Managing Infant Spit-Up: Tips for Parents of 5-Month-Olds

Q: Managing Infant Spit-Up: Tips for Parents of 5-Month-Olds

Hello： Spitting up is most common around the age of four months. <br>As children grow, by the time they reach one year old, only 5%-10% of them still experience reflux issues. <br>First, some children with cow's milk protein allergy may present with vomiting. <br>Mothers can temp

Vomiting after each meal?

Hello Doctor: My daughter is currently five months old and drinks 90cc per meal.
Recently, after feeding, when I try to burp her, sometimes she moves or lies down and ends up spitting up all the milk.
Other times, she spits up one or two hours later.
Is this related to the formula? I have started adding probiotics, but she almost always spits up after each meal, sometimes more and sometimes less.
How can I take care of my baby’s spitting up issue?

Pei-Wen, 30~39 year old female. Ask Date: 2016/04/09

Dr. Pei Rensheng reply Pediatrics

Hello: Spitting up is most common around the age of four months.
As children grow, by the time they reach one year old, only 5%-10% of them still experience reflux issues.
First, some children with cow's milk protein allergy may present with vomiting.
Mothers can temporarily switch their baby's formula to a hydrolyzed protein formula for 2-4 weeks to see if the vomiting resolves; if it does, it may indicate a cow's milk protein allergy.
The second method is to add one teaspoon of dry rice cereal to every 30cc of formula, which can thicken the milk and reduce the likelihood of reflux.
The third method is to feed smaller amounts more frequently, rather than sticking to a four-hour feeding schedule; shorten the intervals and reduce the amount per feeding, while also burping the baby during and after feeding.
The fourth method is to keep the baby upright for at least 15 minutes after feeding.
While tummy sleeping can reduce spitting up, it increases the risk of sudden infant death syndrome (SIDS), so it is not recommended for frequent use unless parents are closely monitoring the baby.

Medications for treating gastroesophageal reflux (GER) are divided into two categories: prokinetic agents that promote gastric emptying and acid-neutralizing medications.
In severe cases, surgical treatment for gastroesophageal reflux may be recommended.
In summary, spitting up in infants can vary in severity, and most cases of gastroesophageal reflux can be managed through observation or conservative treatment.
Further medication or surgery is only necessary if there is a failure to thrive or severe symptoms associated with gastroesophageal reflux.
Wishing you health and happiness.

Sincerely,
Dr.
Pei Ren-Sheng,
Director of Pediatrics, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2016/04/09

More Info

Managing spit-up in infants, especially around the age of five months, can be a common concern for many parents. It’s important to understand that spit-up is a normal part of infant development and often occurs due to the immaturity of the digestive system. Here are some tips and insights to help manage this situation effectively.

Understanding Spit-Up
Spit-up, or gastroesophageal reflux (GER), occurs when the contents of the stomach flow back into the esophagus. This can happen for several reasons, including:
1. Immature Digestive System: At five months, an infant's digestive system is still developing. The lower esophageal sphincter, which helps keep food in the stomach, may not be fully functional yet.

2. Overfeeding: If an infant consumes more milk than their stomach can hold, it may lead to spit-up. In your case, if your daughter is drinking 90cc per feeding, ensure that this amount is appropriate for her age and weight.

3. Positioning: The way an infant is held during and after feeding can impact spit-up. Laying them flat immediately after feeding can increase the likelihood of reflux.

4. Movement: Active movements, such as wiggling or lying down shortly after feeding, can also trigger spit-up.

Tips for Managing Spit-Up
1. Feeding Position: Hold your baby in a more upright position during feedings. This can help gravity assist in keeping the milk down. After feeding, keep her upright for at least 20-30 minutes.

2. Burping: Ensure you are burping your baby adequately during and after feedings. This can help release any trapped air that might contribute to spit-up.

3. Smaller, More Frequent Feedings: Instead of larger feedings, consider offering smaller amounts more frequently. This can help prevent overfilling the stomach.

4. Monitor Dairy Intake: If you are using formula, consider whether it contains any ingredients that might not agree with your baby. Some infants may have sensitivities to certain proteins in formula or even breast milk if the mother consumes dairy.

5. Probiotics: Since you mentioned using probiotics, continue to monitor how they affect her digestion. Probiotics can help balance gut bacteria and may reduce spit-up in some infants.

6. Avoid Tight Clothing: Ensure that your baby is not wearing tight clothing around her abdomen, as this can put pressure on the stomach and contribute to reflux.

7. Consult a Pediatrician: If the spit-up is excessive, causing discomfort, or if there are signs of distress (like arching the back, refusing to eat, or poor weight gain), it’s essential to consult a pediatrician. They may evaluate for conditions like gastroesophageal reflux disease (GERD) or other underlying issues.

When to Seek Help
While spit-up is usually harmless, you should seek medical advice if:
- Your baby is not gaining weight or is losing weight.

- There is blood in the spit-up or it appears green or yellow.

- Your baby seems to be in pain or is excessively fussy after feedings.

- There are signs of dehydration, such as fewer wet diapers.

Conclusion
Managing spit-up in a five-month-old can be challenging, but with the right strategies, it can often be minimized. Remember that every baby is different, and what works for one may not work for another. Patience and observation are key. If concerns persist, don’t hesitate to reach out to your pediatrician for personalized advice and support.

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