Friday, May 16, 2014

Spitting Up

Most babies spit up. It is just a fact of life. Of course some of them do it more than others. I would still crown my daughter Alana the queen of spitting up. I often didn't bother changing my shirt unless there were 15 splots of spit up all over it; it simply wasn't worth it. Sandy, the clean freak in our family, would follow after her with a spray bottle of Resolve carpet cleaner and a scrub brush, so that she didn't completely stain the carpets with the constant regurgitation. (No, he isn't for sale.) Lauren rarely spit up. Kids do things differently.

Lani was a happy spitter. It didn't bother her in the least and she grew in leaps and bounds.

With large babies like Alana, sometimes the spit up is simply  the overflow. I know that it is very hard to estimate how much milk your baby is actually spitting out. I have parents calling all the time reporting that the baby seems to spit up the entire meal. If you aren't sure about a steady weight gain, we are going to want to have the baby officially weighed to make sure they are doing okay, but do relax; the spit ups are not nearly as much volume as you think they are. When we weigh them, most of the time they are still gaining weight beautifully.

When babies spit up it is not unusual for it to also come out of the nose. This can be scary. Having a Nose Frida or aspirator handy will help you clear them if they seem to be having a moment of difficulty when this happens. (I find the Nose Frida to be more effective for this.)

Once in a while you might note some blood in the spit up. To no surprise this tends to freak many parents out, but take a deep breath. Most of the time this is simply a symptom of mom's sore nipples. There is a good chance that if the nipples are cracked at all, the baby might get a little blood when they are sucking. There is a way for a lab to check the blood to see if it from the baby or the mom. If the baby is swallowing some blood during nursing it is also possible that you may see some show up in the poop. It will no longer look like fresh blood by the time it makes its way through the system but would more likely look very dark and tarry. If the baby seems perfectly fine, it is very unlikely that they have any type of active bleeding going on.

While most spitting up is fairly benign, projectile vomiting is something that warrants attention. There is a fairly uncommon condition called pyloric stenosis that usually shows up between 2-6 weeks of age. For some reason it is more common in little boys. I am fine with the occasional more forceful spit up, but with pyloric stenosis think exorcist. The spit up literally flies out of your baby and this happens multiple times a day. Of course you never want to have anything wrong with your baby, but on the scale of things, this finding is relatively benign with a simple surgical fix.
We rarely see this, but I have had two cases so far this year and things always happen in threes, just saying....

If you have a baby who is a big spitter and is also fussy, it might be some reflux. These babies tend to arch their backs a lot. They seem more uncomfortable when they are lying flat. With reflux, the spitting up seems uncomfortable. If you suspect reflux , consider the following:

*Smaller more frequent feedings
*Keep your baby upright as much as possible, but especially the first 20 minutes after the feeding
*There are some wedge pillows available that some parents find helpful.
*Breast feeding moms should see if there are any dietary factors that impact the spitting.
*Babies getting formula might consider using one of the sensitive formulas
*Some babies are very burp dependent. You will notice that if you aren't patient enough to get a good burp, part of that meal is going to come back up. Other babies never seem to burp and have no issues.
*Probiotics may be useful

If nothing is helping, the doctor may prescribe Zantac; make sure you bring this up at your next well child exam. If the baby is really miserable call for a sooner evaluation. More often than not, the copious spitting slows down significantly by the time they are seven months or so.

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