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Ask Dr. Sears: Constant Spitting Up

Q. I know it's typical for babies to spit up sometimes, but with my 6-week-old it happens all the time! She's still gaining weight, but is there some way to know if this isn't normal?

A. Spitting up—a common nuisance of infancy—is usually more of a laundry problem than a medical one. (Do you know any new parents who don't have spitup stains on their shirts?) Most babies spit up due to their immature suck/swallow mechanisms and digestive systems. As these mature, regurgitation usually subsides. Picture what happens when babies eat and you'll better understand why they spit up: While sucking milk, a hungry baby often gulps down air. The air settles beneath the milk in the stomach; when the stomach contracts, the air acts like a pneumatic pump, shooting the milk back up the esophagus. A basic remedy for minimizing regurgitation is to allow less air and milk to gather in the stomach and to let gravity do its part in keeping the milk down. Here's how to know when to worry and when not to worry, plus tricks for keeping baby's meals in her tummy where they belong.

When not to worry 

There are several signs that your baby's spitup is not something to stress about. First of all, she is gaining the normal amount of weight, which indicates that she's not spitting up excessively. What may look like a cupful of spitup is probably less than a tablespoon. Second, she doesn't seem to be suffering from colic or abdominal pain during the episodes (if she were, you would note her facial grimaces and the drawing up of her legs). As a general rule of thumb: If your baby's pediatrician isn't worried, then you don't need to worry.

When to worry 

The most common medical cause of persistent regurgitation is gastroesophageal reflux (GER): The stomach acids are regurgitated up into the esophagus, irritating the lining and causing "baby heartburn." Some babies with mild GER may still show reasonable weight gain. The main characteristic is abdominal pain, which is why GER is often misdiagnosed as colic. Another possible medical reason for spitup is pyloric stenosis, a condition in which the muscle at the end of the stomach is too large to let stomach contents pass easily. As a result, when the stomach contracts, the milk forcefully shoots up and out. Symptoms of pyloric stenosis include projectile vomiting (during or immediately after a feeding) and poor weight gain. Yet another possibility is an allergy to formula or to dairy products or wheat in the breastfeeding mother's milk. Key allergy clues: abdominal bloating, gassiness, diarrhea, and a red rash around the anus. If you notice any of these symptoms, or if your baby has painful night-waking, there's cause for concern. Your pediatrician has likely considered all these medical possibilities, but it's still worth discussing on your next visit.

What to do 

Try these home remedies to help alleviate your baby's spitup tendencies:

* Feed your baby twice as often and half as much. This is my general rule for any digestive disturbance. Naturally, if the stomach is less full, the milk will be digested sooner, reducing spitup.

* Burp your baby well during and after a feeding. Breastfeeding moms: Burp before you switch breasts. Formula-feeding moms: Burp halfway through the bottle.

* Keep your baby upright and quiet for 20 to 30 minutes after a feeding. Gravity will hold the food down. Jostling or laying your baby flat right after a feeding encourages spitup.

Keep a diary 

One of the best ways to monitor a health concern and to differentiate between a nuisance and a medical problem is to keep a running diary. List the frequency and amount of spitup, and whether it's associated with any symptoms, such as abdominal pain or poor weight gain. If your diary reveals the occurrence of these or other worrying clues, report these to your baby's doctor. If, on the other than, your diary shows that her spitup episodes gradually decrease in frequency and volume, you have reason to relax. Fortunately there is an end in sight. You can expect the last spate of spitup between 6 and 8 months, when baby spends most of her time upright and her digestive system has matured.