Babies spit up because they are just being babies. They gulp milk and air, and the air settles beneath the milk in the stomach. When baby’s stomach contracts, like an air gun, the stomach shoots some milk back up the esophagus, and you have sour, curdled milk on your shoulder. Some ravenous eaters gulp too much milk too fast, and the overloaded tummy sends some back. Jostling babies after eating may also trigger regurgitation. Spitting up can sometimes become more than a laundry problem and reflects a medical problem, such as a formula allergy , pyloric stenosis, or gastroesophageal reflux.
SPIT UP TIP
Try what we call the fist test: Tiny babies have tiny tummies, about the size of their fists. Place a full bottle next to baby’s fist, notice the size mismatch, and you’ll see why the overloaded tummy rebels.
The spots of dried milk on your clothing are telltale signs that you are the parent of a spitter. Most babies regurgitate, or spit up, their milk or formula several times a day during the early months. This is more of a laundry problem than a medical problem and seldom bothers baby. Dress for the occasion. If you are blessed with a baby who shares a bit of each meal with your clothing, wear prints and avoid dark-colored clothing. Keep a cloth diaper handy as a burp cloth. Don’t worry if:
- Baby is gaining weight optimally
- Baby is not in colicky abdominal pain
- The spit-up doesn’t always shoot out (projectile) a couple feet
- The spitting up is getting less frequent and less volume
- Baby is thriving and acting well
When baby spits up, you may feel she has lost all the milk your body worked so hard to produce, or wasted the expensive formula you bought. But you are likely to vastly overestimate the volume of regurgitated milk. Pour a tablespoon of milk or formula on the countertop and watch the huge puddle it makes. Now, does that amount match the spot on your dress? Most spit- up measures only a teaspoonful.
Spitting up becomes a problem and needs medical attention if any of the following occur:
- Baby is losing weight or not gaining weight sufficiently.
- The vomiting increases in frequency and volume and becomes projectile (the spit-up flies across your lap and onto the floor).
- The vomitus is consistently green (bile stained).
- Painful colicky behaviors accompany the vomiting
- Baby gags and coughs during every feeding.
BLOOD IN SPIT-UP
Don’t panic at baby’s first bleed. If you breastfeed, most often this is your blood, not baby’s. It usually comes from cracked nipples during breastfeeding and subsides when your nipples heal. Occasionally, baby may retch or spit up forcefully and tear a tiny blood vessel at the end of the esophagus. This also heals quickly. If neither of these causes seems likely and the bleeding continues, notify your doctor.
- Slow the feedings. Respect that tiny babies have tiny tummies. If formula feeding, give your baby smaller-volume, more frequent feedings.
- Burp baby during and after the feedings. Formula-fed spitters should be burped every three ounces (ninety milliliters) of milk, and breastfed spitters should be burped when switching sides or during a pause in baby’s sucking if baby lingers on one side.
- Feed upright and keep baby upright twenty to thirty minutes after a feeding. If you do not have time simply to sit and hold your baby upright, wear your baby in the upright position in a baby sling as you go about your work. Gravity is the spitter’s best friend.
- Avoid jostling or bouncing baby for at least a half hour after a feed.
- If bottlefeeding, be sure the nipple hole is neither too large nor too small.
When to expect the last spat. Most spitting up subsides around six to seven months when baby sits upright and gravity holds down the milk.