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Babies and Spit-Up: What’s Normal, What’s Not

Blog Babies and Spit-Up: What’s Normal, What’s Not

There’s a developmental reason for why infants are prone to spitting up, says Dr. Dixon, and it has to do with the muscle that surrounds the esophagus called the lower esophageal sphincter (LES).


It can be difficult to know what is the normal amount of spitting up and what’s a problem that could require a doctor’s attention. Here, Rebecca M. Dixon, M.D., FAAP, a pediatrician at Indiana University Health, shares some expert advice.

Why babies spit up

There’s a developmental reason for why infants are prone to spitting up, says Dr. Dixon, and it has to do with the muscle that surrounds the esophagus called the lower esophageal sphincter (LES). “As the stomach squeezes to empty, this muscle is also supposed to squeeze so that what’s in the stomach will move down to the rest of the intestines,” she explains. “Babies are born with a weak LES, and like all muscles of the body, it strengthens with time,” she says. “Infant who are premature have even lower LES tone.”

“It’s like trying to squeeze a water balloon that has holes on the top and bottom,” says Dr. Dixon. “That’s why it’s normal for babies to have some reflux, which is when the fluid comes back up the esophagus and out of the mouth or even sometimes through the nose.” In most cases, the problem resolves once a baby reaches six months of age or so, because by that time they’re eating more solid food, they’re not lying down all the time and their LES muscles are stronger.

Some simple measures can help

One change that may help minimize spitting up is to reduce the volume of formula or breast milk you give your baby at one time, and decrease the amount of time between feeds. “So if you’re normally feeding your baby three ounces of breast milk or formula every three hours, you’d switch to two ounces every two hours,” says Dr. Dixon. Because the baby’s stomach is not as full, reflux is less likely to occur.

After every feed, make sure you burp the child well, and then try to hold your baby upright (or at least a 45-degree angle) for about 30 minutes. Don’t put the baby in a car seat or bouncy seat, says Dr. Dixon, “because being scrunched up like that with a full belly makes it more likely that they’ll spit up. In the past, pediatricians used to use medication frequently, but they’ve been shown to not be particularly effective so we’re using them less and less,” says Dr. Dixon.

Signs of a more serious problem

Even if your child is spitting up with every feed, as long as they are gaining weight and having adequate wet diapers (meaning at least one every eight hours), those are signs that the baby is getting adequate nutrition and hydration. When it becomes “more than just a laundry problem,” is when a baby is having difficulty gaining weight. “That’s a sign that your baby is spitting up more than he or she is taking in,” she says.

If your baby is having projectile vomiting with every feed, and you notice fewer wet diapers (less than one every eight hours), those could be signs of a more serious issue. “If this is the case, your baby should be seen by a doctor within 12 to 24 hours,” says Dr. Dixon.

-- By Patricia Scanlon

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