First, let’s discuss what is normal when it comes to spitting up: there’s reflux and then there is acid reflux. Reflux is a backward flow of milk (when it goes up instead of down). Acid reflux is when stomach acid comes back up with the milk, causing heartburn-like pain.
The Normal Spitty Baby
- The normal spitting baby has a small to moderate amount of milk come back up. 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. They may have a mouth dripping with spit up and a big ol’ smile on their face.
- The normal spitting baby sometimes “chokes” on his puke a little and it might come out his nose. This startles them and they may get upset if it was scary and hard to breathe for a moment while they coped.
- The normal spitting baby might spit up chunky “curdled” looking milk or it may look exactly like freshly pumped milk. Neither is a problem; one was just in his tummy a little longer than the other.
- The normal spitting baby may or may not be hungry after spitting up. More often than not, they are more interested in sucking than eating after spitting up–a pacifier works well in this scenario.
- Did the baby just spit up the whole feeding?!
- Often, it seems like the amount that baby spits up is a lot. The common refrain is “it looks like the baby just spit up their whole feeding!” It rarely is as much milk as it seems.
- Try this: Fill a shot glass with water and dump it on the counter. That is 1 ounce.
- By 2 weeks, baby’s are eating about 2-3 times that volume. So, look again. Was it the whole feeding or just a few teaspoons? Maybe the baby needed to spit up that little bit. It wasn’t much.
- The normal spitting baby doesn’t mind laying flat on his back, for example on a play mat or a changing table.
- The normal spitty baby is what we call 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
- There are two types of excessively spitty babies: the well-gaining spitter and the poorly-gaining spitter. Here we are discussing the well-gaining spitter. If you have a poorly-gaining spitter, do not adhere to the following advice. A baby who is not gaining well is not a happy baby.
- A happy spitter spits up large amounts, frequently. They still don’t seem to care much at all, but you are really sick of being wet. Everything feels wet all the time.
- If you have a well gaining spitter and you are bottlefeeding, you may consider decreasing bottle size slightly and giving more non nutritive sucking time right after the bottle with baby upright for 10-15 minutes.
- If you are nursing, there is a strong correlation between this type of spitting up and oversupply.
- 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 they are looking to suck, give more non nutritive sucking time right after the bottle with the baby upright for 10-15 minutes.
The Unhappy Spitter
- Sometimes, a baby will spit and then scream.
- The main difference between the happy excessive spitter and an unhappy spitter is that parents almost always describe the baby’s behavior by saying, “My baby seems like he is in pain.” This is the most important identifying factor of acid reflux.
- Often, parenting instinct really kicks in and says something is not right.
- The best thing to do for this baby is to try to decrease the refluxing and lessen the acidity of the spit up.
- Decrease the refluxing, 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.
- To lessen the acidity of the reflux, pediatricians may prescribe medication. 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. 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.