Nutrition • Jan 24, 2013

Baby Spit-up: Medical Problem or Laundry Problem?

One of the more common problems we encounter in pediatrics is spit up or reflux.  Sorting through whether a baby has typical reflux or something more can be a challenge for both parents and healthcare providers.

This past year I learned a lot about spit up the hard way.  My son spit up every time he ate for the SpitUPfirst three months and continued to have frequent episodes until he was almost 9 months old.  Every time we passed the baby we also passed the burp rag.  He wore a bib at all times to help reduce the number of outfit changes during the day.  My husband and I made sure that everything we wore was washable because inevitably we ended up covered in spit up too. We did laundry every day to keep up with all the clothes, bibs, and rags. Luckily, we had a laundry problem and not a medical problem. He continued to grow and thrive despite the spitting up.

How do you sort through whether spit up is a laundry problem or a medical problem? Spit up is a normal occurrence for most newborns.  All babies have some degree of reflux (medical term for spit up) and most outgrow it by one year of age.  Some babies are more affected than others and within the same family there may be variation in how much each child spits up.

Indications that it might be more than just “spit up”:

–          Weight Gain: If your baby is having trouble gaining weight or is losing weight they should be further evaluated for GERD (gastroesphageal reflux disease) or other underlying health conditions.

–          Sudden change in amount or type of spit up: If your baby all of a sudden starts spitting up frequently or develops projectile vomiting you should contact your pediatrician immediately.  This could be a sign of pyloric stenosis which is an urgent medical condition and usually develops in babies around 4-8 weeks of age.

–          Extreme fussiness or irritability with feeds: All babies are fussy some of the time but fussiness may be related to GERD if your baby seems extremely uncomfortable after feeds or in pain when spitting up.

–          If there is blood or bile (bright/dark green color) in the spit up

How to decrease spitting up

–          Feed smaller amounts more frequently:  We ended up feeding my son every two hours during the day.  It was challenging for me because so much of the day was spent feeding, but he seemed happier eating smaller amounts more often.

–          For bottle feeding moms: If bottle feeding, try a slower flow nipple and bottles designed to decrease amount of air swallowed.  You may have to experiment with a variety of bottles before finding the best one for baby. If formula feeding you may find that certain formulas seem better tolerated by your baby and may need to try a different formula.  It is always best to talk with your child’s care provider before making formula switches.

–          For Breastfeeding moms: If you are breastfeeding you may find some improvement in symptoms by eliminating dairy or spicy foods from your diet.  I do not recommend switching from breast milk to formula.  Breast milk in general is better tolerated than formula and comes with many other benefits for both mother and baby.

–          Keep baby upright for 30 minutes after feeds: In practice this can be very challenging.  At times it felt like all we were doing was feeding my son.  I was nursing for 30 minutes and then holding him upright for 30 minutes and starting the whole process over again one hour later.  This was especially not practical at night time when I needed to get some sleep too.

–          Elevating the head of the bed. Some bassinets are designed so they can be set at a slight incline. Otherwise a small blanket or towel can be used UNDER the mattress to raise the head of the bed slightly.  The mattress needs to be very firm and the baby should not slide down in the bed.  Sometimes it can be helpful to let baby sleep in a swing or bouncer chair temporarily.

Remember that this is a temporary problem and most babies outgrow frequent spitting up between 6 months and 1 year of age.  If you are concerned about the amount of spitting up or that your baby seems unusually fussy you should bring up your concerns at your baby’s next appointment.