Baby spits up at every feeding
Breastfeeding FAQs: Spitting Up, Gagging, and Biting (for Parents)
Breastfeeding is natural, but it takes practice to get it right. Here's what you need to know about spitting up, gagging, and other concerns during breastfeeding.
Is it Normal for My Baby to Spit Up After Feedings?
Sometimes, babies spit up when they eat too much, or when they burp or drool. Many infants will spit up a little after some — or even all — feedings or during burping because their digestive systems are immature. That's perfectly normal.
As long as your baby is growing and gaining weight and doesn't seem uncomfortable with the spitting up, it's OK. The amount of spit-up often looks like more than it actually is. But spitting up isn't the same as forcefully vomiting all or most of a feeding.
What’s the Difference Between Spitting Up and Vomiting?
Vomiting is a forceful projection of stomach fluids. Spitting up is a more gentle "flow" of fluids that come up. Babies don’t usually react to spitting up, but a vomiting baby will usually look upset or cry.
If you're concerned that your baby is vomiting, call your doctor. In rare cases, there may be an allergy, digestive problem, or other problem that needs medical care. It helps to keep track of how often and how much your baby is vomiting or spitting up.
How Can I Keep My Baby From Spitting Up?
If the doctor says your baby's spitting up is normal, here are some things you can do to help lessen it:
- Burp your baby after each feed from each breast. Sometimes giving smaller feeds more often can help, rather than giving larger-volume feeds.
- Keep your baby upright after feedings for at least 30 minutes. Holding your baby is best, since the way your baby sits in an infant seat may actually make spitting up more likely.
- Don't jiggle, bounce, or actively play with your baby right after feedings.
- Keep your baby's head above the feet while feeding. Don't hold your baby in a dipped-down position when feeding.
- Raise the head of your baby's crib or bassinet. Roll up a few small hand towels or receiving blankets (or you can buy special wedges) to place under — not on top of — the mattress. Never use a pillow under your baby's head. Make sure the mattress doesn’t fold in the middle, and that the incline is gentle enough that your baby doesn’t slide down.
If your baby also gets bottles of breast milk or infant formula supplements:
- Burp after your baby drinks 1–2 ounces from a bottle.
- Don't give the bottle while your little one is lying down.
- Make sure the hole in the nipple is the right size and/or flow for your baby. For example, fast-flow nipples may cause babies to gag or may give them more milk than they can handle at once. Many breastfed babies do well with the slow-flow nipple until they are 3 months old, or even older.
Many babies outgrow spitting up by the time they're sitting up.
How Can I Keep My Baby From Gagging?
Sometimes the force of your milk (especially when it “lets down”) is so strong that it can cause your baby to gag and pull off of the breast. If this happens during feeding:
- Try nursing your baby in a more upright position (head above the breast). This may ease the force of the milk.
- Nurse in a side-lying position, which also might help slow the flow of milk.
- Make sure your breasts are not engorged or over-full. Nursing every 2–3 hours can help prevent engorgement. If your breasts are too full and you’re concerned about a forceful letdown, express or pump a little bit of milk a few minutes before feeding time to avoid a strong letdown.
If your baby is pulling off and gagging or coughing during feeding, sit your baby up in a seated burp position. Gently pat the back to help your baby calm down before continuing feeding. If you’ve tried the steps above and this continues to happen, talk to your doctor or lactation consultant.
If your baby sometimes gags or chokes while taking a bottle of breast milk:
- Try a different nipple with a slower flow.
- Practice “paced” bottle feeding. This is where you slow down the milk flow from the bottle by holding it at less of an angle and allowing your baby to pause for breaks.
My Baby Bites During Breastfeeding. What Can I Do?
Babies will often play with their mothers' nipples with their gums, not meaning to cause any harm. But once they start teething, a baby might bite down, not knowing this is hurting mom.
Sometimes you can tell when your baby's about ready to bite down — usually when satisfied and starting to pull away from the breast. When you sense that your baby is finished feeding and may be bored or feeling playful, end the feeding. Break the suction by slipping your finger into the corner of your baby’s mouth.
If your baby is already biting down, pull your baby closer to you to make it more difficult to pull off easily. Then, break the suction. React calmly without raising your voice.
Here are more ways to make baby less likely to bite:
- Before a feed, give your baby something to chew on. Make sure it's big enough that it can't be swallowed or choked on and that it can't break into small pieces. A wet washcloth placed in the freezer for 30 minutes makes a handy teething toy. Be sure to take it out of the freezer before it becomes rock hard — you don't want to bruise those already swollen gums. Wash after each use.
- Say, "Mommy is not for biting. You can bite this." Then, offer your little one a teething toy or ring.
- Praise your baby — with a hug, kiss, or cuddle — whenever they nurse without biting or trying to bite.
Usually this is enough to stop the biting, but if your baby continues, talk to your doctor or lactation consultant for advice.
Reviewed by: Jamila H. Richardson, BSN, RN, IBCLC
Date reviewed: January 2021
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My baby is frequently spitting up – it seems like it’s all of my breast milk! I never thought breastfed babies spit up this much. This can’t be normal, can it? Is there something wrong with my baby?
Don’t worry – we get these questions often. Caring for a baby who spits up can be stressful for parents, creating worries about the baby’s health and proper growth. Spitting up is a very common occurrence in healthy babies, and usually won’t cause any issues in regards to the baby’s growth or development. This often happens because the baby’s digestive system is so immature, making it easier for their stomach contents to flow back up into the esophagus.
Several different factors can contribute to babies spitting up, including:
- Babies regularly spit up when they drink too much milk, too quickly. This can happen when the baby feeds very fast, or when mom’s breasts are overfull. The amount of spit up can appear to be much more than it really is.
- Food sensitivities can cause excessive spitting up in babies. Products with cow milk in the mom or baby’s diet can be a common food sensitivity.
- Some babies can become distracted when feeding at the breast, pulling off to look around. This can cause babies to swallow air and spit up more often.
- Breastmilk oversupply or forceful let-down (milk ejection reflex) can cause reflux-like symptoms in babies.
If your baby seems comfortable, is eating well, gaining weight and developing normally, there’s typically little cause for concern. “Happy spitters” will grow and thrive, despite spitting up frequently. As babies grow and get older, they usually spit up less. Most will stop spitting up by 12 months of age.
Consider these tips:
- Keep your baby upright. Try feeding your baby this way and keep them upright for about 30 minutes after feedings.
- Avoid engaging in immediate active play for at least 30 minutes after feedings. Active play includes use of a bouncy seat, vibrating seat, infant swing or bouncing the baby while walking/holding.
- Frequent burps during and after each feeding can keep air from building up in your baby’s stomach.
- Avoid overfeeding. Feeding your baby smaller amounts more frequently might help decrease spitting up.
- Put your baby to sleep on his or her back. Placing a baby to sleep on its tummy to prevent spitting up is not recommended.
- Monitor your diet closely if you’re breastfeeding. If you feel there are certain foods that might be upsetting your baby’s stomach, try avoiding them for a while.
- If you notice weight loss, forceful spit up, fussiness or other symptoms, talk to your child’s pediatrician about your concerns.
Lactation Support Services at Texas Children’s Hospital offers a variety of services to mothers with questions and concerns regarding breastfeeding, pumping, medications and more. Click here to learn more.
Shelly Nalbone, APRN, CPNP, IBCLC
Why does the baby spit up after feeding?search support icon
Regurgitation is a common condition in newborns and infants and is most often a normal variant. However, it is not uncommon for parents to worry if their baby is spitting up frequently, believing that it is due to nutritional or health problems in general. Sometimes these fears are not unfounded, and regurgitation really has a pathological origin. What is its cause and when should you really consult a doctor about this? nine0003
Regurgitation - Return of a small amount of food (uncurdled or partially curdled milk) from the stomach up the digestive tract: into the esophagus and further into the oral cavity. According to statistics, at least 1 time during the day, at least 50% of babies from 0 to 3 months old can spit up, more than 60% of children 3-4 months old, and in 5% of children spit up continues up to the year 1 .
Regurgitation in newborns is considered a physiological process. It is caused by a number of factors, including:
- Features of the structure of the upper digestive tract in babies
- In newborns and infants up to a year of life, the stomach has a spherical shape. It holds a small amount of food, besides, the release from it into the duodenum is slower in comparison with children after the year 2 .
- Weakness of the lower esophageal sphincter that separates the esophagus from the stomach
- Normally, the lower esophageal sphincter should tightly "close" the esophagus, allowing food to pass into the stomach and not allowing it to enter back into the upper digestive tract. However, in young children (up to a year), the muscles of the esophageal sphincter are poorly developed, and it does not do its job very well 2 .
- Slow movement of food through the gastrointestinal tract
- The neuromuscular system of newborns is immature. It does not ensure the proper movement of food through the esophagus, causing regurgitation.
One of the important risk factors contributing to regurgitation in newborns is aerophagia. This is the swallowing of large amounts of air during feedings. This happens when the baby is not properly attached to the breast, the mother has a lack of breast milk, or the bottle is in the wrong position in the child who receives the mixture. The size of the opening in the nipple also matters - if it is too large, the newborn swallows a lot of air 3 .
With aerophagia, the baby becomes capricious, restless immediately after feeding. Noticeable bloating. If the baby spits up immediately after a feed, the milk (or formula) remains practically fresh, uncurdled 3 .
Promotes regurgitation after feeding and a predominantly horizontal position of the baby during the day, combined with relatively high intra-abdominal pressure 4 . Therefore, the correct position of the baby after feeding is so important. To avoid regurgitation of an excessive amount of stomach contents, after feeding, it is necessary to hold the baby in an upright “column” position for some time (10-20 minutes), lightly patting on the back and allowing excess air to “exit”. nine0003
Regurgitation in many newborns can be provoked by other situations in which pressure in the abdominal cavity increases and stomach contents are thrown into the esophagus, in particular 3 :
- tight swaddling;
- stool disorders, in particular constipation;
- long, forced cry and some others.
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How can you tell the difference between normal spitting up and vomiting?
Sometimes regurgitation is considered a manifestation of disorders in the digestive tract of children. Due to the constant reflux of acidic stomach contents into the upper sections, inflammation and other complications may develop, including growth retardation, a decrease in hemoglobin levels, and others. Therefore, it is important for parents to understand where the line is between physiological and pathological regurgitation 1 .
If the mother is worried that her baby is spitting up, keep track of when this happens and count the total number of spit ups per day. Normally, regurgitation usually occurs after eating (the child burps after each feeding), lasts no more than 20 seconds and repeats no more than 20-30 times a day. With pathology, the problem manifests itself at any time of the day, regardless of when the baby was fed. Their number can reach 50 per day, and sometimes more 1 .
The amount of discharge during regurgitation also matters. With normal, physiological regurgitation, it is approximately 5 - 30 ml. If this volume fluctuates between 50 and 100 ml, it is already defined as profuse vomiting. When the range of the jet of vomit is up to 50 cm, doctors talk about "vomiting a fountain." A variant of atonic vomiting is possible, when the contents of the stomach flow "sluggishly". It occurs with atony of the stomach (decrease in muscle tone of the stomach wall) and disruption of the esophagus 1 .
Vomiting in babies is a warning sign. Doctors are especially alarmed by repeated vomiting, a fountain, with an admixture of bile, in combination with constipation. Vomiting can lead to the development of dehydration, acid-base imbalance and other consequences, therefore, if it occurs, you should urgently contact a pediatrician to find out the cause and begin treatment. A doctor's consultation is necessary if the child is spitting up a lot (more than 15-30 ml at a time), with a frequency of more than 50 episodes per day 1.3 .
Physiological regurgitation: symptoms
Regurgitation in newborns, which is considered a normal variant and does not cause concern to pediatricians 3 :
- usually continues for a certain period of time;
- is characterized by slow, "passive" leakage; if the baby spits up a fountain, it is better to consult a doctor;
- has a sour smell of curdled milk;
- occurs without the participation of muscles - the baby does not strain during regurgitation;
- does not affect the general well-being of the baby.
How to help a newborn who spit up often?
If the baby is healthy, no medication is prescribed for spitting up. To help the child allow simple measures based on lifestyle changes and feeding.
- Frequent feeding of the baby
It is known that the baby is more prone to spit up if his stomach is full. To improve the situation, it is recommended to feed the baby more often, avoiding oversaturation, best of all - on demand 5 .
- Correct feeding technique
Every feeding, the mother must ensure that the baby does not swallow too much air during suckling. When sucking, there should be no loud, smacking, clicking sounds. You also need to control that the baby captures the nipple along with the areola.
- Choosing the right bottle and nipple
If the newborn is bottle-fed and receiving formula, it is important to choose the right bottle and nipple. The hole in it should be such that the milk flows out in drops, and not in a stream. The nipple must not be filled with air
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The AirFree valve prevents air from entering the baby's stomach.
- Baby standing upright after eating
To allow air that has entered the digestive tract during meals to escape, it is important to keep the newborn upright for 10-20 minutes after feeding 4 .
- Ensure the correct position of the baby during sleep
To reduce the negative impact of the acidic contents of the stomach on the esophagus, it is necessary to put the baby to sleep in the supine position. The side or prone position, which many pediatricians used to recommend, is no longer recommended. It was found to be associated with an increased risk of sudden infant death syndrome 5 .
If parents notice alarming symptoms, such as spitting up too often or large volume, etc., it is important to consult a pediatrician without delay. This will allow you to identify the real problem in time and help the baby grow up healthy and happy. nine0003
1 Zakharova I. N., Andryukhina E. N. Regurgitation and vomiting syndrome in young children // Pediatric pharmacology, 2010. V. 7. No. 4.
Nagornaya 2900 V., Limarenko M. P., Logvinenko N. G. Experience with the use of domperidone in suspension in young children with regurgitation syndrome // Child Health, 2013.No. 5 (48).
3 Zakharova IN Regurgitation and vomiting in children: what to do? //Pediatrics. Supplement to Consilium Medicum, 2009. No. 3. S. 58-67.
4 Zakharova I. N., Sugyan N. G., Pykov M. I. Regurgitation syndrome in young children: diagnosis and correction // Effective pharmacotherapy, 2014. No. 3. P. 18-28.
5 Vandenplas Y. et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) //Journal of pediatric gastroenterology and nutrition. 2009; 49(4): 498-547.
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why this is happening and what to do
First we need to figure out what can be considered regurgitation? According to experts, if a small trickle of milk flows out of the baby’s mouth after feeding, this is not regurgitation.
— The sphincter between the esophagus and stomach in babies still does not work very well, so such leaks are quite possible, — explains neonatologist of the highest category, pediatrician Anna Volik . - But constant or periodic, insignificant or rather abundant discharge of food, even in an upright position, immediately after eating or after 1-2 hours, this is regurgitation. nine0003
Why does the baby spit up after feeding
If the baby has eaten, and then there is a return flow of food, this phenomenon can frighten an inexperienced mother. But in most cases, such regurgitation is quite acceptable. “More than 50% of spitting up is considered physiological (functional) and does not require treatment,” says Dr. Volik. - It often seems to mothers that the child spits up everything that he eats. But at the same time, the baby feels good and is gaining weight well. In this case, it can be assumed that the mother is exaggerating. nine0003
There are certain physiological reasons for the infant that cause regurgitation.
- Regurgitation is often combined with colic, which goes from about 3 weeks to 3-4 months. The child cries, tightens his legs, there is pressure on the diaphragm and food is ejected, sometimes in a fountain, - says our expert. - Also, if the baby burped after active movements: for example, he tries to crawl or rolls over on his stomach immediately after feeding, you should not be scared. This is also normal in the case when, after eating, the child went off in a big way, the mother began to change his clothes, wash him, and he burped. nine0003
But it is still important to observe: if regurgitation occurs at each feeding, this may already be a pathological process, and the child must be examined.
Symptoms of pathological regurgitation
- Poor weight gain;
- poor tissue turgor (insufficient skin elasticity) indicates dehydration;
- pale skin;
- blueness under the eyes;
- marked restlessness or apathy.
Even more severe symptoms, according to the pediatrician, are respiratory arrest during regurgitation, loss of voice and broncho-obstructive syndrome. nine0003
— Pathological (including organic) regurgitation occurs several times a day, they are plentiful, may be accompanied by problems with digestion and skin, the child is not gaining weight well, Anna Volik explains. “Things like this need to be dealt with. Causes may be neurological or gastrointestinal.
- The child does not sleep well. There may be a negative trend;
- regurgitation becomes more frequent;
- frequent regurgitation through the nose; nine0017
- startling, fear of sharp sounds.
Important: if such symptoms appear, with frequent and profuse regurgitation at the age of 2-3 months, it is necessary to see a neurologist.
Pathologies of the gastrointestinal tract
- Gastroesophageal reflux disease, in which food is thrown from the stomach into the esophagus. By the way, one of the causes of this disease can be a prolonged cough.
— Mothers often ask when this disease goes away, says Dr. Volik. - The decrease in the process occurs by 7 months, and completely disappears in about 85% of infants by the year, at 95% of cases - by 1.5 years, and in 5% of children this reflux persists after reaching the age of 1.5 years.
- Regurgitation in combination with liquid frothy stools and increased gas formation may be a sign of lactase deficiency.
What to do if the baby spit up after feeding
First you need to exclude the possibility of pathology. If the mother does not observe alarming symptoms, such as weight loss, poor sleep, pallor and poor elasticity of the skin, bruises under the eyes, tremors, then in general, we repeat, there is no need for treatment. nine0013 However, when a child spits up after feeding, it is not pleasant enough. What can be done to minimize spitting up? First of all, pay attention to the feeding process itself, and it is also worth eliminating excessive activity immediately after eating.
— The presence or absence of regurgitation largely depends on how you feed your baby, says Anna Volik. - The baby needs to be applied to the breast in a calm state, he must correctly capture the nipple. If he cries or does not grasp the nipple tightly, air enters the stomach and the baby may spit up. nine0003
Hold the bottle at an angle
What should I do if my baby spit up after bottle feeding?
- If you are formula-fed, it is important to hold the bottle correctly - an angle of at least 45 degrees. Pay attention to the nipple itself - it should be with a small hole, - notes the pediatrician.
Do not overfeed
Yes, yes, it turns out that a child can burp simply because he ate too much.
— In the first 1.5 months, while lactation is developing, it is permissible to feed the baby on demand. But then you need to take breaks for 2-3 hours and develop a regimen, - emphasizes Dr. Volik. - Free feeding should last no more than three months! The child may not worry at all because of hunger, but the mother gives the breast to any anxiety of the baby. Of course, in such cases, he overeats and burps. nine0003
Calmness, only calmness
Immediately after feeding, do not make any active manipulations with the baby, change clothes, bathe, shake him up, do massage. It is not recommended that the baby himself begin active actions: crawl, roll over. Many experts recommend immediately after feeding for some time to hold the baby in an upright position, “column”, so that excess air comes out and in order to exclude the possibility of spitting up.
Popular questions and answers
Can regurgitation occur not immediately, but after an hour or two after feeding?
- Both physiological and pathological regurgitation occurs immediately after feeding or delayed (after 1-2 hours).