Infant Spitting Up: Causes and Solutions for Parents

Infant regurgitation?

Hello, thank you for your response.
My son is 1 month and 16 days old, consuming 160 ml per feeding, five times a day.
He was born weighing 3.1 kg and now weighs 4.8 kg.
He originally used an SS-sized round nipple but has now switched to an S-sized round nipple.
He vomits after every feeding (without being moved), with projectile vomiting occurring at least once and up to five times per feeding, with a range approximately the size of five 50-cent coins.
While sleeping, he tends to have hiccups or spit-up (in a curd-like consistency) about every two hours.
After vomiting, he exhibits a strong rooting reflex.
Currently, we are feeding him in an upright position, burping him every 30 ml, keeping him seated and still for 15 minutes after feeding, and massaging his abdomen in a clockwise direction after an hour.
We try to avoid letting him cry, and even if he shows strong rooting reflexes between feedings, we do not feed him.
We have tried the following without improvement: 1.
Smaller, more frequent feedings (100 ml every 2-3 hours), but he gets very hungry and tends to vomit more, sometimes crying to the point of holding his breath and turning red without making a sound.
2.
Breastfeeding, which results in projectile vomiting like a waterfall, but he can sleep for four hours.
If he is moved while sleeping, he tends to vomit or spit up.

In the future, we would like to try switching to an SS cross-cut nipple to allow him to drink slowly, and temporarily ignore any fussiness or leaking.
Are these changes feasible? What else can we modify? Are there any other methods we could try? What issues could arise from this vomiting? Thank you.

Yun Yun, 20~29 year old female. Ask Date: 2022/06/07

Dr. Zhang Yingwen reply Pediatrics

1.
A 1-month-old baby is consuming 160 cc of formula per feeding, with a total of 5 feedings per day.
The baby weighed 3.1 kg at birth and now weighs 4.8 kg, indicating excellent weight gain.
The cause of vomiting may be due to overfeeding, so it is recommended to adjust the feeding volume and frequency.

2.
The baby vomits only when in motion, so it is advised to burp the baby after feeding and keep them slightly upright (using a car seat for support) instead of laying them flat to sleep, and to minimize movement as much as possible.
3.
Due to the presence of projectile vomiting, it is recommended to visit the clinic for an in-person evaluation by a physician for a more accurate assessment.

Reply Date: 2022/06/07

More Info

Understanding infant spitting up can be a challenging experience for many parents, especially when it seems persistent and concerning. In your case, your son, who is 1 month and 16 days old, is experiencing frequent spitting up after feedings, which can understandably cause worry. Let’s explore the potential causes, implications, and solutions for this common issue.

Causes of Spitting Up in Infants
1. Immature Digestive System: Infants have an immature gastrointestinal tract, which can lead to frequent spitting up. The lower esophageal sphincter (LES), which prevents the backflow of stomach contents, may not be fully developed in young infants, leading to reflux.

2. Overfeeding: While you are already practicing smaller, more frequent feedings, it’s essential to ensure that your baby is not being overfed. Infants can sometimes take in more milk than their stomach can handle, leading to spitting up.

3. Air Swallowing: If your baby is feeding too quickly or is very hungry, he may swallow air along with the milk, which can lead to discomfort and spitting up.
4. Positioning During Feeding: Although you mentioned using an upright feeding position, it’s crucial to maintain this position during and after feeding to help reduce the likelihood of spitting up.

5. Sensitivity to Formula or Milk: If you are formula feeding or if you are breastfeeding and consuming dairy, your baby may have a sensitivity to certain proteins, which can cause gastrointestinal distress and lead to spitting up.

Implications of Frequent Spitting Up
While spitting up is common in infants, excessive spitting up can lead to complications such as:
- Dehydration: If your baby is losing more fluid than he is taking in, it could lead to dehydration.

- Poor Weight Gain: If spitting up is frequent and significant, it can affect your baby’s ability to gain weight appropriately.

- Esophagitis: In severe cases, frequent reflux can lead to inflammation of the esophagus.

Solutions and Recommendations
1. Feeding Techniques: You are already implementing some good strategies, such as feeding in an upright position and burping frequently. Consider trying the following:
- Paced Bottle Feeding: If using a bottle, try paced bottle feeding techniques that mimic breastfeeding, allowing your baby to suck and swallow at a more natural pace.

- Experiment with Nipple Sizes: You mentioned switching to an S-sized nipple. If you find that he is still gulping or seems frustrated, you might want to try a slower flow nipple, such as the SS cross-cut nipple, to help him manage the flow better.

2. Post-Feeding Care: After feeding, keep your baby upright for at least 30 minutes. Gentle rocking or holding him in a vertical position can help reduce spitting up.

3. Monitor for Allergies: If you suspect a sensitivity to formula or dairy, consult your pediatrician about trying a hypoallergenic formula or eliminating dairy from your diet if breastfeeding.

4. Consult a Pediatrician: Since your baby is experiencing significant spitting up, it’s essential to discuss this with your pediatrician. They may want to rule out any underlying conditions such as gastroesophageal reflux disease (GERD) or other gastrointestinal issues.

5. Keep a Feeding Diary: Documenting feeding times, amounts, and spitting up incidents can help identify patterns and triggers, which can be useful information for your pediatrician.

Conclusion
Spitting up is a common occurrence in infants, but when it becomes excessive, it’s essential to explore potential causes and solutions. Your proactive approach to feeding and care is commendable, and with some adjustments and close monitoring, you can help alleviate your son’s spitting up. Always consult with your pediatrician for personalized advice and to ensure your baby’s health and well-being. Remember, as your baby grows, his digestive system will mature, and these issues often resolve on their own.

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