Baby Spit-Up: Causes, Concerns, and Care Tips

Q: Baby Spit-Up: Causes, Concerns, and Care Tips

Hello： The daily food intake for a child should be around 150 cc/kg/day. <br>If your child weighs 3.7 kg, they should drink approximately 3.7 * 150 = 555 cc in a day. <br>If you feed every 4 hours with 90 cc each time, that totals 540 cc for the day, which is close to the 555 cc

Babies who are prone to spitting up?

My daughter is now over one month old, born on October 18.
She is currently drinking Nestlé NAN formula.
Since birth, she has had a tendency to spit up frequently, often doing so even two hours after feeding when lying down for a diaper change.
At her one-month check-up, her height was 54 cm, head circumference was 37 cm, and weight was 3.7 kg.
The doctor mentioned that her birth weight was 3165 g, and it is fine that she has gained weight, but her milk intake needs to be increased.
Therefore, we increased her feeding from 90 cc every four hours to 120 cc, although sometimes she still does not finish the bottle.
Regarding her spitting up, the doctor advised: 1.
To pause halfway through feeding to burp her before continuing.
However, she often spits up while I am burping her, and sometimes after she finishes feeding and lies down to sleep, she suddenly cries and then spits up.
Is this normal? Also, does spitting up two hours after feeding indicate poor digestion? 2.
After feeding, she should be positioned on her right side.
I have tried this, but she tends to spit up less if I wait about three hours after feeding before lying her down.
Therefore, she usually sleeps in a semi-reclined position; I elevate her head with a pillow or use an adult pillow at about a 45-degree angle for support.
Will this long-term sleeping position affect her spinal development? My mother-in-law is concerned that it might harm her spine.
3.
I have a safety car seat for her, which can recline backward at about a 30-45 degree angle when not in the car.
Since it can rock, she spends most of her daytime sleeping in it.
Is this okay, or could it affect her spinal development? Thank you, doctor.

Xiao Jie, 20~29 year old female. Ask Date: 2006/12/08

Dr. Pei Rensheng reply Pediatrics

Hello: The daily food intake for a child should be around 150 cc/kg/day.
If your child weighs 3.7 kg, they should drink approximately 3.7 * 150 = 555 cc in a day.
If you feed every 4 hours with 90 cc each time, that totals 540 cc for the day, which is close to the 555 cc mentioned earlier, and should be sufficient for your baby.
Recommendations for managing reflux (gastroesophageal reflux):
1.
Breastfeeding: Breast milk is easier to digest and less likely to lead to overfeeding (as babies will stop sucking when they are full).
2.
Feed small amounts frequently.
3.
After feeding, keep the baby in a position with their head elevated for 30 minutes before laying them flat.
4.
After 4 months, consider using thickened formula (with added solids).
5.
You may use a physician-prescribed medication to increase gastrointestinal motility.
When purchasing a child safety seat for vehicles, ensure it meets national standards (CNS) and has been tested and certified by the Bureau of Standards, Metrology and Inspection, with a safety label.
This should not adversely affect your child's spinal development.
Wishing you health and happiness! Sincerely, Dr.
Pei Ren-Sheng.

Reply Date: 2006/12/08

More Info

Understanding baby spit-up is a common concern for many new parents, and it’s essential to differentiate between normal occurrences and potential issues that may require medical attention. Spit-up, or gastroesophageal reflux (GER), is quite common in infants, especially those under six months of age. It typically occurs when the contents of the stomach flow back into the esophagus, often due to an immature lower esophageal sphincter.
In your case, your daughter, who is just over a month old, has been experiencing frequent spit-up after feedings. This is not unusual, as many infants do spit up after eating. The fact that she is gaining weight and growing in height is a positive sign. Pediatricians often assess growth patterns to ensure that the baby is healthy despite spit-up occurrences.

Causes of Spit-Up
1. Overfeeding: If a baby consumes more milk than their stomach can hold, it may lead to spit-up. You mentioned that your doctor advised increasing her intake from 90cc to 120cc every four hours. It’s essential to monitor her cues and ensure she is not being overfed.

2. Positioning During Feeding: Feeding your baby in a more upright position can help reduce spit-up. Additionally, taking breaks during feeding to burp her can help release any trapped air, which may contribute to spit-up.

3. Digestive Maturity: Infants’ digestive systems are still developing, and as they mature, many will outgrow frequent spit-up.

Concerns Regarding Spit-Up
1. Frequency and Volume: If your baby is spitting up large amounts frequently or appears to be in distress, it may warrant further evaluation. However, if she is generally happy and gaining weight, it is likely within the normal range.

2. Spit-Up After Lying Down: It’s common for babies to spit up after lying down, especially if they have just eaten. Keeping her upright for at least 30 minutes after feeding can help minimize this.

3. Sleep Positioning: You mentioned that you are keeping her in a slightly elevated position to prevent spit-up. While it is generally safe to have infants sleep on their backs, using a wedge or a pillow to elevate the head can help with reflux. However, it’s crucial to ensure that the baby is not at risk of rolling over or sliding down, which could pose a suffocation hazard.

Long-Term Effects on Spine Development
Regarding your concerns about her spine development due to sleeping positions, it’s essential to provide a safe sleep environment. While slight elevation can be beneficial for reflux, prolonged use of inclined surfaces, like car seats or swings, should be limited. The American Academy of Pediatrics recommends that infants sleep on a flat, firm surface to reduce the risk of Sudden Infant Death Syndrome (SIDS) and to promote healthy spine development.

Recommendations
1. Feeding Techniques: Continue to practice paced bottle feeding, where you allow her to suck and swallow without overwhelming her. Take breaks to burp her, and observe her cues for fullness.

2. Sleep Position: It’s advisable to place her on her back for sleep on a firm mattress without any soft bedding. If you need to elevate her head, consider using a wedge designed for infants rather than a regular pillow.

3. Monitor Growth and Behavior: Keep track of her weight gain and overall behavior. If she seems uncomfortable or if the spit-up worsens, consult your pediatrician for further evaluation.

4. Consult with a Pediatrician: If you have ongoing concerns about her spit-up, feeding patterns, or growth, it’s always best to consult with your pediatrician. They can provide tailored advice and reassurance based on her specific health needs.

In summary, while spit-up is common in infants, monitoring her growth and comfort is crucial. With time, as her digestive system matures, you may find that the frequency of spit-up decreases. Always prioritize safe sleep practices and consult with your healthcare provider for any concerns.

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