Regurgitation in babies: what to do when they spit up milk

You just fed your baby and suddenly… he spits up the milk! Although it causes a lot of stress at first, regurgitation in babies is very common, especially in the first year of life.

As moms, we worry, but before “freaking out” we must learn to identify what is normal and what is not, what causes it and how we can differentiate it from vomiting.

What is regurgitation in babies?

Regurgitation in babies, known in medical terms as gastroesophageal reflux, happens when the milk in the baby’s stomach returns to the esophagus, the tube that connects the mouth with the stomach.

According to the Mayo Clinic, regurgitation is quite common in young babies, mainly between 0 and 6 months of age. As the organism is not yet fully developed, there is immaturity in the closing mechanism (lower esophageal sphincter), which prevents food from the stomach from going back to the esophagus.

In the vast majority of cases

Regurgitation or “mouthful of milk” has a physiological origin that is corrected as the baby grows up.

It improves when complementary feeding begins (at 6 months of age) and the baby spends more time in an upright position, and usually it disappears around one year of age.

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Causes of regurgitation in our babies

All babies regurgitate, spit up or drop a “thread of milk”, it is normal. According to the American Academy of Pediatrics (AAP), a spit-up is especially produced under the following conditions:

• After swallowing air while breastfeeding or being fed with a bottle. The air occupies a large volume in the stomach and ends up pushing the milk up.
• When his stomach is full or he has had too much milk. The contents of the stomach cause the sphincter to open and flood the stomach.
• When the baby is suddenly moved or he is moved carelessly.
• When the baby’s stomach is accidentally squeezed. Imagine that it is a full bag, if you squeeze it, it spills over.

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How many times does a baby spit up?

Up to 10 or 12 times a day is considered within the “normal” limits, although the average is one to three regurgitations per day.

A research by Reiko Miyazawa, published in the National Library of Medicine, indicates that 47% of one-month-old infants have one to three episodes of regurgitation per day.

The proportion decreased to 28.8% at 4 months of age, and 6.4% at 7 months of age.

There were no significant differences in the frequency of spitting up episodes among breastfed, formula-fed, and mixed-fed infants.

“A normal regurgitation does not affect the well-being of the baby. As long as the baby is not in discomfort, he is eating well and gaining weight, there is nothing to worry about. If your baby gains weight, the calories lost through spitting up don’t affect him”, explains the Mayo Clinic.

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What is the difference between regurgitating and vomiting?

Doctor Jesús Garrido, author of My Online Pediatrician and promoter of Respectful Pediatrics explains, “Vomiting is a violent contraction of the stomach walls that are trying to expel the contents inside because they hurt it”.

“It can be identified because the baby begins to eat, he gets very restless, and ends up expelling the milk vigorously. Vomiting is always accompanied by pain, pale skin, sweating, or pouting.

The causes must be determined by the doctor

It is possible that the baby is allergic to milk. If your baby expels milk and there is no discomfort, then he is just spitting up or regurgitating”.

According to the expert, regurgitation must also be differentiated from acid reflux or gastroesophageal reflux disease:

“People tend to interpret acid reflux when the baby expels a lot of milk, but there are some babies who practically do not expel anything. If the baby is very uncomfortable, he arches back and begins to feel something is coming up”.

The baby has a little cough, some mucus in his throat (because the reflux irritates the throat increasing the mucus production), he can’t lie down, he asks you to pick him up because it hurts so much.

“If you also see that his tongue is whitish (because the acid reflux burns the tongue buds), notice that the skin around his mouth is easily irritated and the bib has a foul smell, the milk is curdled, with lumps or there is a clear liquid that smells like vomit, then it is very likely that it is acid reflux”, says Garrido.

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What can we do to reduce regurgitation?

Now it is easier to identify if it is regurgitation, vomiting or gastroesophageal reflux disease. For these latter two, only the doctor will be able to treat your baby after identifying the causes. If it is normal regurgitation, there are some tips that can help you:

• Keep your baby in an upright position. After each feeding, do not lay him down, keep him upright for 30 minutes.
• Avoid active games for at least 20 minutes after the feeding.
• Avoid rocking him immediately after the feeding.
• Don’t overfeed him. Give smaller amounts of milk, but more often.
• Burp your baby to prevent air from building up in the stomach.
• Put your baby down to sleep on his back, reducing the risk of sudden infant death syndrome.
• If you are breastfeeding, experiment with your own diet. Your doctor will be able to guide you what foods you can take, or if you should avoid dairy products, spicy foods or other foods in your diet.

About the use of home remedies

The Mayo Clinic warns, “We do not recommend adding rice cereal or any other cereal to breast milk or formula. This is commonly done, but it has been found to be helpless, it only adds carbohydrate calories too soon. Rice or other cereals can be introduced around the 6 months of age (and not before 4 months)”.

“You can keep the baby upright for 30 minutes after feeding, and this can sometimes improve reflux. Remember, reflux is normal in babies, but if he suddenly gets worse, if your baby is not gaining weight (or loses weight), or if he shows symptoms of illness (cough, etc.), seek medical attention”, says Dr. Lee Johnson, Pediatrics, Mayo Clinic Health System in La Crosse Wisconsin, USA, in response to Baby Creysi.

Translated by: Ligia M. Oliver Manrique de Lara

Spanish version: Here

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