Spitting
All babies spit up at one time or another, some more than others. We all have a sphincter between our esophagus and stomach which loosens when food and liquid go down, but tightens while the stomach churns the food to prevent everything from coming back up. Infants tend to have a sphincter that is a little loose, resulting in spit-ups. There are other reasons babies might spit up. Pressure on the belly (many women who have experienced pregnancy can attest to this) can overcome the resistance in the sphincter and lead to stomach contents coming up. Some babies whose stomachs are irritated for whatever reason will spit up or vomit (e.g. stomach virus or formula allergy). Finally, obstruction somewhere between the mouth and intestines can also cause spitups or vomiting.
Most spitting by babies is completely benign, nothing to worry about. If your baby is generally happy, growing well, and does not have frequent cough or gagging, nothing more than buying extra spit cloths is necessary. As the famous bib slogan says, "spit happens". There are some simple steps to reduce spitting. Keep your baby uproght fpr 20-30 minutes after feeds. Decrease the volume of feeds, but increase the frequency (instead of 6 oz every 4-5 hours, for your 1 month-old, give 3-4 oz every 3 hours). Elevate the head of the crib or bassinet 20 degrees or so (do not put anything inside the crib or bassinet, only underneath).
The following lists circumstances in which spitting may be concerning;
1. Is your baby unusually fussy throughout the day? (See FAQ on infantile colick for nighttime fussiness). Does your baby seem unsatisfied after feeds? Does he/she arch her back during or after feeds? Does he/she seem hungry all the time, yet pulls back from the breast or bottle when offered. Your baby may be having severe heartburn (burning in the esophagus) and should be seen within a day or so.
2. Are the contents of the spitup green? This may be a surgical emergency, your baby needs to be seen immediately.
3. Is your baby gagging, coughing, or turning blue during feeds? If so, stop feeding and have the child seen. There may be an obstruction or abnormal connection between the esophagus and windpipe.
4. Are the spitups shooting farther and farther as days go by? Call your doctor or nurse practitioner, as there may be a developing obstruction in the stomach outlet. If your baby is well hydrated, an urgent trip to the emergency room may not be necessary (this is not as dangerous as the green vomiting scenario).
5. Does your baby have an associated fever? Refer to the fever FAQ.
6. Have you seen blood or mucus in your baby's stools? This could be a sign of formula allergy or intestinal infection (if you have a pet reptile, salmonella!). Call your doctor or NP.