The baby finished eating, the parent carefully picked him up, and then all at once the shirt, diaper and sofa are filled with milk. The immediate feeling is that the baby spat up everything. In practice, even a spit-up that looks very large can be a relatively small amount that smeared on the clothing. In many infants, this is a completely normal phenomenon.
Reflux in infants occurs when milk returns from the stomach to the esophagus and sometimes out of the mouth. At a young age, the stomach is small, the baby lies down most hours of the day, and the muscle between the esophagus and the stomach is not yet fully mature. Therefore, spit-ups are very common in the first months, and sometimes begin around the first weeks of life. In most infants, they gradually improve with growth, the transition to sitting and the maturation of the digestive system.
The important difference is between regular reflux and reflux disease. Regular reflux can be messy and bothering, but the baby eats, gains weight, develops, appears vital and does not suffer from signs of distress. Reflux disease is suspected when there is impaired growth, refusal to eat, unusual crying during or after feeding, multiple vomiting, blood in vomit, blood in stool, breathing difficulties, recurring cough or episodes of choking.
When is reflux a cause for concern
One of the common mistakes is overfeeding. A parent who sees spit-up might think that the baby "lost the whole meal" and immediately give another bottle. Thus a stomach that is too full is created, which increases the chance of another spit-up. If the baby is calm after spitting up, it is not always necessary to complete food. It is important to look at the real indicators: Weight gain, vitality, the number of wet diapers and the feeding pattern over a 24–hour period.
It is possible to reduce spit-ups through simple steps: Calmer feeding, short breaks, avoiding force–feeding, holding upright for a short time after eating, and checking the suitability of the nipple flow in the bottle. Do not lay a baby to sleep on the stomach or on the side to "treat reflux." Safe sleep is on the back, on a firm, flat mattress, without pillows, soft blankets or support accessories.
Simple ways to reduce spit-ups
Anti–acid medications are not a routine solution for regular spit-ups. They are reserved for defined medical conditions, after a doctor's examination. Unnecessary use of medications may expose infants to side effects without real benefit. Thickening food or switching formula should also not be performed automatically, but according to age, medical condition and professional guidance.
The most stressful sign is projectile vomiting, mainly if it recurs, especially in a young infant. Green, bloody vomiting or vomiting accompanied by drowsiness, fever, dehydration or weight loss also requires urgent medical attention. A baby who spits up but smiles, eats, grows and wets diapers, mostly needs patience, available laundry and much less parental guilt.
General warning signs that always require a trip to the emergency room:
- Any fever in a baby under 3 months
- Fever lasting more than 3 consecutive days
- No urination for more than 10 consecutive hours
- More than 3 consecutive vomits
- Bleeding on the skin
- Excessive drowsiness or loss of consciousness
- Extreme headache waking from sleep or fear of light
- Blurred vision
- Bloody cough or bloody stools
- Shortness of breath and inability to complete a sentence
Dr. Itay Gal is a specialist in pediatrics, sports and aviation medicine, and the medical commentator for Maariv. For more articles click here