Infant Regurgitation (Spitting Up)

Spitting up, or regurgitation, is very common during a baby's first few months
of life. About 40% of normal, healthy babies spit up, usually right after feeding.
The liquid your baby regurgitates may look very similar to the milk she or he
was just fed; or, if it has been partially digested, it may appear curdled and
smell like sour milk. Though it may seem like your baby is spitting up a lot of
milk, that's not likely to be the case. The liquid spit up during regurgitation
is usually made up mostly of saliva and gastric juices, and only a small amount
of milk.

What causes regurgitation?

In older children and adults, an elastic-like muscle at the entry to the stomach
closes like a valve to prevent liquids from being pushed back up. In babies,
however, this valve or sphincter isn't fully effective until between
6 and 12 months of age. Since it isn't fully developed yet, the valve is easily
pushed back by the contents of the stomach -- resulting in regurgitation or
spitting up. Regurgitation often occurs after overfeeding, or in combination
with burping. Consequently, breastfed babies tend to spit up less than bottle-fed
babies, because they usually take in only as much milk as they need, and because
they tend to swallow less air. Regurgitation is not caused by allergy or food
intolerance, and shouldn't be confused with vomiting.

How can I tell the difference between regurgitation and vomiting?

Unlike spitting up, vomiting is characterized by the forceful expulsion of the
contents of the stomach. It's important to know the difference between vomiting
and spitting up because repeated vomiting can be a signal of a more serious
illness, and because it can easily lead to dehydration. Dehydration is a dangerous
condition in which excessive loss of body fluids results in a potentially life-threatening
imbalance of water and essential body salts. If vomiting is persistent, accompanied
by very high temperatures and/or increasing lethargy, or if vomit contains blood,
medical attention should be sought immediately. Occasional vomiting, if unaccompanied
by other symptoms, may not be a cause for concern but should be discussed with
a doctor.

What can I do to minimize my baby's regurgitation?

Your baby's stomach and undeveloped sphincter are like a bottle with a cap that
isn't fully closed. If the bottle is filled to the brim with any type of liquid,
be it water, milk or juice, it will overflow through the partially closed cap.
If it is moved or tilted, it will also overflow or spill. Understanding this
comparison will help you better understand regurgitation and what you can do

to minimize it. It's important not to overload your baby's stomach, or it will
"spill" its contents, causing your baby to spit up. Instead, give your baby
less to drink during a feeding, but feed him or her more frequently. And don't
move your baby about too vigorously after a feeding.

In addition, how you position your baby during the 20 minutes after a feeding
is important. Any upright position, such as holding your baby to your shoulder
(as you would to burp him or her), will help reduce regurgitation. However,
placing the baby in an infant seat can make matters worse and should be avoided,
especially immediately after a feeding. The baby's slouching position in this
kind of seat puts pressure on the stomach that can result in regurgitation.
Be sure to consult your doctor before making any changes in your baby's position
or diet.

Can regurgitation affect my baby's health?

Usually, the vast majority of babies outgrow this problem by 12 months or earlier
and their growth and development are not affected at all. However, a small proportion
of babies regurgitate so much that they don't grow properly. For this reason,
babies who spit up frequently should be weighed regularly. If very large amounts
of milk are being spit up, or if regurgitation is forceful, a pediatrician should
be consulted. Fortunately, even if your baby spits up frequently but is growing
normally, there is probably no cause for alarm.