Spit up, it’s common, it seems concerning but what causes it? Dr. Chad Hayes discusses spit up in his post Spit Happens: The Ins and Outs of Reflux. Dr. Hayes says the medical term is gastroesophageal reflux (but it is not gastroesophageal reflux disease) and is usually harmless. Gastroesophageal reflux disease should only be used when the spit up is causing harm, and it rarely does. Basically when your child spits up, what they ate comes back up the esophagus. Dr. Hayes discusses when your baby drinks milk, it will travel down the esophagus to the stomach. Digestion will start then after a little while the milk will be pushed into the intestines where the milk is broken down and eventually is passed.
Dr. Hayes states 4 reasons spit up happens:
- A baby’s stomach is TINY. When an infant is born, her stomach is the size of a cherry and holds about a quarter of an ounce. It doesn’t take much to fill that up. In our hospital, many of the physicians and nurses wear wooden “belly balls” on our name badges to illustrate this to parents (most of whom refuse to believe us).
- Milk goes into the stomach faster than it goes out. Your baby might suck milk down his esophagus like nobody’s business, but then it sits in the stomach until it is slowly released into the intestines through a bottleneck called the pyloric sphincter.
- This stream flows both ways. There’s another muscle, called the lower esophageal sphincter, between the esophagus and stomach. It’s supposed to keep things from flowing backwards, but in babies it doesn’t work very well yet. So I didn’t draw it.
- Gravity pulls stuff down. (Really it pulls it towards the earth’s center of gravity, but most of us call that “down.”) If babies could stand up, this would be less of a problem, but when you lay them down, it runs back out.
So what should you do to avoid spit up?
- Don’t overfeed baby – Watching your baby’s wet diapers and growth is the best way to determine if they are getting enough food.
- Burp often – Burping during and after feeds can release the air that can push milk back out. Dr. Hayes suggests a few solid thumps with a cupped hand in the middle of the back usually does the trick. You don’t want to leave bruises but light tapping is not going to get the job done. Not all babies burp with every meal.
- Keeping baby upright for 20-30 minutes can help prevent the milk from coming back up.
- Avoid a car seat, infant seat or other products that position baby with their waist ‘scrunched. This can put added pressure on baby’s tummy which can increase the chance of spitting up.
Dr. Hayes also wants parents to remember:
- When babies spit up, it often looks like it’s much more than it actually is, when liquid is poured onto a flat surface (like the floor) it looks like there is so much more!
- It will get worse then it will get better. Usually between 6 and 12 months your baby will stop spitting up.
- Even if the spit up is curdled, it’s ok. Milk will curdle in stomach acid.
Lastly, Dr. Hayes said you should call your pediatrician if your baby isn’t gaining weight, they appear to be in pain when they are spitting up or lying down after a feed, or if what they spit up are weird colors like red or green!
Chad Hayes is a physician passionate about providing parents with evidence-based information about children’s health, development, and behavior. You can find out more on his website, chadhayesmd.com and follow him on FACEBOOK!
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