Is There a Link Between Spitting Up and Colic in Premature Infants?

Q: Is There a Link Between Spitting Up and Colic in Premature Infants?

Hello： 1. Premature infants are more likely to experience gastroesophageal reflux compared to full-term infants. 2. During the corrected age of 3 to 4 months, some babies may exhibit signs of colic. 3. Typical colic is characterized by crying for more than 3 d

Is there a relationship between spitting up milk and colic or premature infants?

Hello doctor, my child was born on July 28, at 36 weeks of gestation, with a birth weight of 2196g, which is somewhat low.
At birth, his white blood cell count was elevated, and he was hospitalized for observation and treated with antibiotics for a week.
After returning home, the hospital reported that the bacterial cultures showed no significant abnormalities.
He then stayed at a postpartum care center for 20 days, during which his weight was approximately 2800g and he was consuming 80cc of milk.
Up to this point, there have been no abnormalities.

However, one week after leaving the postpartum center, which was when he turned one month old, he started to spit up, sometimes forcefully, and occasionally choked.
This occurred right after feeding or even one to two hours later, with white curdled milk and clear liquid (could this be stomach acid?) coming up.
I took him to see a doctor, who suggested that it might be gastroesophageal reflux and prescribed gastrointestinal medication.
I have been feeding him smaller amounts more frequently since breastfeeding is difficult to control; I now only nurse from one side for about 20 minutes at a time.
After feeding, I hold him for about 30-40 minutes, which has been quite taxing on my arms.
At that time, his weight was around 4kg.
The doctor mentioned that his weight had increased, so there was no need to worry.
However, after three visits, he still continues to spit up or vomit.
By the third visit, his weight had dropped to 3.8kg.
To make matters worse, he has also developed symptoms of colic, crying all night.
The doctor said that for colic, we should start with probiotics and observe, and that I should hold and comfort him during episodes.
After taking the prescribed medication, he has been spitting up less during feedings, but during sleep, he makes struggling sounds and when I check on him, he raises his arms and seems to be trying to vomit but holds it back, eventually swallowing the liquid back down.
Sometimes, when the urge to vomit is strong, he wakes up crying, which is heartbreaking.
He has been experiencing a persistent feeling of nausea during sleep, which disrupts his rest.
Is there any way to improve this? As a mother, hearing him struggle at night is very distressing, and it has affected my sleep as well.
It feels like his gastroesophageal reflux is quite severe and is impacting his sleep.
I have read online that feeding smaller amounts more frequently and holding him upright for over half an hour after feeding can help, and I have tried these methods.

What should I do if there has been no improvement in his urge to vomit during sleep one to two hours after feeding? I am also hesitant to let him sleep on his stomach, as I have heard that it might be better for him.

Dale, 30~39 year old female. Ask Date: 2016/09/11

Dr. Pei Rensheng reply Pediatrics

Hello: 1.
Premature infants are more likely to experience gastroesophageal reflux compared to full-term infants.
2.
During the corrected age of 3 to 4 months, some babies may exhibit signs of colic.
3.
Typical colic is characterized by crying for more than 3 days a week, with each of those days involving at least 3 hours of inconsolable crying.
4.
If severe projectile vomiting, which does not contain bile, occurs between 2 to 6 weeks, it is important to consider the possibility of hypertrophic pyloric stenosis.
5.
It is not recommended for babies to sleep on their stomachs before they can roll over, as stomach sleeping is associated with sudden infant death syndrome (SIDS).
Wishing you health and happiness! Sincerely, Dr.
Pei Ren-Sheng, Pediatric Attending Physician.

Reply Date: 2016/09/11

More Info

The concerns you have regarding your premature infant's spitting up and colic symptoms are quite common among parents of preterm babies. Premature infants, like your child born at 36 weeks, often face various challenges, including feeding difficulties and gastrointestinal issues. Let's break down the situation and explore the potential links between spitting up and colic, as well as what you can do to help alleviate your baby's discomfort.

Understanding Spitting Up in Premature Infants
Spitting up, or gastroesophageal reflux (GER), is prevalent in infants, especially those born prematurely. The lower esophageal sphincter, which prevents stomach contents from flowing back into the esophagus, is often not fully developed in preterm infants. This immaturity can lead to frequent spitting up, particularly after feeding. The fact that your baby sometimes spits up immediately after feeding and at other times later is also typical.
The white, curd-like substance you describe is likely undigested milk, which is common in infants who are still developing their digestive systems. The transparent liquid could be gastric secretions, which can sometimes accompany spitting up.

Colic and Its Symptoms
Colic is characterized by excessive crying and fussiness in infants, often occurring in the late afternoon or evening. The exact cause of colic is not well understood, but it is believed to be related to gastrointestinal discomfort, which can be exacerbated by feeding issues. In your case, the combination of spitting up and signs of colic, such as prolonged crying and discomfort, suggests that your baby may be experiencing both conditions simultaneously.

Potential Links Between Spitting Up and Colic
There is a recognized relationship between spitting up and colic in infants. The discomfort caused by reflux can lead to irritability and crying, which are hallmark symptoms of colic. When infants experience pain or discomfort from reflux, they may cry more, leading to a cycle of feeding, spitting up, and increased fussiness.

Managing Your Baby's Symptoms
1. Feeding Techniques: You mentioned that you are feeding your baby smaller amounts more frequently, which is a good strategy. Ensure that you are also burping your baby during and after feeds to help release any trapped air that could contribute to discomfort.

2. Positioning: Holding your baby upright for at least 30 minutes after feeding can help reduce the likelihood of spitting up. You might also consider using a slightly elevated position during sleep, but always consult your pediatrician before making any changes to sleep positioning.

3. Probiotics: Since your doctor recommended probiotics, continue to monitor their effects. Probiotics can help improve gut health and may alleviate some gastrointestinal discomfort.

4. Consulting a Pediatrician: Since your baby has lost weight and is experiencing significant discomfort, it is crucial to maintain open communication with your pediatrician. They may consider adjusting medications or exploring other underlying issues that could be contributing to the reflux and colic symptoms.

5. Sleep Environment: Ensure that your baby's sleep environment is conducive to rest. A calm, quiet space can help reduce stimulation that may contribute to fussiness.

6. Monitoring Symptoms: Keep a diary of your baby's feeding, spitting up, and crying episodes. This information can be invaluable for your pediatrician in determining the best course of action.

Conclusion
While spitting up and colic can be distressing for both you and your baby, understanding the potential links between the two can help you manage the symptoms more effectively. Continue to work closely with your healthcare provider to monitor your baby's growth and comfort levels. With time and appropriate interventions, many infants outgrow these issues as their digestive systems mature. Remember, you are not alone in this journey, and seeking support from healthcare professionals can make a significant difference in your baby's well-being and your peace of mind.

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