Spit happens! Even people who have not spent much time with babies know that spit up comes with the territory. But did you know that more than two-thirds of babies spit up regularly? More often than not, spit up is nothing to worry about. There are some tried-and-true methods out there that can help reduce the frequency of spit up in babies and there are also some very common misconceptions about preventing spit up, But, contrary to popular belief, holding your baby upright after a feeding does not help. In this blog we will discuss:
- why babies spit up.
- the difference between spit up and vomit.
- when to worry about spit up.
- why holding your baby upright after a feed is not necessary.
- tips and bottles that can help minimize spit up.
Why do babies spit up?
Spitting up is physiologically and developmentally appropriate in babies. This is because the lower esophageal sphincter (LES) has not fully matured – and doesn’t until around 18 months of age. The LES is a circular band of muscle at the bottom of the esophagus that keeps stomach contents in the stomach so they can be digested and to protect your esophagus from stomach acid. You can expect to see a decrease in spit up as baby gains core control, which happens when they begin sitting up, and for spit up to stop by the time baby begins to walk. Similar to all muscles, they get stronger with time. Because babies spend much of their time laying down, the stomach contents put some pressure on this muscle that can result in spitting up, even an hour or more after they have finished feeding.
Your baby may also spit up if the drank too much. The extra fluid can increase the pressure on the LES, leading to spit up. It’s similar to that ‘uncomfortably full’ feeling after a holiday meal. However, you don’t spit up your food because your LES is fully matured. Heartburn? That’s stomach acid coming up through your LES and irritating your esophagus. But because you’re upright and your esophagus is longer than when you were a baby, you don’t spit up.
What is the difference between spit up and vomit?
Spit up and vomit are not the same. The distinction between the two has nothing to do with the volume of fluid that is ejected. Spit up tends to leave your baby’s mouth at a slower speed; it may even dribble out. This can happen when you’re burping your baby. Vomiting is a forceful event. The liquid projects out from the mouth and may travel several inches.
When should I worry?
Every baby is different. Typically if your baby is continuing to gain weight and doesn’t seem bothered by spitting up, it is not a reason to worry. These babies are often dubbed “happy spitters” and the spitting up is more of a “laundry problem” than a medical one.
If you feel your baby is spitting up excessively, I definitely recommend calling their pediatrician. Other scenarios which may be a cause for concern include:
- when it occurs after every feeding despite baby burping well after a feed.
- if your baby is not gaining weight.
- if the spit up looks like anything other than milk/formula (undigested or partially digested). This includes spit up that is green, yellow, bloody, or looks like coffee grounds.
- a baby who cries for more than 3 hours daily and is irritable.
- if spitting up begins after your baby turns 6 months old.
Keep in mind, it may appear that your baby has spit up an ‘entire feed’ but the amount of spit up usually looks like more than it actually is.
Why isn’t holding your baby upright after a feeding necessary?
I realize this idea may be different than what you’ve heard in the past, but hear me out. It takes approximately 2 hours for your baby’s stomach to empty. While holding your baby upright for 30 minutes after a feeding may allow for some of the feed to leave the stomach, the majority of the feed remains in their stomach after that time. When you lay your baby down, pressure is still put on their immature LES and they can spit up. Your baby got an extra 30 minutes of snuggles, but there isn’t much benefit beyond that.
Unless you are holding your baby upright until their stomach is completely empty, the chance of them spitting up still remains. But holding them up until their stomach empties brings you to the time of their next feeding, making this strategy grossly inefficient. It would result in you getting no rest, and your baby getting into the habit of having to be held or worn at all times.
You may wonder about propping your baby up in their bassinet to reduce spit up. The American Academy of Pediatrics no longer recommends this as it has been recognized as unsafe. Products like nursing pillows, baby loungers, and bouncy seats put your baby at risk for positional asphyxiation and don’t diminish the incidence of spit up!
Myths and Truths to Reduce Spit Up
Many pediatricians will recommend switching from breastmilk to formula because it is “heavier.” The ‘heaviness’ is negligible and only means it takes longer to digest than breastmilk, not that it will be less likely to come back up. While how you feed your baby is a personal choice, and one that we fully respect, recommendations to stop breastfeeding that are not based on medical reasons (for you or your baby) don’t sit well with us.
Years ago our parents were told to add rice or oatmeal cereal to our bottles to prevent spit up. Not only does this not work, but babies can’t digest grains until they have their first set of molars, and it is a choking hazard.
The best ways to help reduce spit up in your baby include:
- avoiding overfeeding.
- burping your baby, well, during and after feeding. Trapped air in the stomach can increase the incidence of spit up.
- avoiding rigorous activity soon after a feed.
- choosing a slower flow nipple if you’re bottle feeding your baby. This helps baby to recognize when they are full before they become overly full.
Tips and Bottles to Reduce Spit Up
When babies take in excess air during feedings, that air has to go somewhere. If you’re unable to get it all out by burping your baby, it becomes trapped in baby’s stomach and creates pressure against their LES. In infants this increased pressure can contribute to spit up and reflux symptoms. Bottles have started to be designed to minimize how much air baby swallows during a feeding, helping reduce gas buildup, discomfort, and ultimately spit up.
A bottle that many overlook because it’s old news is the Playtex Drop-In Bottle. Before feeding your baby, press on the liner to expel the excess air from the bottle. As your baby drinks, the liner collapses preventing air from being swallowed. They combine “anti-colic” functionality with ease of clean up – you simply throw out the liner after feeding leaving just the nipples to be washed!
For families looking for a glass bottle option, our top recommendation are the Tyseed bottles that are vented at the bottom. Our clients love this bottle because it does not have any extra parts to wash, streamlining cleanup.
And, above all, please do not hold your baby’s bottle horizontally, resulting in the nipple only filling about halfway with milk. This is a common recommendation with pace feeding, but can actually cause your baby to take in more air. If you’re hoping to prevent “nipple confusion” (which doesn’t exist, it’s actually a flow preference- you can read why here), opt for the slowest flow nipple made for your baby’s bottle and drop-in style bottles.
Other Blogs You May Like
The Truth About Nipple Confusion
Does Breast Milk Cause Cavities?
Pass the Bottle, Please!
The information contained in this blog is the opinion of Rebecca Tucci, certified doula and lactation counselor. It is not meant to take the place of consultation with your child’s healthcare provider. The above information cannot diagnose, treat, cure, or prevent any disease or condition.