Ah, baby puke. Spit happens, right? That’s why bibs were invented after all. It can be really troubling when your baby spits up. Well, let’s start with what’s normal, because the world seems to spend too much time talking about what isn’t normal rather than what is normal.
Just to define these terms real quick:
reflux- a backwards flow of milk (when it goes up instead of down!)
acid reflux– when stomach acid flows back along with the milk up the esophagus causing heartburn like pain.
(By the way, I should mention that I have a comprehensive set of online courses on everything breastfeeding, if you’re interested 😉
Normal Spitty Baby:
The normal spitting baby has a small to moderate amount of milk come back out at you. This baby seems to think nothing has happened at all to him and that sitting is a pool of his own vomit is no big deal. He may have a mouth dripping with spit up and a big ‘ol smile on his cute fat face.
The normal spitting baby sometimes chokes on his puke little and it might come out his nose. It bothers him and he may get upset for a minute, but that was probably just because he was scared that he couldn’t breathe for a second. This kid is upset because he seems startled, not in pain.
The normal spitting baby might spit up chunky “curdled” looking milk or it may look exactly like freshly pumped milk. Neither really mean anything, one was just in his tummy a little longer than the other.
The normal spitting baby may be hungry after spitting up or he may not. More often then not, he would be interested in sucking, but not eating after spitting up (ie on a pacifier). This may surprise you since it looked like he just thew up the entirety of his feeding!
The normal spitting baby doesn’t mind laying flat on his back (not for too long, mom, jeez!).
The normal spitty baby we will refer to as a “Happy Spitter.” The spitting up bothers you more than it bothers your baby. The worst problem you have is a laundry problem. Sorry, this seems to be particularly annoying in the summer months when everything smells like well aged cheese.
Excessively Spitty Happy Baby:
This is a happy spitter who seriously spits up ridiculous amounts. Like large amounts. All. The. Time. Again, he doesn’t seem to care much at all, but you are really sick of being wet.
Now, there are 2 categories here. The well gaining spitter and the poorly gaining spitter. Pay attention. The advice I am about to give it for the well-gaining spitter. If you have a poorly gaining spitter, do not follow the following advice (see unhappy spitter below. Because a poor gainer is not a happy baby).
If you have a well gaining spitter, I am going to bet you have a heavy milk supply. When your baby eats, it is fast and furious. Like, it reminds you of chugging a beer in college. Five minutes of chugging and he is done. The problem is, everything you have read (not on this blog of course) says that babies are supposed to nurse for 15 minutes to get the good milk, right? So you coax your baby to nurse longer. He does it begrudgingly because boob juice is soooo good and he really wants to suck, but then he gets even more milk and gets even more full in another 2 minutes.
This is like the Ben & Jerry’s phenomenon. I am going to go out on a limb here and assume everyone does this, not just me. If that isn’t true, just don’t tell me, ok?
So, you are sitting on the couch with your pint of Ben & Jerry’s (because who eats it out of a bowl?). You get half way through your delicious Phish Food and realize you are full. BUT, it is SO good. And the freezer is far away. And it is SO GOOD. And it is almost gone anyway….so you finish off the pint. Then, you sit there feeling disgustingly overly full, but also really satisfied by that delicious treat.
That is how your baby feels on your boob. Except, when he feels that full, he pukes. Then he feels better (no, he is not bulimic). No biggy, just a big puke to take the edge off and now he is comfortable again. See, he told you when he was done at the half way mark on of the Ben & Jerry’s, but you thought he couldn’t possibly be done in 5 minutes so you coaxed him to take more and he did because it was soooo good. See the analogy?
So, if your baby shows you signs that he has taken in a lot very quickly and needs a break, give him a break. Let him digest a little! If he is looking to suck, give him a pacifier and hold him upright so he can let his brain catch up with his belly.
See, your baby has a really immature digestive tract. The muscles and flaps that are supposed to keep his food down tend to not work so well all the time and the food just sloshes back up into his throat. Top that off with being supine all the time and you have weak muscles and gravity working again him. Fat spit up babies remind me of the passengers on the spaceship in Wall-E. They don’t have the muscle tone sit up let alone keep their food down. So, that advice to hold your baby upright after feedings really does make sense. Gravity keeps food down.
The Unhappy Spitter:
Sometimes, a baby will spit and then scream. Blood murder scream. The main difference here is that a mom/dad almost always says “my baby seems like he is in pain.” This is the most important identifying factor of acid reflux. Mama’s gut really kicks in and says something is not right.
The best thing to do for this baby is to
1. Prevent the spitting
2. Lessen the acidity of the spit up
1. Prevent spitting:
Use gravity to your favor. Angle the pillow while feeding, have baby sit upright while feeding. Slow the feeding down by taking frequent breaks to burp and have non-nutritive sucking time on the pacifier so he doesn’t accidentally overeat himself.
2. Lessen the acidity of the spit up:
Meds. Acid reflux hurts! It is heartburn after all, so if your baby is having painful spit ups, strongly consider talking to your doctor about medication.
FYI: Sometimes you need to try a few different types and strengths of reflux medication for it to work. Also, this medication is weight dependent, so as baby gets bigger, the medication may need to be increased in order for it to work better.
Also, your pediatrician will most likely only be able to handle the basics of managing reflux, so if the first few tries of medication aren’t working, you or he should suggest visiting a pediatric GI specialist.
Remember- reflux and food intolerance are different. I DO NOT recommend taking a whole bunch of foods out of your diet and also treating the reflux with medication. Why? Because then you will have no idea which worked. You will be left without ice cream at night when you might not have needed to inflict that unnecessary torture on yourself.
You might think I am going to be all hippy dippy here and tell you to try eye of newt to get your baby’s reflux to feel better, but I am not. I am a nurse first. When I or my child is in pain, I medicate it. Drugs work. Don’t hate, that is just my philosophy.
The Unhappy Eater:
Now THIS is a tricky one. The baby that cries at the boob is really hard to figure out. Ideally, I would like to watch this baby feed to figure it out for you, but since I can’t be in everyone’s bedroom at 3am, I am going to give you the quick run down of what crying at the boob might be.
1. Too much milk– the firehouse is just too fast for your little baby to keep up with. This baby may look like he is “choking” but he isn’t because there are no bones in milk. The milk just went down the wrong pipe. Choking in milk is scary so your baby may pop off and cry because he thinks the boob is trying to kill him. Just give him a second to catch his breath, hold upright, burp, let you milk passively spray if it needs to, and then go back to business.
2. Not enough milk- This baby is either impatient or hungry. He sucks furiously, then pops off and cries, then tries again.
3. Something is bugging him- a burp, a fart or, you guessed it, reflux. This is a baby that occasionally or always fusses at the breast. If this is reflux, your baby may eat because it feels better or avoid eating because it hurts. This is when back arching really becomes an obvious sign of reflux because the baby will suck and drink while simultaneously arching back and pulling away from the breast, then pop off and scream.
If you baby has acid reflux, my heart goes out to you because it sure is hard to handle. Seek help and when the help doesn’t help, seek more help. Reach out to other moms. Go to support group. And, as much as you don’t want to hear this….this too shall past. A few hundred loads of laundry and months of sleepless nights later, this will all be a distant moist memory.