your infant is, the less the reflux.
• Eliminate all environmental tobacco fume exposure, every bit this is a significant contributing factor to reflux.
• Reduce or eliminate caffeine. Excessive caffeine in mom'due south nutrition tin contribute to reflux.
• Allergy should be suspected in all infant reflux cases. According to a review commodity in Pediatrics [Salvatore 2002], up to half of all GERD cases in babies under a yr are associated with moo-cow'southward milk poly peptide allergy. The authors note that symptoms can be similar and recommend that pediatricians screen all babies with GERD for cow's milk allergy. Allergic babies generally have other symptoms in add-on to spitting up.
• Positioning:
  • Reflux is worst when infant lies apartment on his back.
  • Many parents have found that carrying baby in a sling or other babe carrier tin be helpful.
  • Avert compressing baby'southward abdomen – this can increment reflux and discomfort. Wearing apparel baby in loose clothing with loose diaper waistbands; avoid "slumped over" or bent positions; for example, roll babe on his side rather than lifting legs toward tummy for diaper changes.
  • Contempo research has compared various positions to make up one's mind which is best for babies with reflux. Elevating babe's caput did not make a pregnant deviation in these studies [Carroll 2002, Secker 2002, Craig 2004], although many moms take found that babe is more comfortable when in an upright position. The positions shown to significantly reduce reflux include lying on the left side and prone (babe on his tum). Placing the baby in a prone position should only be done when the child is awake and tin exist continuously monitored. Decumbent positioning during sleep is almost never recommended due to the increased SIDS run a risk. [Secker 2002]
  • Although recent research does not support recommendations to keep infant in a semi-upright position (30° elevation), this remains a mutual recommendation. Positioning at a 60° elevation in an infant seat or swing has been found to increment reflux compared with the prone (tummy downwards) position [Carroll 2002, Secker 2002].
  • As e'er, experiment to find what works best for your babe.
• If your kid is taking reflux medications, go on in listen that dosages generally need to exist monitored and adapted frequently as infant grows.

What about thickened feeds?

Infant cereal, added to thicken breastmilk or formula, has been used as a treatment for GER for many years, but its utilise is controversial.

Does it piece of work? Thickened feeds tin can reduce spitting up, but studies have not shown a decrease in reflux alphabetize scores (i.eastward., the "silent reflux" is withal present). Per Donna Secker, MS, RD in Gastroesophageal Reflux Disease, "The effect of thickened feedings may be more corrective (decreased regurgitation and increased postprandial sleeping) than beneficial." Thickened feeds take been associated with increased coughing after feedings, and may also decrease gastric elimination time and increment reflux episodes and aspiration. Note that rice cereal will not effectively thicken breastmilk due to the amylase (an enzyme that digests carbohydrates) naturally nowadays in the breastmilk.

Is it healthy for baby? If you do thicken feeds, monitor baby's intake since babe may take in less milk overall and thus decrease overall nutrient intake. There are a number of reasons to avoid introducing cereal and other solids early. In that location is prove that the introduction of rice or gluten-containing cereals before 3 months of age increases infant's risk for type I diabetes. In improver, babies with GERD are more likely to need all their defenses confronting allergies, respiratory infections and ear infections – simply studies show that early introduction of solids increases baby'southward chance for all of these weather.

The breastfeeding relationship: Early introduction of solids is associated with early weaning. Babies with reflux are already at greater risk for fussy nursing behavior, nursing strikes or premature weaning if babe assembly reflux discomfort with breastfeeding.

Safety problems: Never add cereal to a canteen without medical supervision if your baby has a weak suck or uncoordinated sucking skills.

Additional Information

Spitting Up: Is it Reflux? by Anne Smith, IBCLC

LLL FAQ on breastfeeding and reflux

Gastroesophageal Reflux in Young Children by Pamela Tyler, One thousand.S., CCC SLP

The Children's Digestive Wellness and Nutrition Foundation (CDHNF)

NASPGHAN Guidelines on Pediatric GERD and Guidelines Summary on Pediatric GERD from the Children's Digestive Health and Nutrition Foundation (CDHNF)

North American Society for Pediatric Gastroenterology and Diet (NASPGHAN)

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Carroll AE, Garrison MM, Christakis DA. A Systematic Review of Nonpharmacological and Nonsurgical Therapies for Gastroesophageal Reflux in Infants. Arch Pediatr Adolesc Med. 2002;156:109-113.

Craig WR, Hanlon-Dearman A, Sinclair C, Taback South, Moffatt G. Metoclopramide, thickened feedings, and positioning for gastro-oesophageal reflux in children nether two years. Cochrane Database Syst Rev. 2004 Oct 18;(iv):CD003502.

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