Baby sick when lying down after feed

Reflux | Breastfeeding Challenges | Start for Life

Breastfeeding challenges

There may be times when breastfeeding is challenging. Never ignore any issues you may have – talk to your health visitor, midwife, GP or breastfeeding specialist as soon as possible, they will be able to help you sort it out quickly.

Here are some common breastfeeding issues, and tips on what to do.

Colic
Constipation
Mastitis
Milk supply
Reflux
Sore nipples
Thrush
Tongue-tie

Baby reflux

If your baby brings up milk, or is sick during or after feeding, this is known as reflux. Reflux, also called posseting or spitting up, is quite common and your baby should grow out of it, usually by the time they are 12 months old.

What causes baby reflux?

The muscle at the bottom of the food pipe acts as a kind of door into the stomach – so when food or milk travels down, the muscle opens allowing the food into the stomach.

However, while this muscle is still developing in the first year, it can open when it shouldn't (usually when your baby's tummy is full) allowing some food and stomach acid to travel back up again. Acid in the stomach is normal and a necessary part of the digestion process – it helps break down food.

In most babies, reflux is nothing to worry about as long as they are healthy and gaining weight as expected.

Baby reflux symptoms

Constant or sudden crying when feeding.
Bringing up milk during or after feeds (regularly).
Frequent ear infections.
Lots of hiccups or coughing.
Refusing, gagging, or choking during feeds.
Poor weight gain.
Waking up at night a lot.

GORD

When reflux becomes painful and it happens frequently, this is known as 'gastro-oesophageal reflux disease' (GORD). GORD is more serious than mild, everyday reflux. The strong stomach acid can irritate and make the food pipe sore and inflamed, which is painful for your baby and may result in them needing medication.

The main signs and symptoms of GORD in your baby are:

spitting up frequently
abdominal pain
feeding difficulties
seeming unsettled and grizzly after a feed

These symptoms can lead to your baby not gaining weight, or even losing weight.

Silent reflux

Silent reflux can be confusing as there are no obvious signs or clues (such as spitting up). It's when the food travels back up the food pipe – but it's swallowed rather than spat out so is harder to identify. But your baby may display similar symptoms to those of regular reflux.

Breastfeeding Friend from Start for Life

The Breastfeeding Friend, a digital tool from Start for Life, has lots of useful information and expert advice to share with you – and because it's a digital tool, you can access it 24 / 7.

Breastfeeding tips for babies with reflux

Feeding little and often (smaller feeds stop their tummy getting too full).
Burping them requently during feeds – have a look at our guide to burping your baby for techniques.
Try a different feeding position – check out our our guide to breastfeeding positions.
Keep your baby upright, for at least an hour after feeding, this should help keep the milk down.

If you are mixed feeding (combining breastmilk and formula feeds), have a look at our advice on bottle feeding and reflux.

When to see the GP

If your baby has difficulty feeding or refuses to feed, regularly brings milk back up and seems uncomfortable after a feed, talk to your pharmacist, GP, or health visitor. They'll be able to give you practical advice on how to ease the symptoms and manage it – they may also need to rule out other causes (such as cow's milk allergy).

It might be helpful to keep a record of when your baby feeds, with details of how often and how much your baby brings the food back up, and how often your baby cries or seems distressed. This will help your health visitor or GP decide if your baby needs treatment.

Reflux in babies - NHS

Reflux is when a baby brings up milk, or is sick, during or shortly after feeding. It's very common and usually gets better on its own.

Check if your baby has reflux

Reflux usually starts before a baby is 8 weeks old and gets better by the time they're 1.

Symptoms of reflux in babies include:

bringing up milk or being sick during or shortly after feeding
coughing or hiccupping when feeding
being unsettled during feeding
swallowing or gulping after burping or feeding
crying and not settling
not gaining weight as they're not keeping enough food down

Sometimes babies may have signs of reflux but will not bring up milk or be sick. This is known as silent reflux.

Things you can try to ease reflux in babies

Your baby does not usually need to see a doctor if they have reflux, as long as they're happy, healthy and gaining weight.

Do

ask a health visitor for advice and support
get advice about your baby's breastfeeding position or how to bottle feed your baby
hold your baby upright during feeding and for as long as possible after feeding
burp your baby regularly during feeds
give formula-fed babies smaller feeds more often
make sure your baby sleeps flat on their back (they should not sleep on their side or front)

Non-urgent advice: See a GP if your baby:

is not improving after trying things to ease reflux
gets reflux for the first time after they're 6 months old
is older than 1 and still has reflux
is not gaining weight or is losing weight

Urgent advice: Ask for an urgent GP appointment or call 111 if your baby:

has vomit that's green or yellow, or has blood in it
is projectile vomiting (being sick with more force than usual)
has blood in their poo
has a swollen or tender tummy
has a very high temperature or they feel hot or shivery
keeps being sick and cannot keep fluid down
has diarrhoea that lasts for over a week or has signs of dehydration
will not stop crying and is very distressed
is refusing to feed

Also call your GP or 111 if you have any other concerns about your baby.

Treatment for reflux in babies

A GP or specialist may sometimes recommend treatments for reflux.

If your baby is formula-fed, you may be given:

a powder that's mixed with formula to thicken it
a pre-thickened formula milk

If the thickening powder does not help or your baby is breastfed, a GP or specialist might recommend medicines that stop your baby's stomach producing as much acid.

Very rarely, surgery might be needed to strengthen the muscles to stop food or milk travelling back up. This is usually only after trying other things or if their reflux is severe.

Causes of reflux

Reflux usually happens because your baby's food pipe (oesophagus) has not fully developed, so milk can come back up easily.

Your baby's oesophagus will develop as they get older and the reflux should stop.

Page last reviewed: 13 December 2021
Next review due: 13 December 2024

Article | Neurotic vomiting in children

Bobylova M.Yu. (neurologist)

Vomiting in children is not an independent disease, but a manifestation of various diseases. Vomiting can be caused by disorders of the gastrointestinal tract, metabolic diseases, tonsillitis, inflammation of the nasopharynx, pneumonia, influenza, SARS, acute appendicitis. Such vomiting is treated by a pediatrician. But there are also vomiting associated with dysfunction of the central nervous system. It develops in children of the first months of life who have undergone hypoxia during fetal development or childbirth. After 6 months, habitual vomiting is often associated with improper introduction of complementary foods if the child is force fed. Also, vomiting can be a sign of increased intracranial pressure. Vomiting attacks are characteristic of the childhood form of migraine. nine0005

In infants , especially in the first 3 months of life, regurgitation of a small amount of food (15-30 ml) 2-3 times a day is a common phenomenon that disappears with the growth of the child. The horizontal position of the baby and the relatively large amount of food predispose to the occurrence of regurgitation in healthy infants. It is also characteristic of regurgitation when swallowing air during breastfeeding, when there is not enough breast milk in the mammary gland, or when the baby does not capture the areola. With artificial feeding - swallowing of air occurs when the nipple is not completely filled with milk, when there is a large hole in the nipple, when the position of the bottle during artificial feeding is horizontal. nine0005

Swallowing air is more common in infants who are hyperexcitable, greedily sucking, and also with general muscular hypotension.

Regurgitation, unlike vomiting, occurs suddenly, does not affect the behavior and general well-being of the child, while children do not lose weight gain.

Helping a child with spitting up: firstly, immediately after feeding and during sleep, you should hold the baby in an upright position. If regurgitation has occurred, it is necessary to turn the child's head to one side, toilet the child's nose and mouth (clean it from food debris). Wash and caress the baby. nine0005

Feeding rules must be observed: the baby should be fed in a semi-vertical position, which helps to expel swallowed air. These babies should sleep with their heads up.

If regurgitation is frequent and profuse, and the baby begins to lag behind in weight, then this may be a manifestation of a disease of the stomach or intestines (pylorospasm or pylostenosis). It is necessary to contact a pediatrician for timely examination, diagnosis, treatment and prevention of complications. nine0005

Neurological disorders as a cause of vomiting in a child

The vomiting center of a person is located in the brain, therefore, in case of any damage to the head (trauma, infection, vegetative-vascular dystonia, increased intracranial pressure), vomiting occurs not associated with food intake and fever .

Vomiting in children under 1 year of age is associated with hypoxia during fetal development and at birth.

Neurotic vomiting develops as a manifestation of neurotic reactions in response to nasty and undesirable actions: coercion, protest against punishment, feeding. Functional vomiting in such children is more often combined with refusal to eat, with selectivity in food, behavioral changes, and stubbornness. More common is functional vomiting in children who are emotional, easily excitable, vulnerable. There are no signs of intoxication of the body, pain in the stomach, diarrhea or temperature in the child. This behavior requires prompt treatment to a neurologist. nine0005

Vomiting in children, even if it is not accompanied by diarrhea and fever, requires the attention of parents. In no case should you self-medicate, since for each disease the methods of treatment are different.
Only a doctor can recognize the causes of the problem after a series of examinations. To clarify the cause of constant vomiting in a child, it is necessary to clarify when it began, what kind of character it is (periodic, after each feeding), whether it is somehow connected with food intake and with the time of day. Important information about possible diseases is also provided by the diagnosis of vomit. The masses are checked for the presence of mucus, bile, milk, blood, digested and undigested food debris. When making a diagnosis, the age of the child is taken into account. If in infants and young children, in most cases, vomiting is a symptom of CNS disorders due to asphyxia (intrauterine or postpartum), trauma, defects in the gastrointestinal tract, and intolerance to cow's milk, then in older children it is a sign of a possible migraine. nine0035 Diagnostic procedures in determining the cause include ultrasound of the abdominal cavity, blood, feces, examination by a neurologist, if necessary, tomography, EEG, neurosonography. In the complex treatment of vomiting, sessions with a psychologist are important.

Help with neurotic vomiting includes a wide range of preventive and therapeutic measures that require an integrated approach.

Required tasks:

1) elimination of emotional disorders (emotional lability, irritability, anxiety, etc.;

2) treatment of asthenic manifestations, overcoming physical and mental exhaustion;

3) regulation of autonomic disorders;

4) treatment of obsessions and fears, if any;

5) correction of personality traits;

6) elimination of negative factors;

Spitting up and vomiting in infants

Spitting up and vomiting in babies is a common reason to see a doctor. nine0005

Regurgitation and vomiting is a reflex action that occurs when receptors located in various anatomical zones are irritated, incl. in the stomach, esophagus, pharynx, oral cavity. The signal is transmitted to the vomiting center, which is located in the medulla oblongata and a gag reflex occurs.

What is the difference between regurgitation and vomiting?

The difference lies in the volume and kinetics (movement) of the gastric contents expelled to the outside. When regurgitation occurs, leakage occurs without the participation of the diaphragm and abdominal muscles, i.e. passively. There is little content, up to about 10-15 ml. If the child does not swallow it, it quietly expires from the oral cavity. When vomiting, a wave-like bending of the upper half of the body occurs as a result of contraction of the muscles of the diaphragm and the anterior wall of the abdomen, the volume of vomit is greater, and they are erupted with pressure from the oral cavity with an ejection trajectory of up to 50 cm. In children of the first year of life, this is defined by the term "fountain vomiting" . nine0005

Regurgitation is observed only in children of the first year of life and, mainly, up to 6 months. Contribute to this anatomical and physiological features of the esophagus and stomach of the baby. Their esophagus is short and wide, the angle of connection of the esophagus with the stomach is less pronounced, and its obturator function is weak. These regurgitations are physiological. They can be after each feeding, up to 15 ml, do not affect the well-being and weight gain of the baby. They can also be caused by excessive feeding, aerophagia (swallowing air while sucking), straining during intestinal colic. The frequency and volume of such regurgitation decreases with the growth of the child. With the introduction of complementary foods, and this is a thicker food, regurgitation stops or becomes much less frequent. nine0005

If regurgitation persists in a child older than 1 year, then this is a sign of a pathological process.

Vomiting, in contrast to regurgitation, is accompanied by vegetative symptoms - increased salivation, pallor of the skin, palpitations. This is due to the fact that next to the vomiting center there are additional centers of autonomic regulation, which are reflexively excited, and active biological substances such as serotonin, dopamine, histamine and others are released into the blood. nine0005

Regurgitation and vomiting, from the moment of eating, may occur during feeding, after feeding for the first 20-30 minutes or delayed, sometimes after several hours.

Regurgitation and vomiting that occurs immediately after feeding unchanged breast milk or formula may be due to narrowing of the esophagus. If they persist until the next feeding, and the milk / mixture is curdled, has a sour or musty smell, then this is the result of a long standing food in the stomach. The reason for this may be the low tone of the muscle layer of the stomach and, as a result, its peristalsis or narrowing of the output section due to an anomaly in the development or high tone of the sphincter of the lower stomach. With narrowing of the duodenum, bile is present in the regurgitated masses. nine0005

Gastroesophageal reflux is a common cause of regurgitation in infants. It is likely that there is a complex problem here, starting with the immaturity of the gastrointestinal tract and disorders of the central nervous system. Perinatal injuries of the central nervous system accompany every second child. Their manifestations are varied. Regurgitation and vomiting can be facilitated by an increase in intracranial pressure, disorders in the segment of the cervical spine, and so on. Therefore, quite often, when carrying out rehabilitation measures for neurological dysfunctions, a positive effect is manifested in the form of a decrease or cessation of regurgitation. A hernia of the esophageal opening of the diaphragm will also manifest itself in a similar way. nine0005

We should not forget about allergic gastrointestinal reactions in the form of regurgitation and vomiting. The most common cause of this is cow's milk protein. With intolerance to cow's milk protein, inflammation of the mucous membrane of the esophagus, stomach and intestines occurs. And, as a result of this, regurgitation and vomiting, pain and increased gas formation, diarrhea or constipation.

Rare endocrine disorders (adrenogenital syndrome) are manifested by vomiting in children from the first weeks of life. In such cases, vomiting is frequent, there may be an admixture of bile, the child loses weight due to loss of fluid and nutrients, and severe metabolic disorders develop. nine0005

Vomiting can also be caused by an intestinal infection. Viral gastroenteritis is now common. It must be remembered that the younger the child, the more severe the disease. Within a few hours, the child's condition can go from satisfactory to extremely serious.

As you can see, the causes of regurgitation and vomiting in children of the first year of life are quite diverse, but most often these are transient conditions that disappear with the growth of the child.

Prevention of regurgitation in children of the first months of life is quite simple. Don't overfeed your baby. If he cries, it does not always mean that he is hungry. Excess feeding leads to increased gas formation and colic, during which the child is worried, straining, thereby increasing the likelihood of spitting up. After feeding, hold the baby more upright so that he can burp the swallowed air. This will take 15-20 minutes. If the child is bottle-fed, do not change his formula milk without the recommendation of a pediatrician. nine0005

If the child has frequent regurgitation and vomiting, it is necessary to consult a pediatrician or gastroenterologist to diagnose the cause.