Understanding Infant Spit-Up: Differentiating It From Vomiting

Introduction

‘Spitting up’ is a medical term related to gastroesophageal reflux. While spitting up, the stomach contents return to the tube connecting the mouth to the stomach, called the esophagus. In the case of babies, spitting up occurs when milk, fluids, or other solid foods regurgitate into the baby’s esophagus. It is not similar to vomiting and will usually happen to babies unknowingly, especially when they burp.

Why Do Babies Spit Up?

Spitting up in babies is normal, and all babies do it. But the frequency and timing may vary from one baby to another. A baby’s stomach is a developing organ and is very small compared to that of adults. It may not be able to hold more content, and during and after feeding, it gets quickly filled up with air, milk, or other food. If the baby changes posture or moves, the esophageal sphincter (the flap or muscle between the food pipe, esophagus, and stomach) gets forced to open up. This regurgitates the stomach contents. Spitting up mainly happens when the baby gets fed more air, the chances of which are higher while breastfeeding.

What Are the Symptoms of Spitting Up?

• A small amount of regurgitation often occurs when the baby burps. It is called wet burping.

• Spitting up is mainly seen in babies below the age of one year and may begin in the first week of life.

• In normal cases, spitting up will not be forceful and may not make the baby cry.

• Overfeeding the baby can lead to spitting up large amounts.

• Spitting up immediately after feeding is normal.

What Are the Causes of Spitting Up in Babies?

The following are some causes of spitting up in babies:

• Gastroesophageal Reflux Disorder (GERD): An underdeveloped muscle of the food pipe can lead to gastroesophageal reflux disorder in babies. This may lead to spitting up or vomiting. The babies may also experience difficulty falling asleep or disturbed sleep due to the condition. Spitting up in the case of GERD may be forceful and persist even after one year of age. The regurgitated contents will be bloody, greenish, or yellowish. If the baby lacks interest in having milk or food, becomes irritable or cries a lot during feeding, experiences weight loss, or arches the body while feeding, it may be due to GERD. When the esophageal muscles mature with age, the symptoms may fade. Otherwise, the baby should get medical attention to treat the underlying condition.

• Aerophagia: Aerophagia is when the baby swallows air while feeding. The air reaching the stomach tries to escape, for which the valve opens up. While escaping, some content within the esophagus or stomach may also accompany it, leading to spitting up.

• Normal Physiology: Since the babies' muscles are developing, making their core strength minimal, they spend more time lying horizontally. The valve that prevents the regurgitation of food pipe contents may be weak and open up quickly, making it leaky. This may lead to normal spitting in babies.

• Overfeeding: Since the baby's small stomach cannot hold more content, they can only take less food at a time. Overfeeding or feeding the babies more frequently forces more content into the stomach than it can accommodate. The contents will gradually try to escape from the stomach, resulting in the baby spitting up. When playing or bouncing immediately after feeding, overstimulation can also result in spitting up.

• Allergies: Some babies with allergies develop inflammation in the body. It may lead to acidity-like symptoms and cause discomfort in the baby. As a result, the baby may spit up pain and other aches.

What Is the Difference Between Spitting Up and Vomiting in Babies?

Spitting up and vomiting differ in many ways and must be well-identified.

• Spitting up is normal, and the baby might not show any discomfort while spitting up. On the other hand, the baby seems uncomfortable while vomiting.

• Spitting up usually begins within a week after birth. Vomiting may start spontaneously due to some underlying causes.

• The baby will not cry or show any pain while spitting up. No effort is required to spit up. Vomiting will be forceful.

• Spitting up in babies will not be accompanied by diarrhea. The vomitus may contain discolored elements and be accompanied by diarrhea. This makes the baby look tired and sick. At the same time, the baby seems healthy and shows signs of normal hunger in case of spitting up.

When to See the Doctor?

The baby should be taken to the pediatrician in the following cases:

• Green or yellow fluid or blood in the spit up.

• Spitting changed to vomiting at less than 12 weeks of age.

• Trouble gaining weight or severe weight loss.

• Difficulty consuming milk or solid foods.

• Spitting up makes the baby tired and sick.

• Breathing difficulties.

• The baby’s skin turns blue or has a severe cough.

• Spitting persists after one year of age.

How to Reduce Spitting Up in Babies?

The following steps will help reduce spitting in babies:

• Overfeeding the baby should be avoided. Instead, the baby should be given more minor potions intermittently.

• Burping the baby after feeding will help eliminate the air bubbles that enter the stomach and the food.

• The baby should be fed in an upright position. Even after feeding, the baby should be held upright for a few more minutes to settle the food.

• The baby should not be allowed to move frequently immediately after meals, which may overstimulate, leading to spitting up.

Conclusion

Spitting up in babies is normal due to the immaturity of their digestive tract. However, following some beneficial steps can reduce the chances of the same. Spitting is often confused with vomiting. But the latter is forceful and makes the baby tired and sick. Vomiting may be due to some underlying conditions and may be accompanied by diarrhea. It should be treated on an emergency basis for the babies.