Baby spit up: When should you worry?

Sure reflux happens, but when should you be concerned about your baby's spit up habits?

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Recently, we were having lunch with friends when their teenaged son appeared from the other room, stricken, holding Ezra, our 15-week-old, at arm’s length. The 14-year-old had been spit-up bombed. For that poor kid, baby puke is the stuff of nightmares. For us, Ezra’s upchuck-inured moms, dealing with spit up is like changing a diaper—a vaguely unpleasant ritual that happens several times a day and involves the strategic containment of bodily fluids.

That’s not to say I’m entirely blasé about Ezra’s post-meal attacks. I’ve often wondered whether he’s having an adverse reaction to the breastmilk-formula combo we’re feeding him. Are we to blame? New mom Manusha Janakiram has had similar woes: “I used to feel so defeated when Uma would spit up. Watching milk gurgling out of her mouth made me feel like something was wrong with me, with her, and the milk.”

According to Aubrey Maze, a Thornhill, Ont., paediatrician, Ezra and Uma are in good company. He estimates that two-thirds of all babies will experience at least one episode of spitting up—usually between one to two tablespoons—by the time they’re four months old. “The muscle that acts as a valve between the esophagus and stomach is not fully developed, which allows milk to flow backward,” says Maze, who notes that an infant’s small stomach and short esophagus, as well as his default position of lying down can also exacerbate things. In medical terms, your child is experiencing gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD). The difference between the two, he says, is that GERD results in more troublesome symptoms, such as irritability, poor weight gain, difficulties breathing and consistent forceful vomiting (the barf is an unusual colour, like green or yellow, or is bloody).

If you notice these red flags, consult your healthcare provider, who can assess whether there are underlying causes other than GERD. If your kid is in serious pain or discomfort and not gaining weight, they might prescribe an infant-specific dose of a medication like lansoprazole, commonly known as Zantac and Prevacid. (Editor’s note: some formulations of ranitidine were recalled in 2019.)

By and large, as Maze notes, most babies are “happy spitters.” That is, they eat well, they don’t seem distraught after feeding, and, most importantly, they gain weight as expected. Ezra falls into this category—though he occasionally shows signs of reflux post-bottle. Maze says that using infant cereal to thicken breastmilk or formula (one tablespoon for every two ounces) can decrease reflux in bottle feeders, as can smaller and more frequent feedings with both the bottle and breast.

We’ve experimented with different kinds of formula—an intervention, Maze says, that’s often unnecessary. Switching Ezra to a brand with partially broken-down proteins (recommended for sensitive stomachs) actually made matters worse. Though we’ve been tempted by fancy probiotic formulas, which promise to bolster a little one’s digestive system, they don’t seem to deliver. According to a 2012 study published in Nutrition Journal, neither probiotics nor prebiotics decreased the frequency of gastrointestinal ailments, including diarrhea and spit up, in babies less than a year old.

But there’s good news: Maze attests that only five percent of infants are still spitting up by their first birthday—though don’t be alarmed if your kid falls into that group. (If reflux is still an issue by the time he hits 18 months, then you may want to consult your paediatrician.) In the meantime, the best approach, it seems, is a pragmatic one. That’s the tack taken by Kate Henderson, mom of one-year-old Merrick, who was a frequent regurgitator. “We learned quickly to always have a receiving blanket on hand! It saved our outfits, Merrick’s outfits and our furniture.” To paraphrase the parenting-guru Dr. Sears, most of the time, spit up isn’t a medical problem, it’s a laundry problem.

Read more:
How your breastfeeding diet affects your baby
Baby poop colour guide
Common causes for your kid’s stomach aches

A version of this article appeared in our November 2014 issue with the headline “Guide to spit up,” p. 52.

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