Vomiting after breastfeeding – when to be concerned

Posted on September 13th, 2018

Is your baby vomiting after feeding? We investigate why this happens and when you should be concerned. By Kim Bell

Vomiting afte breastfeeding

There’s a reason why bibs and spit-up cloths were invented – because babies spit up. Usually after you have dressed them, and yourself, ready to go out, and you have to start the process all over again. Anne Smith, founder of Breastfeeding Basics, an International Board Certified Lactation Consultant, and a mother of six who has over 35 years’ experience in lactation counselling explains that nearly all babies will spit-up or vomit after some feedings. “In a healthy baby who is gaining weight well and has good urine output (six to eight wet cloth nappies or five to six disposable nappies) and at least three bowel movements in 24 hours, spitting up is more of a laundry problem than a medical one.

ALSO SEE: Everything you need to know about baby poo, pee and spit-up

According to research conducted Dr Neil Chanchlani, a specialist trainee in paediatrics for the Royal Free London NHS Foundation and his associate, the involuntary passage of a baby’s stomach contents back up the oesophagus, “is a common, normal psychological event”.

Dr Chanchlani explains that your young baby may regurgitate or vomit shortly after feeding several times. This common occurrence is known as gastro-oesophageal reflux or (GOR). Symptoms include refusal to feed, crying and back arching. “As the lower oesophageal sphincter has not yet matured, milk refluxes through the opening into the oesophagus, causing discomfort for the infant.” He adds that this usually resolves without further investigation or treatment.

However, it is recommended that doctors investigate further if gastro-oesophageal reflux disease (GORD) is suspected − particularly if the symptoms interfere with the baby’s quality of life and cause complications like poor weight gain, difficulty sleeping and recurrent chest infections.

“It can be difficult to distinguish between colic – excessive, frequent crying in an otherwise healthy baby – and GOR, GORD, or “fussy eating” because of the overlap of symptoms and the lack of useful investigations,” adds Dr Chanchlani, who cites one Australian study that revealed GOR was reported in almost a quarter of babies. “Symptoms commenced in the first month of life in 50% of the cases and was resolved by six months for 75% of infants.”

Anne concurs, saying that babies spit up for a variety of reasons, including gagging when the milk lets down too quickly, an oversupply of milk, immature muscle control, allergy or illness. Many times, the reason for the spitting-up can’t be determined. Most healthy babies will outgrow the spitting-up stage within four to six months,” she adds.

As long as this vomiting is not excessive and is not impacting her health or wellbeing, there is no cause for concern. However, if you are concerned that this is something more serious, such as GORD, then speak to your healthcare provider.

ALSO SEE: How to cope with your baby’s acid reflux

Minimise the spit-up

Anne offers the following tips for healthy, thriving babies:

  • Burp her often
  • Try to keep her in an upright position after feeding.
  • Feed frequently as smaller, more frequent feeds are easier to digest.
  • Have a spit-up cloth handy.
  • If you have loads of milk, and it seems like your baby is choking or gagging when your milk lets down and she spits up afterwards, try offering only one breast per feed. Anne suggests that you take her off the breast when your milk first lets down, and catch this spray in a towel, placing her back on the breast once the initial flow of milk has subsided.

ALSO SEE: How to burp your baby

Tip: If you are eating a lot of dairy products or have a family history of allergies, try cutting back or limiting allergenic foods in your own diet, such as milk, eggs or wheat. Remember that it can take up to two weeks to completely eliminate milk protein from your breastmilk, so allow for this and see if it makes a difference to your baby’s spit-up or vomiting.

Reflux  

This occurs when the muscle at the opening of the stomach open up at the wrong time, which causes the milk to back up into the oesophagus. The gastric juices are acidic, which can burn and irritate the throat and oesophagus, resulting in pain and discomfort (much like an adult’s version of indigestion).

Symptoms include:

  • Sudden or inconsolable crying
  • Refusing to feed or wanting to feed constantly
  • Difficulty swallowing
  • Vomiting, sometimes hours after feeding
  • Frequently sore or irritated throat
  • Breathing difficulties
  • Apnoea
  • Disrupted sleep
  • Slow or low weight gain.

Anne adds that research shows breastfed babies have fewer and less severe episodes of reflux compared to formula-fed babies, as breastmilk is more easily digestible. Most symptoms alleviate within six months to one year. “One common challenge to overcome when dealing with reflux is that since the baby experiences pain when she eats, she may decide she doesn’t want to nurse. This can be frustrating for both of you,” adds Anne. If your baby’s symptoms are severe, you will need to seek medical treatment. She recommends that, along with your doctor and caregivers’ support, you should consider treatment options available and find what works for both you and your baby.

ALSO SEE: 5 things you should know about caring for a baby with acid reflux

Pyloric stenosis

This is more severe than reflux, but is also rarer and is seldom found in breastfed babies. It is more common in males and develops around four to six weeks of age, says Anne. In this case, the baby projectile vomits, which means the stomach muscles force the milk up and out of his throat and mouth. Occasional projectile vomiting is not a problem, but if this is happening once a day or more, and your baby is not gaining or is losing weight, speak to your healthcare provider.