Baby Keeps Spitting Up and Then Wants to Eat Again

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My baby spits upwards – is this a problem?

Spitting up, sometimes called physiological or uncomplicated reflux, is mutual in babies and is commonly (but not always) normal. Most young babies spit up sometimes, since their digestive systems are young, making it easier for the breadbasket contents to flow support into the esophagus (the tube connecting rima oris to stomach).

Babies oft spit upwards when they go likewise much milk too fast. This may happen when baby feeds very speedily or aggressively, or when mom'southward 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 look around) or fussy at the breast, he may swallow air and spit up more oft. Some babies spit upward more than when they are teething, starting to clamber, or starting solid foods.

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A few statistics (for all babies, non just breastfed babies):

• Spitting upwards unremarkably occurs correct after baby eats, but information technology may also occur 1-ii hours after a feeding.
• Half of all 0-3 month old babies spit upwardly at least in one case per mean solar day.
• Spitting up usually peaks at two-4 months.
• Many babies outgrow spitting up by 7-8 months.
• Most babies take stopped spitting upward by 12 months.

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

Some causes of excessive spitting up

• Breastmilk oversupply or forceful let-down (milk ejection reflex) can cause reflux-like symptoms, and usually can be remedied with simple measures.

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

• Babies with Gastroesophageal Reflux Disease (GERD) commonly spit up a lot (see below).

• Although seldom seen in breastfed babies, regular projectile airsickness in a newborn can be a sign of pyloric stenosis, a tummy problem requiring surgery. It occurs four times more often in boys than in girls, and symptoms usually announced between 3 and v weeks of age. Newborns who projectile vomit at least once a day should be checked out past their doc.

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

Some older babies will start spitting upwards more later on a catamenia of time with little or no spitting up. It's not unusual to hear of this happening around 6 months, though you also meet it at other ages. If the spitting upwards is very frequent (particularly if baby does not seem well), consider the possibility of a GI disease.

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

• Information technology'south unlikely that your infant has suddenly developed a sensitivity to something in your milk, unless there's something actually new in your nutrition or you're eaten LOTS of a particular food very recently. Whatsoever foods that baby eats are more probable than mom's foods to cause the spitting up. Has baby started solids recently or tried a new food? Are y'all or baby taking whatsoever new medications? Take you or baby started taking vitamins or changed your vitamins?
• Has infant been fussier than normal, and/or crying more lately? If and so, he is probably swallowing more air than usual, which can cause the spitting up.
• Spitting up tin exist caused past teething. When teething, babies tend to drool more and frequently consume a lot of that actress saliva – this tin can cause extra spitting upward.
• A common cold or allergies tin issue in baby swallowing mucus and spitting upward more.
• Baby may be hitting a growth spurt and swallowing more than air when he nurses, especially if he's been "guzzling" lately.
• If you tend to have oversupply or a fast let-down, some moms see renewed symptoms (which can include spitting up) later on a growth spurt.

Essentially, though, if your infant is salubrious and doing well despite the spitting upward — gaining well, having enough wet/dirty diapers — then this is a laundry problem rather than a medical outcome.

Gastroesophageal Reflux Illness (GERD)

A small-scale percentage of babies experience discomfort and other complications due to reflux – this is called Gastroesophageal Reflux Affliction. These babies have been termed by some every bit 'Scrawny Screamers' (as compared to the Happy Spitters). There seems to be a family tendency toward reflux. GERD is specially common in preemies (due to their immaturity) and in babies with other health bug. GERD usually improves by 12-24 months.

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

• Frequent spitting upwardly or airsickness; discomfort when spitting upwardly. Some babies with GERD practice not spit up – silent reflux occurs when the stomach contents only go every bit far as the esophagus and are then re-swallowed, causing hurting just no spitting up.
• Gagging, choking, frequent burping or hiccoughing, bad breath.
• Infant 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 upward blood or greenish/yellow fluid.
• Sandifer's syndrome: Baby may 'posture' and arch the cervix & dorsum to relieve reflux pain–this lengthens the esophagus and reduces discomfort.
• Animate bug: bronchitis, wheezing, chronic coughing, pneumonia, asthma, aspiration, apnea, cyanosis.

GERD may cause babies to either undereat (if they associate feeding with the subsequently-feeding hurting, or if it hurts to swallow) or overeat (because sucking keeps the stomach contents down in the breadbasket and considering mother's milk is a natural antacid).

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

When GERD is suspected, many doctors offset try a trial of various reflux medications (without running tests), to run into if the medications better baby'due south symptoms. If testing is done, a 24-hour pH probe study () is the electric current "aureate standard" for reflux testing in babies; this is a procedure where a tube is placed down baby'south throat to measure the acid level at the bottom of the esophagus. A barium swallow (upper GI) is not so invasive (baby swallows a barium mixture, then an 10-ray is taken) but is non really effective for diagnosing reflux in babies, since virtually babies will reflux when given barium. An upper GI will not identify whether baby's stomach contents are college in acid or if in that location has been whatsoever esophagus damage due to reflux, merely it volition show if there are any blockages or narrowing of the stomach valves that may be causing or aggravating the reflux. Additional tests may be recommended in certain circumstances (see the links beneath for additional information). In rare cases, when baby has very severe reflux that is not relieved by medication, surgery may be recommended.

Breastfeeding Tips

• Aim for frequent breastfeeding, whenever babe cues to feed. These smaller, more frequent feedings can be easier to assimilate.
• Try positioning baby in a semi-upright or sitting position when breastfeeding, or recline back and then that babe is above and breadbasket-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 bathroom or when baby is sleepy.
• Ensure skilful latch to minimize air swallowing.
• Allow baby to completely end one chest (by waiting until baby pulls off or goes to sleep) before yous offer the other. Don't interrupt active suckling just to switch sides. Switching sides too soon or too ofttimes can cause excessive spitting up (run into Too Much Milk?). For babies who want to breastfeed very frequently, endeavour switching sides every few hours instead of at every feed.
• Encourage non-nutritive/condolement sucking at the breast, since non-nutritive sucking reduces irritation and speeds gastric emptying.
• Avoid rough or fast movement or unnecessary jostling or handling of your baby right later feeding. Baby may be more comfortable when help upright much of the time. It is oft helpful to burp frequently.
• As always, spotter your baby and follow his cues to determine what works all-time to ease the reflux symptoms.

What can I practise to minimize spitting upward/reflux?

• Breastfeed! Reflux is less common in breastfed babies. In addition, breastfed babies with reflux accept been shown to have shorter and fewer reflux episodes and less severe reflux at night than formula-fed babies [Heacock 1992]. Breastfeeding is likewise best for babies with reflux considering breastmilk leaves the stomach much faster [Ewer 1994] (so there's less time for information technology to back up into the esophagus) and is probably less irritating when it does come dorsum up.
• The more relaxed your infant is, the less the reflux.
• Eliminate all environmental tobacco smoke exposure, as this is a significant contributing factor to reflux.
• Reduce or eliminate caffeine. Excessive caffeine in mom's diet can contribute to reflux.
• Allergy should be suspected in all infant reflux cases. Co-ordinate to a review commodity in Pediatrics [Salvatore 2002], upward to half of all GERD cases in babies nether a year are associated with cow's milk protein allergy. The authors annotation that symptoms can be like and recommend that pediatricians screen all babies with GERD for cow's milk allergy. Allergic babies generally have other symptoms in improver to spitting upwards.
• Positioning:
  • Reflux is worst when babe lies apartment on his back.
  • Many parents have found that carrying baby in a sling or other babe carrier can exist helpful.
  • Avoid compressing baby's abdomen – this tin can increase reflux and discomfort. Dress babe in loose clothing with loose diaper waistbands; avoid "slumped over" or bent positions; for example, gyre baby on his side rather than lifting legs toward stomach for diaper changes.
  • Recent research has compared various positions to decide which is best for babies with reflux. Elevating babe's head did not make a meaning deviation in these studies [Carroll 2002, Secker 2002, Craig 2004], although many moms accept found that baby 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 breadbasket). Placing the babe in a decumbent position should only be done when the child is awake and tin be continuously monitored. Prone positioning during sleep is almost never recommended due to the increased SIDS risk. [Secker 2002]
  • Although recent enquiry does not support recommendations to keep baby in a semi-upright position (30° summit), this remains a common recommendation. Positioning at a 60° elevation in an baby seat or swing has been plant to increase reflux compared with the decumbent (breadbasket downward) position [Carroll 2002, Secker 2002].
  • Equally always, experiment to notice what works best for your baby.
• If your child is taking reflux medications, continue in listen that dosages more often than not need to be monitored and adjusted ofttimes every bit baby grows.

What nigh thickened feeds?

Baby cereal, added to thicken breastmilk or formula, has been used every bit a treatment for GER for many years, but its use is controversial.

Does it work? Thickened feeds can reduce spitting upward, but studies have non shown a decrease in reflux alphabetize scores (i.e., the "silent reflux" is nevertheless nowadays). Per Donna Secker, MS, RD in Gastroesophageal Reflux Disease, "The upshot of thickened feedings may be more cosmetic (decreased regurgitation and increased postprandial sleeping) than beneficial." Thickened feeds have been associated with increased cough afterwards feedings, and may also decrease gastric emptying fourth dimension and increase reflux episodes and aspiration. Notation that rice cereal will not effectively thicken breastmilk due to the amylase (an enzyme that digests carbohydrates) naturally present in the breastmilk.

Is it healthy for infant? If you lot practice 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 avert introducing cereal and other solids early. There is evidence that the introduction of rice or gluten-containing cereals earlier 3 months of age increases baby's risk for type I diabetes. In addition, babies with GERD are more than likely to need all their defenses confronting allergies, respiratory infections and ear infections – but studies evidence that early introduction of solids increases baby's hazard for all of these conditions.

The breastfeeding relationship: Early on introduction of solids is associated with early weaning. Babies with reflux are already at greater take chances for fussy nursing behavior, nursing strikes or premature weaning if baby associates reflux discomfort with breastfeeding.

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

Additional Information

Spitting Up: Is information technology Reflux? by Anne Smith, IBCLC

LLL FAQ on breastfeeding and reflux

Gastroesophageal Reflux in Immature Children by Pamela Tyler, M.Due south., CCC SLP

The Children'southward Digestive Health and Nutrition Foundation (CDHNF)

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

North American Society for Pediatric Gastroenterology and Nutrition (NASPGHAN)

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