Newborn baby spit-up: What parents need to know

As a parent, chances are you’ve seen it or have even worn it on your shirt: spit-up! Sometimes, it may feel as if your baby spits up everything they’ve just been fed, and after every meal. Spit-up is a common occurrence in babies, but if there are other symptoms, it’s important to check in with your baby’s pediatrician or primary care provider.

What’s up with spit-up?

Everyone experiences reflux from time to time, but it is especially common for babies, as their esophageal sphincter is still developing. The esophageal sphincter is a muscle located at the bottom of the esophagus — the tube that runs from the throat down to the stomach. It relaxes to let food and drink into our stomach and to let air (burps) come up. When this muscle relaxes too much, food, formula/milk, and digestive juices can travel back up the esophagus. This may cause some discomfort or may just be messy.

Because a baby’s esophageal sphincter muscle is not as strong as an adult’s and their stomach is much smaller, it relaxes more frequently and results in spit-up. Another name for regular spit-up is gastroesophageal reflux (GER). GER typically peaks around 4-6 months of age, and a baby’s reflux may get worse for a period of time, before it gets better. Babies may also spit up more if they are teething, constipated, or have a cold.

When it’s time to talk to your doctor

The good news is that the majority of infant reflux is not caused by an underlying medical problem. If your baby is continuing to gain weight, is meeting developmental milestones, and is generally not irritable with spit-up, they are likely a “happy spitter.”

However, there are some “red flag symptoms” to look out for, and this is when it’s time to talk to your baby’s primary care provider. These symptoms include but are not limited to:

• Poor weight gain
  
  
• Poor hydration
  
  
• Breathing difficulties
  
  
• Bloody or bright green spit up
  
  
• Projectile vomiting.

If your baby’s reflux is causing any of these concerning symptoms, it could be a sign of an underlying problem. If you have concerns about slow weight gain, check in with your primary care provider to make sure that your baby is reaching milestones and following their growth curve at regular well child check-ups.

If your infant’s primary care provider suspects your baby might have reflux, they will obtain a medical history and perform a physical examination. If the reflux is bothersome or impacting you baby’s feedings or growth, your doctor may prescribe medication to decrease stomach acid. It is important to note that acid medication does not stop the spit-up from occurring, but it does make it less acidic, which can help with discomfort from the reflux. In certain infants, your provider may order an imaging test such as an ultrasound or upper GI x-ray to make sure there is not an underlying problem. They may also recommend a referral to a pediatric gastroenterology (GI) specialist for more evaluation.

At-home diet and feeding tips

Often, medical treatment isn’t necessary for infant spit-up. While there are medications that can decrease stomach acidity and help with discomfort or irritation, these medications can come with side effects, including headaches and constipation. If the medications are used long-term, they can also put your child at an increased risk for pneumonia, intestinal infections, and bone density problems, which could lead to fractures later on. Generally, GER improves when your baby starts eating infant solids around 6 months of age, and resolves itself spontaneously by 12-18 months of age. In the meantime, here are a few at-home tips and tricks to help reduce your baby’s spit-up:

• Keep your baby upright (not in a car seat) for 30 minutes after feeding.
  
  
• If bottle-feeding, prevent your baby from swallowing too much air by keeping the bottle nipple filled with milk.
  
  
• Burp your baby several times during feeding.
  
  
• Feed more frequently, but with smaller amounts. Babies will spit up more with a full stomach.
  
  
• Do not bounce or jiggle your baby during or right after feedings.
  
  
• Avoid smoking around your baby.
  
  
• For babies on formula and who have a milk protein intolerance, changing to a soy-based, hypoallergenic (hydrolysate), or amino acid-based (elemental) formula may be helpful. For breastfed babies, avoiding dairy and/or soy in the mother’s diet might help.
  
  
• Using a formula which contains added rice starch can help reduce spit-ups for some infants, and works best if the infant is not on acid-blocking medication.
  
  
• Adding rice cereal to formula or breast milk has also been shown to benefit babies with frequent spit-ups, although this may result in constipation. You should always talk to your baby’s primary care provider about adding rice cereal and how much is safe to use.

Have no fear

The majority of infants will outgrow their reflux symptoms as their esophageal sphincter muscle becomes stronger with time. GER in most infants can be managed through diet and lifestyle changes, and medication can be prescribed for more serious cases when there is poor growth or feeding difficulties. This may be handled through your baby’s primary care provider, or you may be referred to a provider who specializes in GER in infants. With a little guidance (and a few burp cloths), you’ll be well on your way to managing your baby’s spit-up.

Kirsten Osen, APNP Pediatric Nurse Practitioner Children's Wisconsin

Children’s Wisconsin has more than 20 primary care offices conveniently located throughout the Milwaukee area and southeast Wisconsin. Find a pediatrician near you.