Breastfed baby vomiting after formula feeding
Baby Vomiting After Feeding Formula: Causes and Treatment
Your little one is happily gulping their formula while cooing at you. They finish off the bottle in no time flat. But shortly after feeding, it seems to all come out as they vomit.
There are several reasons why your baby might be vomiting after a formula feeding, but it’s important to remember that it can be — and often is — very normal.
It’s common for babies to throw up sometimes after feeding on formula or breast milk. Their shiny new digestive systems are still learning what to do with all the yummy milk coming down into their tummy.
However, if your baby often has a hard time keeping their formula down on a regular and frequent basis, let your pediatrician know.
Having a baby around means getting used to soft mushy stuff coming out fairly often. This includes spit-up and vomit.
Spit-up and vomit might seem pretty much the same — and require similar amounts of cleaning to get them off of your sweater and the sofa — but they’re very different. Spitting up is an easy, gentle dribble of milk. Baby may even smile at you as the curd-like spit-up flows from their mouth.
Spit-up is normal in healthy babies, especially if they’re under the age of 1.
On the other hand, vomit takes more effort, as it comes from deeper in your little one’s stomach. It’s a sign that your baby’s stomach is saying nope, not now, please. You might see your baby strain and recoil just before they projectile vomit. This force happens because vomit is squeezed out by the stomach muscles.
Your baby might also look more uncomfortable during and after vomiting. And vomit looks and smells different. This is because it’s usually formula, breast milk, or food (if your baby is eating solids) mixed with stomach juices.
If you’re not sure whether your baby is vomiting or spitting up, look for other vomiting symptoms, like:
- turning red
- arching their back
That said, there doesn’t seem to be agreed-upon definitions of these two terms among healthcare providers, caregivers, and others. Plus, their symptoms may overlap. For example, spitting up may sometimes be forceful, and vomiting may sometimes seem painless.
It’s easier for your baby to overfeed when they’re drinking from a bottle than when they’re breastfeeding. They can also gulp down milk faster from a bottle and rubber nipple. What’s more, because formula is always available, it’s easier for you to give them more milk than they need by accident.
Babies have tiny stomachs. A 4- to 5-week-old infant can only hold about 3 to 4 ounces in their tummy at a time. This is why they need lots of smaller feedings. Drinking too much formula (or breast milk) in one feeding can overfill your baby’s stomach, and it can only come out one way — vomit.
Not burping properly
Some babies need to be burped after every feeding because they swallow lots of air as they gulp down milk. Bottle feeding your baby breast milk or formula may lead to more air-swallowing, as they can gulp even faster.
Too much air in the stomach can make your baby uncomfortable or bloated and trigger vomiting. Burping your baby right after feeding them formula may help prevent this.
To help prevent your baby from swallowing too much air and vomiting after formula feeding, check your baby’s bottle. Make sure you’re using a smaller bottle that’s just big enough to hold a few ounces of milk. Also, check to make sure the nipple hole is not too big, and don’t let your baby continue gulping when the bottle is empty.
Baby or infant reflux
Baby can have acid reflux, indigestion, or occasionally gastroesophageal reflux disease (GERD just like grown-ups! This happens because their stomach and food tubes are still getting used to holding down milk.
Baby reflux happens when milk travels back up toward your baby’s throat and mouth. This usually just causes some painless spitting up, but it can irritate your baby’s throat and trigger gagging and vomiting.
Sometimes, smaller feedings can help prevent baby reflux. If not, don’t worry! Most little ones outgrow baby reflux by the time they’re 1 year old.
While simple constipation would be an uncommon cause of vomiting in an otherwise healthy infant, sometimes baby vomiting happens because of what isn’t happening at the other end.
Most babies who are formula-fed need to poop at least once a day. Anything less than your baby’s typical pattern, though, might indicate they’re constipated.
If your baby is vomiting after a formula feeding, they might be constipated if they have other symptoms, including:
- not pooping for longer than 3–4 days
- a swollen or bloated stomach
- a firm or hard stomach
- crying bouts or irritableness
- straining very hard but not pooping or pooping only a little
- small, hard pellet-like poop
- dry, dark poop
If your baby doesn’t usually vomit after having formula, they might have a stomach bug. Also known as gastroenteritis or the “stomach flu,” a stomach bug is a very common cause of vomiting in babies. Your little one may vomit several times for up to 24 hours.
Other symptoms of a stomach bug include:
- stomach cramps
- stomach rumbling
- diarrhea or watery poop
- mild fever (or none at all in babies)
In rare cases, the cause of your baby’s vomiting might be in the formula. Although it’s uncommon for babies to be allergic to cow’s milk, it may happen to up to 7 percent of babies under the age of 1.
Most children outgrow a milk allergy by the time they’re 5 years old, but it can cause vomiting and other symptoms in babies. A cow’s milk allergy might cause vomiting right after your baby eats. It can also cause vomiting and other symptoms hours or rarely days later.
If your baby has an allergy to milk or something else, they might have other symptoms of an allergic reaction, like:
- skin rash (eczema)
- difficulty breathing
An allergy to milk is different than being lactose intolerant. Lactose intolerance usually causes digestive symptoms like diarrhea. It can also make your baby vomit after drinking formula containing cow’s milk.
Your baby might get temporary lactose intolerance after getting a tummy bug or gastroenteritis, although this is uncommon.
Other symptoms include:
- diarrhea or watery poops
- stomach pain
- stomach rumbling
Note that lactose intolerance is rare in babies under the age of 1.
Some common health conditions can cause vomiting at any time, including after breastfeeding or formula feeding. Some rare genetic conditions can also cause vomiting in babies.
Other causes of vomiting in babies include:
- colds and the flu
- ear infections
- some medications
- motion sickness
- pyloric stenosis
In most cases, minor tweaks can help stop your baby’s vomiting. Remedies to stop your baby’s vomiting after formula depend on what’s causing it. Try some of these tried and tested methods to see what helps your baby:
- feed your baby smaller amounts of formula more often
- feed your baby slowly
- burp your baby after the feeding
- hold your baby’s head and chest up while feeding
- hold your baby upright after a feeding
- make sure your baby doesn’t move around or play too much right after a feeding
- try a smaller bottle and smaller-hole nipple to feed
- check the ingredient list on your baby’s formula
- ask your baby’s doctor if you should try a different kind of formula
- talk to your baby’s doctor about a possible allergic reaction
- dress your baby in looser clothing
- make sure their diaper isn’t on too tightly
If your baby has the stomach flu, you’ll both usually just have to ride it out for a day or two. Most babies and children with a stomach bug don’t need treatment.
If your baby is vomiting, see your doctor or pediatrician right away if they:
- are vomiting often
- are vomiting forcefully
- aren’t gaining weight
- are losing weight
- have a skin rash
- are unusually sleepy or weak
- have blood in their vomit
- have green bile in their vomit
Also, see your doctor urgently if your baby has any sign of dehydration from all the vomiting:
- dry mouth
- crying without shedding tears
- a weak or quiet cry
- floppiness when picked up
- no wet diapers for 8 to 12 hours
It’s pretty common for babies to vomit, especially after feeding. This happens for many reasons, including that these little people are still just getting used to keeping down their milk.
Check with your doctor about what you can do. See your doctor urgently if your baby vomits often for any reason.
Formula Feeding FAQs: Some Common Concerns (for Parents)
Whether you plan to formula feed your baby from the start, want to supplement your breast milk with formula, or are switching from breast milk to formula, you probably have questions.
Here are answers to some common questions about formula feeding.
Is it Normal for My Baby to Spit Up After Feedings?
Sometimes, babies spit up when they have eaten too much, burp, or drool.
Many infants will spit up a little after some — or even all — feedings or during burping because their digestive tracts are immature. That's 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. Vomiting is a forceful ejection of stomach contents. Spitting up is a more gentle flow out the mouth or nose.
If you're concerned that your baby is vomiting, call your doctor. Keep a record of exactly how often and how much your baby is vomiting or spitting up. In rare cases, there may be an allergy, digestive problem, or other problem that needs medical care. The doctor should be able to tell you if it's normal or something of concern.
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 your little one drinks 1–2 ounces from a bottle.
- Don't give the bottle while your baby is lying down, and keep your baby’s head above their feet.
- Keep your baby upright after feedings for at least 30 minutes. Holding your baby is best. The way your baby sits in an infant seat can make spitting up more likely.
- Don't jiggle, bounce, or actively play with your baby right after feedings.
- Make sure the hole in the nipple is the right size and/or flow for your baby. For example, fast-flow nipples can make babies gag or may give them more milk than they can handle at once. Many breastfed babies do well with a slow-flow nipple until they are 3 months old, or even older.
- 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.
Most babies grow out of spitting up by the time they're able to sit up.
How Do I Know If My Baby Has an Allergy?
Some babies are allergic to the protein in cow's milk formula. Symptoms of an allergic reaction may include:
- belly pain
- blood or mucus in the baby's poop
If your baby has any of these symptoms, tell your doctor. Also talk to the doctor before switching formulas.
If your baby has symptoms of a severe allergic reaction — like sudden drooling, trouble swallowing, wheezing, or breathing problems — see a doctor right away.
Is Soy Formula Safe for My Baby?
Store-bought iron-fortified soy formula is safe and nutritionally complete. Doctors usually recommend soy-based formulas if:
- Parents don’t want their babies to eat animal protein.
- A baby has congenital lactase deficiency, a rare condition where babies are born without the enzyme needed to digest lactose. Lactose is the main sugar found in cow’s milk.
- A baby is born with galactosemia, a rare condition where babies can’t digest galactose. Lactose is made up of glucose and galactose.
Many babies who are allergic to cow's milk also are allergic to the protein in soy formulas, so doctors usually recommend hypoallergenic formulas for these infants.
Soy formula is a good alternative to cow's milk formula for full-term babies (those born at 39 weeks or later). Soy formulas are not recommended for premature babies. Talk to your doctor if you are considering a soy-based formula for your baby.
Do not try to make your own formula at home. Online recipes may look healthy and promise to be nutritionally complete, but they can have too little — or too much — of important nutrients and cause serious health problems for your baby.
Is it OK to Switch to a Different Formula?
It’s probably OK to switch brands of the same kind of formula. For example, parents might buy another brand of cow’s milk formula because it’s on sale or to see if it helps with constipation, or switch to an organic formula because they’re concerned about pesticides.
But before switching formulas, talk to your doctor. Some parents may think that formula plays a part in a baby's fussiness, gas, spitting up, or constipation. But that’s not usually the case. Your doctor can help find out what may be causing these symptoms and recommend the right formula for your baby.
Do I Need to Give My Formula-Fed Baby Vitamins?
No. Commercial infant formulas with iron have all the nutrients your baby needs. Babies who are drinking less than about 1 quart (1 liter) of formula will need a vitamin D supplement.
Does My Baby Need Fluoride Supplements?
Babies do not need fluoride supplements during the first 6 months. Your doctor may recommend fluoride supplements when your baby is 6 months to 3 years old, but only if fluoride is not in your drinking water.
Is it OK to Prop a Bottle in My Baby's Mouth?
Never prop your baby’s bottle. Your baby can choke drinking from a propped bottle. Propping a bottle also can lead to ear infections and tooth decay. Always stay with and hold your baby during feedings.
It is OK to Let My Baby Sleep With a Bottle?
Never put your baby to bed with a bottle. Like propping a bottle, sleeping with a bottle can cause choking, ear infections, and tooth decay.
Reviewed by: Mary L. Gavin, MD
Date reviewed: November 2021
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.
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.