From birth until the age of about 6 months, infants can regurgitate small amounts of milk. Between 5 ml and 10 ml can come out during a feeding, when burping or after being breastfed or bottle-fed. Doctors consider these regurgitations as normal. Over 40% of babies suffer from regurgitations that do not affect their growth and their general state. Mild and occasional vomiting is often seen in babies who spit up daily.
The causes of regurgitations and mild vomiting are many
- Vigorous suction and swallowing when drinking;
- The baby is breastfed too often in between the feedings or drinks for too long during the feeding.
- Too much milk is available in the bottle, beyond the baby’s needs.
- Constant and powerful ejection reflex during breastfeeding;
- Immaturity of the oesophagus sphincter;
- Premature birth and low muscle tone (hypotonia);
- No or only few periods during which the baby is placed on his belly.
Despite the concerns of parents, if the baby is growing normally and does not cry or suffer from discomfort there is no need to see a doctor.
However, it is important to keep an eye on a baby who vomits a lot of milk, every time he drinks, for several days. Some clinics allow you to weigh your baby for free.
Projectile vomiting manifests itself through a violent expulsion of the content of the stomach. A large amount of milk could be projected away from the baby. Repeated projectile vomiting coupled with insufficient growth often indicates a serious condition. The liquid loss caused by the vomiting can result in dehydration. When the baby vomits blood, if he has fever and if his general condition deteriorates, it becomes an emergency and requires consulting a doctor.
Projectile vomiting can be linked to various diseases and pathological conditions such as:
- Pyloric stenosis or intestinal obstruction
- Acute gastroenteritis
- A pathology of the central nervous system
- A tumour
Gastroesophageal reflux disease (GERD)
The gastroesophageal reflux is the rise of the milk contained in the stomach into the oesophagus. Milk can remain in the oesophagus or come out as mild regurgitation or vomiting. Regurgitation considered normal happen during or shortly after drinking. Gastroesophageal reflux disease (GERD) appears most of the time between feedings. It causes medium to severe discomfort and more or less intense crying. The reflux of acid from the stomach into the oesophagus predisposes to irritation (esophagitis) and is responsible for crying and discomfort
Immaturity or abnormal functions of the oesophagus sphincter (LES) is the most frequent cause cited in GERD. Furthermore, a baby lying on the back is more vulnerable because it promotes the rising of milk. Since the ‘”Back to sleep” campaign developed by the Canadian Paediatric Society in 1991, to prevent sudden death syndrome, babies spend most on their time on their back and not enough on their belly when they are awake.
To reduce GERD and before seeking medical advice, some recommendations should be considered:
- Avoid overfeeding your baby. While feeding, burp your baby several times by placing your baby on your shoulder;
- Hold your baby in a vertical position for a few minutes after feeding;
- When your baby is awake before the feedings, place him on his tummy for a few minutes;
- Raise your baby during his sleep by placing a pillow under the mattress on top of the bed.
Paediatricians use medication for persistent or severe cases of GERD. Zantax and Prevacid are prescribed to reduce GERD. Some babies will be relieved of their discomfort and stop crying with this medication. However, despite the use of medication for several weeks, for many babies, parents and physicians observe very little changes in their health conditions. The general recommendation is to wait for the reflux to disappear progressively when parents will introduce solid foods or around their first birthday.