More than half of all babies — breastfed and bottle fed — are what pediatricians call “happy spitters.” They smile as they soak your shoulder, your carpet, and every burp cloth you’ve signed up for with stinking milk.
These fun times in parenting can lead you down a road filled with information (and misinformation) about spitting and solutions and strategies for dealing with it. In this guide, we provide evidence-based information about reflux, ways to reduce the milky mess, and signs it might be time to talk to your pediatrician.
Why do babies spit up?
Many articles tell you “all babies spit,” but Mark Fishbein, MD, a pediatric gastroenterologist at Ann & Robert H. Lurie Children’s Hospital in Chicago, says the focus should shift to whether the reflux is “complicated or uncomplicated.” “is. And remember: the problem is mechanical.
Uncomplicated Reflux (Gastroesophageal Reflux, or GER) refers to those happy spit up who can spit several times a day but are otherwise healthy and not in the least bit bothered by it. This is considered a normal part of baby’s development as the valve between the esophagus, the tube that connects the stomach to the mouth, takes time to mature and tighten during the first few months of life.
Complicated Reflux (gastro-oesophageal reflux disease, or GERD) occurs when there are “difficult symptoms affecting daily functioning and/or complications” in the medical literature. In other words, this is when spitting up is a real problem and can mean your baby is refusing to eat, crying frequently in pain with a hunched neck and back, vomiting forcefully or projectile, coughing frequently and/or not gaining weight. This behavior is not normal and requires further testing to determine if GERD (or another condition) is the cause.
“That’s why it’s so important to maintain your regularly scheduled baby visits with your pediatrician,” says Dr. fishbein. “We monitor your baby’s overall height and weight on a growth chart and advise if your baby isn’t gaining weight properly; hopefully we can also offer reassurance.”
When do babies stop spitting up?
Spitting disappears in more than 50% of babies by age 10 months, 80% by age 18 months and 98% by age 2, according to research published in BMC Pediatrics.
“If I have a 2 or 3 month old baby with uncomplicated reflux, I will tell the family it will probably get worse before it gets better,” says Dr. Fishbein. “As a pediatric gastroenterologist, we usually look to get better by a baby’s first birthday, but it can continue until age 5 and still be uncomplicated.”
Studies show that babies who spit up frequently for more than three months are slightly more likely to experience gastrointestinal symptoms later in childhood.
Spitting vs. Vomiting: What’s the Difference?
While the terms “spit up” and “vomit” are often used interchangeably, there is a major difference between the two from a medical perspective:
spit is effortless and occurs in smaller quantities.Vomit requires strength and occurs in large quantities.
While vomiting can be caused by a number of issues depending on the age of your child, it is most worrisome in newborns and young infants under 3 months of age. Your pediatrician may want to rule out hypertrophic pyloric stenosis, a condition that affects one in 500 babies and occurs when the pylorus — a muscular valve at the bottom of the stomach — becomes too thick for breast milk or formula to penetrate to the small intestines. The result: excessive, projectile vomiting that needs special treatment.
Other reasons to call your pediatrician about vomiting in infants:
Your baby feels noticeably uncomfortable or cries after or during vomiting. Vomiting is a new symptom that started today or yesterday. Vomiting contains bile (a green color). Diarrhea is also present. Your baby looks or acts sick.
5 professional tips to reduce spitting up
“Spitting or reflux should never be looked at in isolation,” explains Dr. Fishbein, who is also co-author of The CALM Baby Method: Solutions for Fussy Days and Sleepless Nights. “Other issues related to breast or bottle feeding quality and understanding babies’ different temperaments and how to regulate them are important, as are at-home strategies for parents.”
Here are some additional tips to keep in mind if you’re struggling with baby spitting up:
Keep your baby upright after feeding. dr. Fishbein says this method is “the best way to support and treat a baby with uncomplicated reflux” and recommends 20 to 30 minutes of breast-to-chest time after each feeding, if possible. However, he tells parents not to stress if they haven’t heard a burp. “Burning a baby after breastfeeding or bottle feeding is more of a cultural phenomenon than a necessity,” he says. In fact, a 2015 study in Child: Care, Health and Development found that burped babies actually spit up more — about eight times a week on average, compared to about four times a week for non-farmed babies.Reduce your baby’s time in car seats, swings and bouncers. Supported sitting, especially in infants under 6 months of age, puts too much pressure on the abdomen and can worsen reflux. If your baby falls asleep while riding in his car seat, remove him from his seat when you reach your destination and place him on his back in a bassinet, bassinet, or playpen.Feed your baby at regular times. “Parents will tell me their baby spits up, so they started reducing the amount of feedings,” says Dr. fishbein. “I would equate that to being hungry for a full cheeseburger and only eating half of it.”
Many babies require smaller but more frequent feedings at scheduled times, which reduces the acidity in the stomach contents and can reduce spitting up. Fortunately, there are many baby food tracking apps available to help you stay on track, but always talk to your baby’s doctor before making any changes to your baby’s feeding regimen.
Do not use reflux medication with ‘happy spitters’. A 2014 report from the American Academy of Pediatrics notes that there is mounting evidence that acid-blocking and motility drugs such as metoclopramide (the generic form of Reglan and Metozolv ODT) are not effective treatments for GER. “Most of the babies I see have already taken reflux medication prescribed by their pediatrician,” explains Dr. Fishbein, who says these drugs are overprescribed by many pediatricians as a result of treating reflux disease not part of their formal training. “I don’t prescribe a lot of reflux medication, especially in children who are usually developing and growing well.”Always be careful with home allergy testing. Many parents will want to blame formula spitting or a milk allergy. Although home allergy testing kits are widely advertised, the American Academy of Allergy, Asthma & Immunology says they are not helpful or effective. Instead, talk to your pediatrician or a pediatric allergist.
When to See a Pediatric Gastroenterologist?
Further testing is usually not necessary for happy spitters with uncomplicated reflux. However, you should always discuss any nutritional concerns with your pediatrician. For example, if your baby’s symptoms get worse, first appear after 6 months of age, or don’t get better by their second birthday, an evaluation by a pediatric gastroenterologist may be recommended.
To find one near you, talk to your child’s pediatrician, visit your local hospital’s website, or search the member list of the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (just enter your state) .
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