Spit-Up Concerns

Spit-up is very common, and all babies will have some sort of reflux. The top of the stomach is just not tight yet, and as they grow, it will get tighter and you won't see that as much.

We start to worry about spit-up when babies aren't gaining weight because they're spitting up too much, or it seems like it's causing them pain. You're watching for signs like arching of the back, pulling away from the bottle, turning their head away from the bottle, and not wanting to eat. Those would be the main symptoms we see with painful reflux.

If it's just reflux and the baby is happy—one of those "happy spitters"—then what we recommend is frequent burping. Also, after eating, keep them elevated either up on your shoulder or in your arms at about a 20-degree angle. We don't want you to put them in car seats or any type of bouncy seat because that puts pressure on the belly and makes them spit up more.

For babies that have reflux that seems painful, we need to hear more about the story and what symptoms they're having. We would want you to come in so we can decide if we need to start a medication to help with the acid, so it doesn't burn when it comes up, or if we need to change the formula or have mom modify her diet if the baby is breastfed. In that case, we really need to see the baby and decide what the best course of action would be.

Spitting up is normal and completely harmless for most infants. When the spitting up or vomiting becomes too frequent, your child may have Gastroesophageal Reflux (GER). This reflux is a result of an immature digestive system and the poor closure of the valve (ring of muscle) at the upper end of the stomach. Most reflux or spitting up occurs during or after a meal, when the stomach, or tube that connects the stomach, is full. GER can begin during the first few weeks of life, peaking around 4 months and ending by 12 months of age. As long as your baby is not experiencing any discomfort and is making the appropriate weight gain, he/she is a healthy and normal infant.

Boys Town Pediatric Gastroenterology offers parents tips to help reduce GER:

Do not over feed your baby. More frequent, smaller feedings may reduce vomiting.
Add rice cereal to bottle feedings. (1 Tablespoon of rice cereal per 1 ounce of formula or breast milk)
Keep your baby in an upright position for 30 minutes after feeding.
Burp your baby during and after feedings.
Do not smoke around your baby.
Elevate your baby’s head during sleep. (According to the American Academy of Pediatrics, the best sleep position for a baby is on his/her back).
Avoid tight diapers or elastic waistbands that put pressure on baby’s abdomen.

Contact your physician right away if your child’s condition is severe, worsens or you notice the following symptoms:

Blood or a yellow or green fluid when vomiting
Poor weight gain or growth
Difficulty eating
Inconsolable or severe irritability
Difficulty breathing, wheezing, turning blue, chronic cough or breathing stops

Always contact your physician if you have questions or concerns about your baby’s health. If GER symptoms continue, you may choose to see a Pediatric Gastroenterologist—a medical doctor who specializes in the digestive health care of infants, children and adolescents.