How common is spitting up?
Spitting of formula or breast milk is a common occurrence for most babies.  Rarely does this present a major health concern.  However, if frequent enough or if forceful large quantities of formula or breast milk are actually vomited, treatment may be necessary. If your child is diagnosed as having gastroesophageal reflux (GER) medication may be prescribed.
What are some of the reasons for “spitting?”
·         One common reason for spitting is over-feeding.  If the baby’s stomach is overfilled and distended, “milk” may not pass readily into the gut.  Instead, milk may be spit up because of the increase in pressure in the stomach.  It is important to feed your baby when he or she is hungry, but do not overfeed or force your baby to drink more formula or milk than he or she desires. (Please refer to general feeding guidelines under the topic “Feeding Your Baby.”)
·         Another reason for spitting is not burping your baby during the feeding. If your baby is a vigorous bottle feeder, air as well as liquid is being swallowed.  This air can build up in the stomach causing excess spitting.  Be sure to burp your baby after every 2-3 ounces of feeding.  Breast fed infants can be burped in between switching to the other breast.
·         Over stimulation after feeding can cause spitting as well. Try not to over stimulate your infant after feeding.  Limit active play prior to the feeding rather than after.
·         Positioning is important after feeding.  Babies have more of a tendency to spit if laid flat on their backs or if bent at the waist.  Both of these positions can encourage spitting.  The best position to place your infant after feeding is on his or her stomach with the head slightly elevated.  (Remember no pillows, instead elevate the mattress or use blocks under the crib to accomplish this.)
When should I call the baby’s pediatrician?
·         If your child is spitting more than ½ to 1 ounce each feeding.
·         If your child is choking on his feeding.
·         If you notice coughing or wheezing associated with feeding.
·         If you notice projectile “forceful” vomiting.
·         If a greenish tinge to the vomit is observed.
·         If you suspect your child is not gaining weight as he or she should.
·         If you observe any symptoms of dehydration such as dry mouth, decreased urination, lethargy (not as active as usual) or excessive sleepiness.
What treatments are helpful for spitting up?
Your physician may prescribe a different formula, especially if there is a family history of cow’s milk allergy or if your child exhibits other allergic symptoms, such as diarrhea, blood in the stools, wheezing, or skin rashes.  Call your physician if any of these symptoms persist before you make any formula changes.
If breast feeding, a mother’s diet can be changed slightly to avoid certain foods that can contribute to your baby’s spitting problem.  Sometimes, too much cow’s milk, chocolate, caffeine and other foods may be the culprit.  Before making any changes in your diet, discuss these with your physician.  A well balanced diet for nursing mother is essential while your baby depends solely on breast milk for his nutrition and for mothers to have proper energy food stores.
If formula feeding, one treatment that may be helpful is to gradually thicken the formula with rice cereal.  Start 1 to 2 tablespoons of rice cereal per 4 ounces bottle.  Gradually increase to 4 to 5 tablespoons of rice per 4 ounce bottle if needed.  Be sure that the nipple hole is large enough to allow an intermittent stream of formula and cereal to go through it, but not too fast that it may cause your baby to gag or choke.  If too much cereal is added to the formula, the mixture may be too thick for your baby to swallow.  Be sure to add cereal to the formula gradually to prevent this from happening.