Spitting Up - Reflux  

This Care Guide Covers:

  • Spitting up (reflux) of 1 or 2 mouthfuls of breastmilk or formula
  • No effort or crying
  • Mainly occurs in young babies

If not, see these topics
When to Call Your Doctor

Call Your Doctor Now (night or day) If
  • Your child looks or acts very sick
  • Blood in the spit up
  • Bile (green color) in the spit-up
  • Choked on milk and turned blue or went limp
  • Age under 1 month old and looks or acts abnormal in any way
  • You think your child needs to be seen urgently
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen, but not urgently
Call Your Doctor During Weekday Office Hours If
  • Chokes a lot on milk
  • Poor weight gain
  • Frequent crying
  • Spitting up is getting worse
  • Age over 12 months
  • Spitting up does not get better with this advice
  • You have other questions or concerns
Parent Care at Home If
  • Normal reflux with no problems
Causes & Health Information

Symptoms

  • Smaller amounts often occur with burping ("wet burps")
  • Larger amounts can occur after overfeeding
  • Most often seen during or shortly after feedings
  • Occurs mainly in children under 1 year of age
  • Begins in the first weeks of life
  • Caution: Normal reflux does not cause any crying

Complications

These problems occur in less than 1% of infants:

  • Choking on spit up milk
  • Heartburn from acid on lower esophagus. Infants with this condition cry numerous times per day. They also act very unhappy when they are not crying. They are in almost constant discomfort.
  • Poor weight gain

Cause

  • Poor closure of the valve at the upper end of the stomach
  • Main trigger: overfeeding of formula or breastmilk
  • More than half of all infants have occasional spitting up ("happy spitters")

Reflux Versus Vomiting: How to Tell

  • During the first month of life, newborns with true vomiting need to be seen quickly. The causes of vomiting in this age group can be serious. Therefore, it's important to tell the difference between reflux and true vomiting.

Reflux. The following suggests reflux (normal spitting up):

  • You've been told by a doctor your baby has reflux
  • Onset early in life (85% by 7 days of life)
  • Present for several days or weeks
  • No pain or crying during reflux
  • No effort with spitting up
  • No diarrhea
  • Your baby acts hungry, looks well and acts happy.

Vomiting. The following suggests vomiting:

  • Uncomfortable during vomiting
  • New symptom starting today or yesterday
  • Forceful vomiting
  • Contains bile (green color)
  • Diarrhea is also present OR
  • Your baby looks or acts sick.
CARE ADVICE FOR SPITTING UP (REFLUX)

  1. What You Should Know:
    • Mild reflux occurs in most infants (50%).
    • Almost always doesn't cause any pain or crying.
    • Infants with normal reflux do not need any tests or medicines.
    • Reflux improves with age.
    • Here is some care advice that should help.
  2. Feed Smaller Amounts:
    • Skip this advice if age less than 1 month or not gaining weight well.
    • Bottlefed Babies. Give smaller amounts per feeding (1 ounce or 30 ml less than you have been). Keep the total feeding time to less than 20 minutes. Reason: Overfeeding or completely filling the stomach always makes spitting up worse.
    • Breastfed Babies. If you have a good milk supply, try nursing on 1 side per feeding. Pump the other side. Switch sides you start on at each feeding.
  3. Longer Feeding Intervals:
    • Formula. Wait at least 2½ hours between feedings.
    • Breastmilk. Wait at least 2 hours between feedings.
    • Reason: It takes that long for the stomach to empty itself. Don't add more milk to a full stomach.
  4. Loose Diapers:
    • Do not put the diaper on too tight. It puts added pressure on the stomach.
    • Don't put pressure on the stomach right after meals.
    • Also, do not play too hard with your baby during this time.
  5. Upright Position:
    • After meals, try to hold your baby in the upright (vertical) position.
    • Use a front-pack, backpack, or swing for 30 to 60 minutes after feedings.
    • Decrease the time in a sitting position (such as infant seats).
    • After 6 months of age, a jumpy seat is helpful. The newer ones are stable.
    • During breast or bottle feeds, hold your baby at a slant. Try to keep your baby's head higher than the stomach.
  6. Less Pacifier Time:
    • Frequent sucking on a pacifier can pump the stomach up with swallowed air.
    • So can sucking on a bottle with too small a nipple hole.
    • The formula should drip 1 drop per second when held upside down. If it doesn't, the nipple hole may be clogged. Clean the nipple better. You can also make the nipple hole slightly bigger.
  7. Burping:
    • Burping is less important than giving smaller feedings. You can burp your baby 2 or 3 times during each feeding.
    • Do it when he pauses and looks around. Don't interrupt his feeding rhythm in order to burp him.
    • Burp each time for less than a minute. Stop even if no burp occurs. Some babies don't need to burp.
  8. What to Expect:
    • Reflux gets better with age.
    • After learning to sit well, many babies are better by 7 months of age.
  9. Call Your Doctor If:
    • Your baby does not get better with this advice
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.
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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 9/1/2012

Last Revised: 1/13/2013

Content Set: Child Symptom Checker

Copyright 1994-2012 Barton D. Schmitt, M.D.