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Breastfed baby vomit after feed


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

Why Do Babies Vomit After Breastfeeding? It's Not The Same As Spitting Up

Life

by Abi Berwager Schreier

Baby puke and spit-up can be pretty gnarly. The worst case of spit-up I dealt with was when I worked in a daycare: after feeding the world’s sweetest baby, I stupidly raised her over my face and she spit-up directly into my open mouth. Rookie move. I thought I would swear off babies for good, especially after another baby threw up down my back and into my shirt. Now, I’m sure you have your own throw up horror stories to tell, but should you be concerned if your baby vomits or spits up after breastfeeding? And how do you distinguish between the two? Fun times, right?

According to pediatrician Jarret Patton, vomiting after breastfeeding usually occurs during the first two weeks of your baby’s life. Typically, it’s because for some women, their breasts produce more milk than the baby can drink, which leads to overfeeding and then vomiting, Patton explains. Thankfully, however, “This quickly goes away as the breasts start to regulate the amount of milk they produce based on the infant’s eating habits. If vomiting persists even after a small feed, this could indicate a medical problem and you should consult your doctor for further evaluation,” he says.

So how can you tell the difference between spit-up and actual vomit? There is a difference. Patton says when your baby vomits, it’s more forceful when your baby ejects his or her stomach contents. “It tends to have a larger volume than spit up which comes out more like a dribble out of the baby’s mouth,” he explains. If your little one is vomiting, keep your baby lying on his or her stomach or side as much as possible to “minimizes the chances of the baby inhaling vomit into his or her upper airway and lungs,” advised the American Academy of Pediatrics (APA).

If your baby is vomiting, the APA noted, for the most part, it "will stop without specific medical treatment.” However, you should watch out for dehydration. Patton says, “The key to determining if the vomiting is too much lies in the weight gain and number of wet diapers. If there is weight loss, or failure to gain weight well, see your child’s doctor. Also, if the number of wet diapers decrease, this could signal dehydration and cause a visit to the doctor.” If you do end up going to the pediatrician’s office, the the pediatrician will probably do a blood and urine test, or even x-rays to determine what’s going on, explained the APA.

As far as spit-up goes, what exactly is going on there, and how much is too much? The Mayo Clinic noted that spitting up is quite common among healthy babies and it typically happens during the first three months. Spit-up is when babies “experience their stomach contents coming back up into the esophagus, a condition known as gastroesophageal reflux, infant reflux or infant acid reflux,” the Mayo Clinic explained. "As long as your baby seems comfortable and is eating well and gaining weight, there's little cause for concern.” However, if your baby isn’t gaining weight or the fluid is yellow, green, bloody, or looks like coffee grounds, or starts when they’re 6 months old or older, call your pediatrician immediately.

So it looks like spit-up is very common among babies, and the throwing up usually occurs after breastfeeding if your baby accidentally overeats because you produced more milk than your baby can handle. But don’t worry, your breasts will figure it out and start to regulate the amount of milk that will fit perfectly into your sweet baby’s needs. If your baby is continuously vomiting and shows signs of weight loss or dehydration, make sure to call your pediatrician asap, as that is definitely worth getting checked out.

Check out Romper's new video series, Bearing The Motherload, where disagreeing parents from different sides of an issue sit down with a mediator and talk about how to support (and not judge) each other’s parenting perspectives. New episodes air Mondays on Facebook.

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.

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.

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.

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.

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.

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.
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.

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" .

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.

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.

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.

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.

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.

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.

If the child has frequent regurgitation and vomiting, it is necessary to consult a pediatrician or gastroenterologist to diagnose the cause. To make a diagnosis, it is sometimes enough to carry out simple and affordable diagnostic methods in a polyclinic. These include an ultrasound of the stomach and, if necessary, stool tests. However, the approach in each case is individual. Examination and treatment will be assigned to your baby, depending on the diagnosis.

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