Spitting Up and Reflux

What is 'spitting up'?

Spitting up is when your baby brings up some milk after feeding. It is caused by your baby swallowing air when he feeds, which then comes back up with a small amount of milk. Spitting up is very common in babies up to 6 months.

Why does it happen?

Milk often comes up because your baby's muscles are not developed. Other reasons for spitting up include your baby eating too much milk, the milk flow from breast or bottle being too quick, or an allergy to cow's milk (if you are breastfeeding). By 4-6 months spitting up should have subsided.

What can I do about it?

If you are worried about the amount your baby spits up, or your baby doesn't seem to be gaining very much weight or otherwise seems uncomfortable, see a doctor to rule out any other causes for these symptoms. If your baby is gaining weight well, appears healthy and happy and producing wet and soiled nappies, try the following to minimise spitting up:

1. Burp your baby after feeds. If your baby pauses mid-feed, gently burp him then.
2. Keep your baby in an upright position when feeding him, as this minimises the amount of air he will swallow while feeding.
3. If your baby drinks a large volume of milk every feed, and spits up at every feed, he might be eating too much. A baby's stomach is only the size of his clenched fist, so it can quickly get full to capacity! Try offering your baby a dummy when he has had a good amount of milk to eat, to satisfy his need to suck while stopping him overfilling his stomach.
4. Some breastfeeding mothers have a fast milk flow, which can cause their baby to gag and swallow air. If this seems to be happening when your baby feeds, take your baby off your breast when your milk lets down, as this can come out too quickly for some babies, and then put your baby back on the breast to continue feeding.
5. Try to keep your baby in an upright position after he feeds for 30 minutes. Be gentle with your baby and try not to jolt him at all.

Reflux

Sometimes spitting up is caused by reflux. This is when a muscle called the lower oesophageal sphincter opens at the wrong time, and forces some of the stomach contents to go up the oesophagus and out of the mouth. The contents of the stomach are acidic, which cause a burning sensation when it comes up through the oesophagus.

About 50% of babies have reflux, and it normally resolves itself after a few months. The tips for minimising reflux are the same as for spitting up (see above), taking extra care to keep your baby upright for half an hour after feeds, and not overfeeding your baby. You could also try giving your baby more frequent, but smaller feeds. If you bottle feed your baby, make sure the hole in the teat isn't too big. If it is, the milk flow will be too fast, but if the hole is too small, your baby may suck too hard and swallow excess air. You might have to adopt a trial and error approach to finding the right teat for your baby. Some babies are allergic to cow's milk, and the symptoms of this allergy are very similar to the symptoms of reflux. If you are breastfeeding, try cutting out dairy to see if this makes a difference.

Most babies with reflux are happy and healthy, and don't need any medical intervention. Some babies, however, have severe reflux which causes them to be extremely uncomfortable, and interferes with their weight gain. If your baby has some or all of the following symptoms, take him to a doctor:

• Poor weight gain
• Difficulty swallowing
• Arching back during and after feeds
• Spitting up after every meal
• Inconsolable crying
• Frequent vomiting in between meals
• Refusal to eat

Your baby's GP might prescribe medicine, which is similar to medicine used for adult heartburn and indigestion. There is over the counter medication you can buy for your baby if you suspect acid reflux, but consult your doctor before using these. In extreme cases, surgery is required, but these cases are very rare. Having a baby with acid reflux can be very difficult on both the baby and the parents, but rest assured that most babies improve by 6 months of age, and by 12 months babies have usually outgrown reflux altogether.