Babies spit up smells like vomit
Why does my baby spit up so much? — Plateau Pediatrics
Nearly all babies spit up to some degree. Occasionally, though, a baby seems to vomit so much that parents wonder if something is wrong.
Persistent spitting up in babies is called reflux (also called gastroesophageal reflux or GER.) Reflux is never concerning in an otherwise normal baby who is growing and developing normally. It will sometimes seem that a baby vomits more than he eats, and may seem amazing that he grows or gains weight at all! These "happy spitters" do quite well, and are chubby more often than scrawny. Most show significant improvement by 6 months of age, and almost all are better by their first birthday.
In our experience, most "spitty babies" are formula fed. This is because formula flows much faster from a bottle than human milk does from the breast. It's a lot easier to "overeat" when the baby doesn't have to work to get the milk. Babies also don't "know when to say when. " An infant's stomach is not much bigger than his two fists together; babies will try to eat more, resulting in vomiting. The baby will then be hungry again, causing a second rapid feeding (and often more vomiting.)
Reflux can be very smelly. Many parents are concerned when they see nasty-smelling curdled milk in their child's vomit. However, this is what milk mixed with stomach acid looks like; it's not a sign of something strange. Reflux can indeed be messy, but it's not harmful to an otherwise normal baby. If reflux bothers you, here are some things you can do to help it:
Feed your baby in the upright position.
Offer your baby smaller feedings that are more frequent. This is the single biggest change you can make to help reduce spitting up. For example, most one month olds spit up if they take 4 oz at a time every four hours. The same baby will probably be much less "spitty" with 2 oz every two hours - which is still the same total amount of milk in a 24 hour period.
Most newborns can only take an ounce or two at a time; most four-month-olds get "spitty" beyond 4 ounces at a time.Elevate the head of your baby's bassinet or crib at an angle of about 15 degrees. This gets gravity on your side. (Let your baby lie flat or stand up; a seated position such as in a car seat can actually cause more reflux.)
Burp your baby well in the middle of and after feedings. "Barracuda babies" who ravenously take a complete feeding in 10 minutes swallow lots of air with their milk.
Try a different type of bottle. There are new "airless" bottles that reduce the amount of air babies swallow with feedings, available at some of our local pharmacies. These bottles also result in slower milk flow, helping infants to feed slower overall.
Add a teaspoon of rice cereal to a bottle to thicken the feedings.
Let us know if the above suggestions don't work.
Sometimes we can recommend other changes if reflux persists, like prescription medication. Vomiting is rarely caused by formula intolerance, and so we don't usually recommend changing formulas simply for persistent spitting up.
Extremely forceful ("projectile") vomiting. Although seen in many normal children, it can be the sign of severe blockage if it happens more than once.
Dehydration, as seen by decreased saliva, tears, and urine (see our information sheet on dehydration.)
Weight loss or minimal weight gain in a child under the age of 1. Ask us if you are concerned about your baby's weight gain.
Peculiar vomit, containing bile (bright green) or blood (red or brown.)
Associated with other symptoms which are themselves concerning, like severe belly pain or distension, wheezing, profuse diarrhea, and/or severe skin rashes. These should be reported to your doctor immediately.
Spitting Up - Reflux
Is this your child's symptom?
- Spitting up small amounts of breastmilk or formula. Also called reflux.
- Spitting up 1 or 2 mouthfuls of milk at a time
- No effort or crying
- Normal symptom in half of young babies
Symptoms of Normal Spitting Up
- Smaller amounts often occur with burping ("wet burps")
- Larger amounts can occur after overfeeding
- Most often seen during or shortly after feedings
- Occurs mainly in children under 1 year of age
- Begins in the first weeks of life
- Caution: normal reflux does not cause any crying
Complications of Spitting Up (GERD)
- Most infants are "happy spitters." Normal spitting up (normal reflux) occurs in half of babies. It does not cause crying or colic.
- Normal crying occurs in all babies. Frequent crying (called colic) occurs in 15% of babies. Crying and colic are not helped by heartburn meds.
These meds also have side effects. - If they develop complications, it's called GERD (gastro-esophageal reflux disease). This occurs in less than 1% of babies.
Symptoms of GERD
GERD problems occur in less than 1% of infants:
- Choking on spit up milk
- Heartburn from acid on lower esophagus. Infants with this problem cry numerous times per day. They also act very unhappy when they are not crying. They are in almost constant discomfort.
- Poor Weight Gain
Cause
- Poor closure of the valve at the upper end of the stomach (weak valve)
- Main trigger: overfeeding of formula or breastmilk
- More than half of all infants have occasional spitting up ("happy spitters")
Reflux Versus Vomiting: How to Tell
- During the first month of life, newborns with true vomiting need to be seen quickly. The causes of vomiting in this age group can be serious.
Therefore, it's important to tell the difference between reflux and true vomiting.
Reflux
The following suggests reflux (normal spitting up):
- You've been told by a doctor your baby has reflux
- Onset early in life (85% by 7 days of life)
- Present for several days or weeks
- No pain or crying during reflux
- No effort with spitting up
- No diarrhea
- Your baby acts hungry, looks well and acts happy.
Vomiting
The following suggests vomiting:
- Uncomfortable during vomiting
- New symptom starting today or yesterday
- Forceful vomiting
- Contains bile (green color)
- Diarrhea is also present or
- Your baby looks or acts sick.
Pyloric Stenosis (Serious Cause)
- This is the most common cause of true vomiting in young babies.
- Onset of vomiting age 2 weeks to 2 months
- Vomiting is forceful. It shoots out of the baby's mouth. This is called projectile vomiting.
- Right after vomiting, the baby is hungry and wants to feed. ("hungry vomiter")
- Cause: the pylorus is the channel between the stomach and the gut. In these babies, it becomes narrow and tight.
- Risk: weight loss or dehydration
- Treatment: cured by surgery.
When to Call for Spitting Up - Reflux
Call Doctor or Seek Care Now
- Blood in the spit up
- Choked on milk and turned blue or went limp
- Age less than 12 weeks and spitting up changes to vomiting (forceful or projectile)
- Age less than 1 month old and looks or acts abnormal in any way
- Your child looks or acts very sick
- You think your child needs to be seen, and the problem is urgent
Contact Doctor Within 24 Hours
- You think your child needs to be seen, but the problem is not urgent
Contact Doctor During Office Hours
- Chokes a lot on milk
- Poor weight gain
- Frequent crying
- Spitting up is getting worse
- Age more than 12 months old
- Spitting up does not get better with this advice
- You have other questions or concerns
Self Care at Home
- Normal reflux (spitting up) with no problems
Seattle Children's Urgent Care Locations
If your child’s illness or injury is life-threatening, call 911.
- Bellevue
- Everett
- Federal Way
- Seattle
- Virtual Urgent Care
Care Advice for Spitting Up (Reflux)
- What You Should Know About Spitting Up:
- Spitting up occurs in most infants (50%).
- Almost always doesn't cause any pain or crying.
- Spitting up does not interfere with normal weight gain.
- Infants with normal reflux do not need any tests or medicines.
- Reflux improves with age.
- Here is some care advice that should help.
- Feed Smaller Amounts:
- Skip this advice if age less than 1 month or not gaining weight well.
- Bottlefed Babies. Give smaller amounts per feeding (1 ounce or 30 mL less than you have been). Keep the total feeding time to less than 20 minutes. Reason: Overfeeding or completely filling the stomach always makes spitting up worse.
- Breastfed Babies. If you have a good milk supply, try nursing on 1 side per feeding. Pump the other side. Switch sides you start on at each feeding.
- Longer Time Between Feedings:
- Formula. Wait at least 2½ hours between feedings.
- Breastmilk. Wait at least 2 hours between feedings.
- Reason: It takes that long for the stomach to empty itself.
Don't add more milk to a full stomach.
- Loose Diapers:
- Do not put the diaper on too tight. It puts added pressure on the stomach.
- Don't put pressure on the stomach right after meals.
- Also, do not play too hard with your baby during this time.
- Upright Position:
- After meals, try to hold your baby in the upright (vertical) position.
- Use a front-pack, backpack, or swing for 30 to 60 minutes after feedings.
- Decrease the time in a sitting position (such as infant seats).
- After 6 months of age, a jumpy seat is helpful. The newer ones are stable.
- During breast or bottle feeds, hold your baby at a slant. Try to keep your baby's head higher than the stomach.
- Less Pacifier Time:
- Frequent sucking on a pacifier can pump the stomach up with swallowed air.
- So can sucking on a bottle with too small a nipple hole.
- The formula should drip 1 drop per second when held upside down.
If it doesn't, the nipple hole may be clogged. Clean the nipple better. You can also make the nipple hole slightly bigger.
- Burping:
- Burping is less important than giving smaller feedings. You can burp your baby 2 or 3 times during each feeding.
- Do it when he pauses and looks around. Don't interrupt his feeding rhythm in order to burp him.
- Burp each time for less than a minute. Stop even if no burp occurs. Some babies don't need to burp.
- Add Rice Cereal to Formula:
- If your baby still spits up large amounts, try thickening the formula. Mix it with rice cereal.
- Start with 1 level teaspoon of rice cereal to each ounce of formula.
- Acid Blocking Medicines:
- Prescription medicines that block acid production are not helpful for normal reflux.
- These medicines also can have side effects.
- They do not reduce excessive crying from colic.
- They are only useful for symptoms of heartburn.
- What to Expect:
- Reflux gets better with age.
- After learning to sit well, many babies are better by 7 months of age.
- Call Your Doctor If:
- Spitting up changes to vomiting (forceful or projectile)
- Poor weight gain
- Your baby does not get better with this advice
- You think your child needs to be seen
- Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Last Reviewed: 04/18/2023
Last Revised: 12/30/2022
Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.
Spitting up and vomiting in infants
Spitting up and vomiting in babies is a common reason for visiting a doctor.
Regurgitation and vomiting is a reflex action that occurs when receptors located in various anatomical zones are irritated, incl. in the stomach, esophagus, pharynx, oral cavity. The signal is transmitted to the vomiting center, which is located in the medulla oblongata and a gag reflex occurs.
What is the difference between regurgitation and vomiting?
The difference lies in the volume and kinetics (movement) of the gastric contents expelled to the outside. When regurgitation occurs, leakage occurs without the participation of the diaphragm and abdominal muscles, i.e. passively. There is little content, up to about 10-15 ml. If the child does not swallow it, it quietly expires from the oral cavity. When vomiting, a wave-like bending of the upper half of the body occurs as a result of contraction of the muscles of the diaphragm and the anterior wall of the abdomen, the volume of vomit is greater, and they are erupted with pressure from the oral cavity with an ejection trajectory of up to 50 cm.
In children of the first year of life, this is defined by the term "fountain vomiting" .
Regurgitation is observed only in children of the first year of life and, mainly, up to 6 months. Contribute to this anatomical and physiological features of the esophagus and stomach of the baby. Their esophagus is short and wide, the angle of connection of the esophagus with the stomach is less pronounced, and its obturator function is weak. These regurgitations are physiological. They can be after each feeding, up to 15 ml, do not affect the well-being and weight gain of the baby. They can also be caused by excessive feeding, aerophagia (swallowing air while sucking), straining during intestinal colic. The frequency and volume of such regurgitation decreases with the growth of the child. With the introduction of complementary foods, and this is a thicker food, regurgitation stops or becomes much less frequent.
If regurgitation persists in a child older than 1 year, then this is a sign of a pathological process.
Vomiting, unlike regurgitation, is accompanied by vegetative symptoms - increased salivation, pallor of the skin, palpitations. This is due to the fact that next to the vomiting center there are additional centers of autonomic regulation, which are reflexively excited, and active biological substances such as serotonin, dopamine, histamine and others are released into the blood.
Regurgitation and vomiting, from the moment of eating, may occur during feeding, after feeding for the first 20-30 minutes or delayed, sometimes after several hours.
Regurgitation and vomiting that occurs immediately after feeding unchanged breast milk or formula may be due to narrowing of the esophagus. If they persist until the next feeding, and the milk / mixture is curdled, has a sour or musty smell, then this is the result of a long standing food in the stomach. The reason for this may be the low tone of the muscle layer of the stomach and, as a result, its peristalsis or narrowing of the output section due to an anomaly in the development or high tone of the sphincter of the lower stomach.
With narrowing of the duodenum, bile is present in the regurgitated masses.
Gastroesophageal reflux is a common cause of regurgitation in infants. It is likely that there is a complex problem here, starting with the immaturity of the gastrointestinal tract and disorders of the central nervous system. Perinatal injuries of the central nervous system accompany every second child. Their manifestations are varied. Regurgitation and vomiting can be facilitated by an increase in intracranial pressure, disorders in the segment of the cervical spine, and so on. Therefore, quite often, when carrying out rehabilitation measures for neurological dysfunctions, a positive effect is manifested in the form of a decrease or cessation of regurgitation. A hernia of the esophageal opening of the diaphragm will also manifest itself in a similar way.
We should not forget about allergic gastrointestinal reactions in the form of regurgitation and vomiting. The most common cause of this is cow's milk protein.
With intolerance to cow's milk protein, inflammation of the mucous membrane of the esophagus, stomach and intestines occurs. And, as a result of this, regurgitation and vomiting, pain and increased gas formation, diarrhea or constipation.
Rare endocrine disorders (adrenogenital syndrome) are manifested by vomiting in children from the first weeks of life. In such cases, vomiting is frequent, there may be an admixture of bile, the child loses weight due to loss of fluid and nutrients, and severe metabolic disorders develop.
Vomiting can also be caused by an intestinal infection. Viral gastroenteritis is now common. It must be remembered that the younger the child, the more severe the disease. Within a few hours, the child's condition can go from satisfactory to extremely serious.
As you can see, the causes of regurgitation and vomiting in children of the first year of life are quite diverse, but most often these are transient conditions that disappear with the growth of the child.
Prevention of regurgitation in children of the first months of life is quite simple. Don't overfeed your baby. If he cries, it does not always mean that he is hungry. Excess feeding leads to increased gas formation and colic, during which the child is worried, straining, thereby increasing the likelihood of spitting up. After feeding, hold the baby more upright so that he can burp the swallowed air. This will take 15-20 minutes. If the child is bottle-fed, do not change his formula milk without the recommendation of a pediatrician.
If the child has frequent regurgitation and vomiting, it is necessary to consult a pediatrician or gastroenterologist to diagnose the cause. To make a diagnosis, it is sometimes enough to carry out simple and affordable diagnostic methods in a polyclinic. These include an ultrasound of the stomach and, if necessary, stool tests. However, the approach in each case is individual. Examination and treatment will be assigned to your baby, depending on the diagnosis.
Perhaps it will be preventive measures or a certain milk formula, perhaps drug therapy. Rarely, but it happens that it is necessary to examine the child in a hospital and surgical treatment.
Regurgitation and vomiting in children. When to see a surgeon
The regurgitation syndrome is one of the most common reasons for parents of small children to visit a pediatrician and a surgeon. The causes of regurgitation in children under 1 year old are different: anatomical and functional features, neurological disorders, infectious processes, malformations or other problems. The mechanism that prevents regurgitation and vomiting in children is very complex and depends on the anatomical structure and physiological processes of the child. The formation of this mechanism occurs in the last trimester of pregnancy and continues in the first months of a child's life. Although regurgitation and vomiting can be a symptom of various diseases, in themselves these processes are physiological, i.
e. normal. The pathological reflux of stomach contents into the esophagus is called gastroesophageal reflux, and the mechanism that prevents vomiting is called the antireflux mechanism.
Anti-reflux mechanism in children
In children, the nervous regulation of the antireflux mechanism is very complex and easily disturbed under the influence of external and internal factors. Regurgitation and vomiting easily occur in children with an immature antireflux mechanism, if the mode or volume of feeding is incorrectly selected, as a reaction to artificial mixtures, at the slightest sign of infectious processes. This is especially often observed in children with intrauterine growth retardation and premature babies, as well as in severe pregnancy and toxicosis, caesarean section, complicated childbirth, etc.
When to see a doctor
Despite the fact that moderate spitting up in a child under 6 months is considered a variant of the norm, parents should definitely tell the pediatrician about this during a routine examination.
The reason for serious concern and immediate examination of the child is an increase in the frequency or increase in the volume of regurgitation, the appearance of streaks of blood or bile impurities, a lag in recruitment or weight loss, and high temperature. In this case, it is urgent to consult a surgeon to rule out surgical causes.
Diagnostics
In most cases, an ultrasound examination (ultrasound) is necessary to establish an accurate diagnosis and select the correct treatment. An experienced doctor of ultrasound diagnostics helps to establish the correct diagnosis in more than half of the cases. Sometimes, for a more accurate diagnosis, a flexible gastroscopy, X-ray examination, or computed tomography of the abdominal organs is performed.
When surgery is required
Pyloric stenosis, or impaired patency of the gastric outlet, is the cause of the most severe regurgitation syndrome (vomiting "fountain") in children under 2 months, accompanied by severe weight loss and progressive deterioration of the child's condition.
This disease requires urgent surgical care. In leading clinics, such operations are performed using a minimally invasive laparoscopic method. The current level of development of surgery and pediatric anesthesiology allows the use of endoscopic surgery techniques even in children in the first weeks of life.
There are also other causes of regurgitation that require surgical intervention, such as hiatal hernia, chalazia (gaping) of the esophagus, and others. These malformations are characterized by a violation of the formation of the antireflux mechanism and lead to constant regurgitation in a child, impaired weight gain, decreased appetite, chronic cough, bronchial asthma, and anemia. If drug therapy is ineffective, then a gastrofundoplication operation is indicated, in which an artificial antireflux valve is surgically formed. Like many other interventions, in modern children's clinics this operation is performed laparoscopically - with less trauma, minimal blood loss, minimal cosmetic defect and a quick recovery of the child after the operation.
Of course, vomiting and regurgitation can be symptoms of many other diseases and occur at any age of the child. Thus, vomiting is often observed in acute appendicitis and intestinal obstruction, it can be a symptom of an intestinal infection, intoxication, etc. In addition to the disease itself, vomiting and profuse regurgitation are dangerous because the child loses a large amount of water and salts necessary for life, which can lead to dehydration - exsicosis. The younger the child, the faster the disruption of compensatory mechanisms and the worsening of his condition. Therefore, the appearance in a child of symptoms of vomiting or severe regurgitation in young children requires immediate medical attention to identify the causes, establish the correct diagnosis and select the optimal treatment, and, if necessary, surgical.
Experienced pediatricians and surgeons are on duty around the clock at the EMC Children's Clinic, providing emergency and planned care to children of all ages, starting from the first days of life.
