When Does Spitting Up Signify a Problem?

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by Mark Moore, MD

My newborn has a lot of spit ups. When should I worry?

"Spit ups" or what is sometimes referred to as "spitting up" is a common concern of new moms. Most know that spit ups are a normal part of infancy due to swallowed air with their feedings; the real worry is knowing the difference between spit ups and vomiting (which is not normal). Spit ups are non-stressful, passive and often come up with a burp. They can be so silent as to not notice it even happened. The baby will not usually mind either. It is caused by weakness and immaturity of the valve between the stomach and esophagus and most resolve by 12 months.

Vomiting, on the other hand, is forceful ("retching") and involves larger amounts of feeding, sometimes all of it. It can be quite distressing to the baby. Vomiting is abnormal but not necessarily an emergency. Common causes are stomach viruses and other infections (earache or upper respiratory), overfeeding and food allergies. The baby may run fever. Pyloric stenosis, although more rare, deserves mention. Its incidence is 1 in 300, most likely seen at 2 to 8 weeks of age and mostly affects male babies. A blockage of the stomach valve causes them to vomit the entire amount of every feeding within 30 minutes. It is associated with "projectile vomiting", and yes, that is easy to identify.

Spit ups are common and pose no danger to the healthy infant; however, there are a few things that can be done to reduce their occurrence.

  • First, give smaller amounts during more frequent feedings
  • Burp the baby frequently, between breasts when breastfeeding and at least every 5 minutes when bottle-feeding
  • Elevate the head of their crib or place infant in car seat or stroller after feeds to keep their head higher than their stomach
  • Do like mama told us: "rest some after eating" to let stomachs settle, that is, limit their playtime and activity after feeds

Mark Moore, MD is an experienced Anesthesiologist, sub-specializating in women's and children's anesthesia. He holds board certifications in both Anesthesiology and Pain Management. Dr. Moore and his wife, Lisa, a pediatric nurse, are the authors of Baby Girl or Baby Boy. They live in Tallahassee, Florida.

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