Dr. Bob: My newborn infant seems to spit up too much. Everything I do doesn’t seem to make a difference. I am worried that she is losing weight. Everyone is recommending changing formula since it is obvious that she must be allergic to this formula. What is your advice?
Answer: Thank you for this question. This is such a common problem. As a matter a fact, it was one of the most common issues that I dealt with in my career. And the good news is that usually this “problem” will go away and resolve on its own. Let’s discuss the basis of the problem and then how to deal with the issue.
- The swallowing and digesting mechanism of infant feeding is immature and improves over time. The muscle (known as a sphincter) between the esophagus and the stomach tends to be a little underdeveloped for some infants. When these infants overfill their stomach with milk, it is very common for the stomach contractions to push some milk back up to the mouth and out, thus the spit up (or regurgitation in doctor talk). In my experience, usually this is just excess milk.
- Since this is usually excess, parents should be careful not to overfeed their infant. It is easy to do since parents often interpret all crying as hunger. This is not necessarily the case.
- The easiest way to determine if the amount of spit up is ok is to have your baby’s weight checked at the pediatrician’s office. In my experience, normal weight gain was usually very reassuring and provides evidence of the benign nature of spitting up. If weight loss or inadequate weight gain is determined, then other reasons can be sought. Forceful spitting (projectile vomiting) needs immediate attention.
- Milk intolerance or allergy is usually not the case for most spitting up. The temptation to switch formulas should be avoided since the problem usually resolves without switching. When formulas are switched, the temptation then is to keep switching when the spitting up continues. Switching formulas can be an annoyance and expensive and can usually be avoided.
- My usual recommendation for treatment has been three-fold – 1) have an extra burp rag (usually a cloth diaper) available for when the spit up occurs; 2) have an extra change of clothes for the baby; 3) have an extra blouse or shirt for the parent. The basis for this therapy is that when the baby spits up, you will need to have an extra burp rag to use. Once a baby spits up, clothes need to be changed for the baby. And as a parent (if you have ever been spit up on like I have), the smell of the spit up can be quite noxious and you will want to change your shirt at the earliest opportunity. The three-fold treatment accepts the spitting as a “normal problem” that resolves over time with reassurance and recognizes that parents just need to be prepared for it, smile and be calm.
- Sometimes your doctor will recommend thickening formula or positioning the baby in a more upright position after feeding.
- Be wary of too much advice from others. Relatives and friends can have advice that oversteps the advice from your doctor. Your doctor will get a history, perform a physical exam, assess the weight and then give you advice that is based on professional experience. They can pursue diagnostic studies if necessary.
- Others will be quick to tell what formula to use or how to deal with this problem. Listen to your doctor.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions