Infant Feeding Issues: Burping, Gas, and Spitting Up

Milk consumption issues?

Hello, doctor.
My daughter has just turned two months old.
I understand that there are issues with feeding amounts, mainly focusing on the total intake for the day.
However, we have been experiencing a problem recently during feeding.
For example, when we prepare 110ml of formula, my daughter drinks very quickly (I know she is very hungry and will drink fast).
Therefore, we burp her frequently, about every 30ml, at least 2-3 times, but she doesn't always burp.
She has difficulty burping and tends to get gassy.

Recently, when she drinks 110ml, if she has consumed 60ml, we try to burp her, but sometimes she won’t burp, possibly because she is too hungry, so we continue to feed her.
After drinking a bit more, we give her the remaining 50ml.
Suddenly, she has milk at the corners of her mouth or spits up, and there was one instance of projectile vomiting, but the color was normal.
Even though she is clearly very hungry, she seems unable to suck effectively and cannot hold too much milk in her stomach.
She can suck and drink, as she has already consumed some, and the feeding process seems normal.
We have checked the bottle nipple and the formula, and everything seems fine.

I don’t understand why, when we continue to feed her a little more, about 10ml, she starts to cry.
She is clearly hungry but refuses to drink.
I wonder if it’s due to gastrointestinal discomfort.
We can only burp her to soothe her, but after a bit of soothing, we continue to feed her, and she drinks a little more before crying or outright refusing to drink.
I’m not sure if it’s because she can’t burp and is gassy, has an upset stomach, or if she is drinking too much at once and is too full to digest.

Previously, she didn’t have this issue; she wouldn’t refuse to drink halfway through when she was clearly hungry, nor would she cry and have milk spilling from the corners of her mouth or spit up.
According to her growth, she has been developing normally, and her bowel movements have been regular.
She should be able to hold more milk in her stomach.
Why is it that now, with a smaller amount, sometimes she finishes normally, but other times, she drinks halfway, we try to burp her, and sometimes she can’t burp, then we continue feeding her, but she cries and has milk spilling out or spits up, appearing uncomfortable?
For instance, with 110ml, she might drink 60ml in the first 10 minutes, we burp her, and then when we continue feeding, she cries and refuses to drink.
After soothing her for 10 minutes, she drinks 30ml, but then cries again.
After another 5 minutes, she finishes the remaining 20ml.
Sometimes, she doesn’t even finish the 110ml and might leave 40-60ml.

Is this what everyone refers to as "colic" or "gas"? Sometimes she can finish 110ml without any of the issues I just described, but other times, she experiences these problems.
At least one feeding a day has been like this, even though she didn’t have these issues before.
For example, during a feeding this morning, when we prepared 110ml, she drank about 50ml, but couldn’t burp and was still very hungry, so I continued to feed her.
Suddenly, she seemed unable to suck on the nipple, and milk was spilling from the corners of her mouth, then she cried, even though she was clearly hungry.
I tried to soothe and burp her, and after 5 minutes, I continued feeding her, but she only drank 10ml.
The same situation occurred again, so I continued to soothe her, and after another 5 minutes, she still only drank 10ml.
Therefore, she only consumed 70ml that feeding, leaving 40ml uneaten.

I have been worried about this issue since last week.
I wonder if it is related to gas, but she used to drink quickly without these problems.
These issues have only appeared recently, and it’s not at every feeding; at least one feeding a day has been like this.

Trista, 20~29 year old female. Ask Date: 2023/07/10

Dr. Xiao Kaiwen reply Pediatrics

Newborns have a more sensitive gastrocolic reflex, so sometimes when they drink milk, it can lead to increased intestinal motility, resulting in temporary colicky pain.
This situation is a normal transient phenomenon, as long as there are no issues with frequent feedings or severe vomiting, and if their height and weight are increasing normally, bowel movements are regular, and slight abdominal distension is not a concern.

Reply Date: 2023/07/10

More Info

Feeding issues in infants, particularly related to burping, gas, and spitting up, can be concerning for parents. Your observations about your daughter's feeding patterns and behaviors are important, and it's understandable to feel anxious about these changes. Let's break down the issues you're experiencing and provide some insights based on pediatric feeding practices.

1. Feeding Speed and Burping: It's common for infants to drink quickly when they're hungry. However, rapid feeding can lead to swallowing air, which may contribute to gas and discomfort. You mentioned that you try to burp your daughter every 30 ml, which is a good practice. If she resists burping, it might be beneficial to pause the feeding for a moment to allow her to settle before continuing. If she seems uncomfortable or is crying, it may indicate that she is experiencing gas or is simply overwhelmed by the amount of milk.

2. Spitting Up and Vomiting: The fact that your daughter sometimes spits up or has episodes of projectile vomiting can be concerning. Spitting up is common in infants due to their immature digestive systems. However, if the spitting up is excessive or accompanied by distress, it could indicate gastroesophageal reflux (GER). In such cases, keeping her upright for 20-30 minutes after feeding can help reduce the likelihood of spitting up. If the spitting up continues or worsens, consulting a pediatrician is advisable.

3. Signs of Discomfort: Your description of her crying during feeding, especially when she seems hungry, suggests that she may be experiencing discomfort. This could be due to gas buildup, which may not always be relieved by burping. If she is consistently refusing to drink after a certain point, it may be a sign that her stomach is full or that she is feeling uncomfortable.
4. Feeding Amounts: It's essential to monitor her total daily intake rather than focusing solely on individual feedings. If she is consistently consuming less than her usual amount but is still gaining weight and having normal bowel movements, it may not be a cause for alarm. However, if you notice a significant drop in her intake or changes in her weight gain patterns, it's crucial to consult with her pediatrician.

5. Colic and Gas: The symptoms you describe, including crying and apparent discomfort, could be related to colic or gas. Colic is characterized by excessive crying in an otherwise healthy infant, often occurring in the late afternoon or evening. While the exact cause is unknown, it is believed to be related to digestive discomfort. If you suspect colic, gentle tummy massages, bicycle leg movements, and warm baths may help soothe her.

6. Feeding Techniques: Consider experimenting with different feeding positions or bottle nipples. Some infants may prefer a slower flow nipple, which can help them manage their intake better and reduce the risk of gulping air. Additionally, ensuring that she is in a comfortable position during feeding can make a difference.

7. Consulting a Pediatrician: Since these feeding issues have recently emerged, it would be wise to discuss your concerns with your pediatrician. They can assess her growth, rule out any underlying conditions, and provide tailored advice based on her specific needs.

In summary, while feeding issues like gas, spitting up, and changes in appetite can be common in infants, it's essential to monitor her overall well-being and growth. Implementing gentle feeding techniques, ensuring proper burping, and consulting with a healthcare professional will help you navigate these challenges effectively. Remember, every infant is unique, and what works for one may not work for another, so patience and observation are key.

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