Baby Spitting Up: Causes and Solutions for New Parents

Baby spitting up?

Hello, doctor.
My baby is one month old.
He was born and stayed in the hospital for seventeen days, and he has been drinking S26 formula.
He was underweight at discharge, so we switched to Similac.
Before that, he was drinking formula for premature infants, and his stools were watery and dark green.
Now that we have switched back to S26, he has been vomiting frequently.
About half an hour after feeding, he vomits everything.
This happens every time he feeds.
We have seen a doctor and he was prescribed anti-emetic and anti-gas medication for four days, but he is still vomiting after every feed.
The doctor suggested that if there is no improvement, we could change the formula, fearing that the baby might not like the taste and thus vomits.
Should we switch to a hydrolyzed protein formula or something else? Also, my baby seems particularly alert at night and does not sleep well.
He makes sounds like "uh-uh" and cries without tears.
I am unsure what the reason is, and I have been trying to soothe him continuously.
Is this considered normal?

Bao, 20~29 year old female. Ask Date: 2009/11/19

Dr. Xiao Kaiwen reply Pediatrics

If a newborn "vomits a lot" at "every feeding," or shows "insufficient weight gain" or even "weight loss," it is considered abnormal and requires a visit to the hospital's neonatology department to check for any structural abnormalities (such as pyloric stenosis) or other metabolic issues.
Conversely, if the weight gain is acceptable, it may be monitored, or some physical methods (such as small, frequent feedings or changing formula) or medications to reduce spitting up may be used.
Newborns' sleep patterns are not like adults, who can differentiate between day and night; the situation you described is still considered normal for a newborn.

Reply Date: 2009/11/19

More Info

Understanding baby spitting up can be a significant concern for new parents, especially when it seems to happen frequently. In your case, your one-month-old baby is experiencing regular spitting up after feeding, which can be distressing for both you and your child. Let's break down the potential causes and solutions for this issue.

Causes of Spitting Up
1. Immature Digestive System: Newborns have an immature digestive system. The muscle at the bottom of the esophagus, known as the lower esophageal sphincter, may not be fully developed, which can lead to spitting up. This is often referred to as "reflux" and is quite common in infants.

2. Overfeeding: If a baby is fed too much at once, they may spit up the excess milk. It's essential to feed your baby smaller amounts more frequently to avoid overloading their stomach.

3. Positioning During and After Feeding: The position in which you feed your baby can also impact spitting up. Keeping your baby in a more upright position during feeding and for about 20-30 minutes afterward can help reduce the likelihood of spitting up.

4. Formula Sensitivity: Since you mentioned switching formulas, it's possible that your baby may have a sensitivity to certain ingredients in the formula. Some babies may react poorly to cow's milk protein or other components in formula, leading to increased spitting up.

5. Gastroesophageal Reflux Disease (GERD): While most infants experience some degree of reflux, GERD is a more severe condition where the reflux causes complications, such as poor weight gain or respiratory issues. If your baby is consistently spitting up large amounts, it may be worth discussing this possibility with your pediatrician.

Solutions and Recommendations
1. Feeding Techniques: Try to feed your baby in a calm environment, and ensure they are not overly hungry or upset before feeding. Burp your baby frequently during and after feeds to help release any trapped air that could contribute to spitting up.

2. Adjusting Formula: If your pediatrician has suggested that your baby may not like the current formula, you might consider trying a different one. Hydrolyzed formulas (like hypoallergenic formulas) can be beneficial for babies with sensitivities. However, any changes should be made under the guidance of your healthcare provider.

3. Monitor for Other Symptoms: Keep an eye on your baby's overall health. If they are gaining weight appropriately, are generally happy, and do not show signs of distress, occasional spitting up may not be a cause for concern. However, if your baby is not gaining weight or seems uncomfortable, further evaluation may be necessary.

4. Sleep Patterns: It's not uncommon for babies to be more alert at night. This can be due to their natural circadian rhythms, which are still developing. Establishing a bedtime routine can help signal to your baby that it’s time to sleep. If your baby is making noises but not crying, it may be a normal part of their development as they learn to communicate.

5. Crying Without Tears: Newborns can cry without producing tears for the first few weeks of life. This is normal as their tear ducts are still developing. If your baby seems to be in distress or is crying excessively, it’s essential to consult your pediatrician to rule out any underlying issues.

Conclusion
Spitting up is a common occurrence in infants, and while it can be concerning, most cases resolve as the baby’s digestive system matures. It’s crucial to maintain open communication with your pediatrician, especially if you notice any concerning symptoms or if the spitting up worsens. They can provide tailored advice and support to ensure your baby is healthy and thriving. Remember, parenting is a learning process, and seeking help when needed is a sign of strength.

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