Spitting Up in Babies, Vomiting, Color, and Texture

Spitting up in infants is normal; however, but sometimes it’s not.

Spitting up is the mild vomiting or regurgitation of food, milk, and saliva that can occur in infants. Spitting up is not forceful and does not contain large amounts of food and fluids. Spitting up is very common among normal infants. Fewer than half of infants spit up on a regular basis, and almost all infants spit up at least once in a while.

Spitting up usually occurs right after feeding or burping. The spit up fluid may look just like the formula or milk that was just fed or may appear slightly curdled. The amount of fluid spit up is usually just a small portion of the feeding, but it often appears to be much more. The infant seems otherwise well and does not seem hungry until the next feeding. Gentle patting on the infant's back should be all that is required during a spitting up episode.

When we eat or drink, food passes down the feeding tube or esophagus and into the stomach. In the stomach, the food mixes with acids and passes slowly into the intestines for further digestion.

A valve between the esophagus and the stomach helps prevent food from coming back up and out of the stomach. In infants, this valve is not well developed and can more easily allow food to go back up the feeding tube and cause spitting up. Because the infant's stomach is small, feeding too much or swallowing too much air can help push food past the valve. As the infant grows and the valve develops, food is less likely to pass this valve and travel up the esophagus. Also, as the infant begins to take solid foods, the spitting up usually decreases.

When to call the doctor

If your baby shows signs of dehydration (which may be difficult to recognize in infants) that include, a decrease in the number of wet diapers; a sunken soft spot (fontanelle) on the top of the head; has a lack of tears when crying, is lethargic, or extremely irritabitable call your newborn's pediatritian for evaluation.

If weight loss is a concern: Normal infant spitting up should not cause a loss of weight. If this is a concern, the doctor should be contacted to check the child's weight in order to compare this to previous measurements. If the spitting up is forceful and shoots out of the mouth (pyloric stenosis). This type of vomiting can be a sign of a condition called pyloric stenosis. This condition usually appears in the first several weeks of life and is caused by an abnormal narrowing of the valve leading from the stomach to the intestine. This causes gradually worsening projectile vomiting after every feeding that usually develops over several days.

Affected children seem hungry between feedings and may lose weight or become dehydrated. Pyloric stenosis is diagnosed based on physical exam as well as an ultrasound or X-ray that shows the narrowing of the valve to the intestines. Pyloric stenosis is treated with a minor surgical procedure. If other worrisome signs of illness appear, including fever, diarrhea, difficulty breathing, or abnormal fussiness. If the material being spit up contains excessive mucous or blood. Generally, spitting up in newborns is not simple and should be evaluated by the doctor.

When to go to the hospital

Normal infant spitting up does not require emergency treatment. The following situations may signal a different, more serious cause for the vomiting, and the child should be taken to the hospital's emergency department. If the infant stops breathing, becomes limp, or has any blue color change during a spitting up episode: With normal spitting up, the child may choke or gag briefly but should not stop breathing or turn blue. If the spit up appears green or brown: A green or brown color of the spit up may be a sign of a blockage in the intestine. If for any reason the child appears to be seriously ill and in your judgment cannot wait to be seen at the doctor's office

Usually, the physician can diagnose normal spitting up based on a detailed history and physical examination. X-rays or blood tests are required only in rare cases to exclude other more serious causes of the spitting up.

Because spitting up is normal in infants, no treatment is required if the child is otherwise healthy and developing well. However, some changes in the feeding technique may help reduce the number of episodes or the amount of the spitting up.

The following feeding techniques may help with spitting up:

• Burp the infant frequently (after every 1-2 ounces) to prevent the build-up of air in the stomach.
• Feed more slowly to allow the stomach contents more time to empty into the intestines.
• Be careful not to feed too much at a time and to stop feeding when the infant seems full.
• Keep the infant upright after feeding for at least 15 minutes. This allows gravity to help prevent the stomach contents from coming up.
• Try to avoid significant activity immediately after feeds. Agitation of the stomach contents may result in more spitting up.

If the child is otherwise well, no specific treatment may be needed other than the feeding techniques mentioned for home care.

Occasionally, the spitting up may be so frequent that the infant may not gain weight appropriately. This is much more concerning and may require specific tests and more aggressive treatment. If the testing confirms gastroesophageal reflux, the treatment may include careful feeding techniques and possibly medications.

Thickening formula with rice cereal may be helpful. This approach should only be considered after reviewing your child's particular situation with his/her pediatrician.

Medications are sometimes prescribed for gastroesophageal reflux. Some medications such as ranitidine (Zantac) help neutralize the stomach acids and protect the sensitive lining of the esophagus, which is being exposed to the stomach acid with the spitting up. Others such as omeprazole (Prilosec) or lansoprazole (Prevacid) help stimulate the stomach to empty into the intestines faster.