08.03.2017

Regurgitation is the spontaneous reflux of gastric contents into the esophagus and mouth. This condition is not uncommon in infants and is often a cause for concern for parents. The frequency of regurgitation syndrome in children of the first year of life is 18-50%: up to 4 months - 67%, up to 6 months 24%, up to 1 year 5%. In most cases, regurgitation is "benign" and disappears on its own after 12-18 months. At the same time, “benign” or physiological regurgitation characterizes:

• the age of the child is up to 12 months;

• spitting up 2 or more times a day for 3 or more weeks;

• sufficient weight gain;

The child has no signs of metabolic disorders, diseases of the gastrointestinal tract or the central nervous system. The child does not experience difficulty in swallowing or feeding, there is no forced position of the body.

Do not confuse regurgitation with vomiting. When a child burps, the abdominal muscles do not tense up. With vomiting, on the contrary, muscle tension occurs and food is ejected by pressure not only through the mouth, but also through the nose. In some cases, there may be general anxiety, pallor, cold extremities. Often with vomiting, the temperature rises, loose stools appear, which is a sign of an infectious disease. Vomit may contain unchanged milk, mucus, blood or bile.

What explains physiological regurgitation

What is the tendency of babies to spit up? This phenomenon is explained by the peculiarity of the structure of the gastrointestinal tract of young children. At the age of one year, the esophagus is shorter and wider, physiological narrowing is weakly expressed. The stomach is located horizontally, its capacity is small, and the muscles that close the entrance to the stomach and prevent the contents from being thrown back into the esophagus are poorly developed. As the child begins to walk, the axis of the stomach becomes more vertical. The capacity of the stomach increases by the year from 30-35 ml to 250-300 ml. The secretory apparatus matures, the work of the closing muscles (sphincters) improves, which leads to a gradual decrease in the frequency and disappearance of regurgitation. These features explain the predisposition of young children to regurgitation and even the inevitability of this condition. However, there are measures to help reduce the frequency of regurgitation.

Factors contributing to physiological regurgitation include:

1. Overfeeding. As a rule, actively sucking babies begin to suffer from overfeeding, with abundant milk secretion, as well as when switching to artificial or mixed feeding with an incorrect calculation of the required amount of milk formula. Regurgitation appears immediately or some time after feeding in the amount of 5-10 ml. Milk can flow out unchanged or curdled.

2. Swallowing air during feeding (aerophagia). A similar situation arises if the child suckles greedily at the breast, and the mother's milk is not very plentiful; due to the retracted, flat nipple of the mother's breast, since the child fails to fully capture the nipple and areola; with artificial feeding, if the hole at the nipple of the bottle is large enough or the nipple is not completely filled with milk. Babies with aerophagia often experience anxiety after feeding, bulging of the abdominal wall (belly inflates). After 10-15 minutes, the swallowed milk flows out unchanged, which is accompanied by a loud sound of air eructation.

3. Intestinal colic or constipation. These conditions lead to an increase in pressure in the abdominal cavity and a violation of the movement of food through the gastrointestinal tract, causing regurgitation.

Until the child is four months old, spitting up up to two teaspoons of milk after feeding, or one spitting up of more than three spoons during the day, is considered the norm. You can check the amount of spitting up in the following way: take a diaper, pour one teaspoon of water on its surface, and then compare this spot with the spot formed after the next spitting up.

Pathological regurgitation may be due to:

• surgical diseases and malformations of the digestive system;

• diaphragmatic hernia;

• pathology of the central nervous system, trauma of the cervical spine during childbirth;

• food intolerance, lactase deficiency;

• increased intracranial pressure.

Such regurgitation is characterized by intensity, systematicity, the child spits up a large amount of milk. At the same time, there is a violation of the general condition of the baby - the child is whiny, loses or does not gain weight, cannot eat the amount of food necessary for his age. In such a situation, a pediatrician, gastroenterologist, surgeon, allergist, neurologist should be examined. It also requires examination and exclusion of anomalies in the structure of the upper gastrointestinal tract, the preservation of regurgitation for more than 1 year.

Scale for assessing the intensity of regurgitation:

1. Less than 5 regurgitations per day with a volume of not more than 3 ml - 1 point.

2. More than 5 regurgitations per day with a volume of more than 3 ml - 2 points.

3. More than 5 regurgitations per day up to half the amount of formula or breast milk, not more often than in half of the feedings - 3 points.

4. Spitting up a small amount of milk for 30 minutes or more after each feeding - 4 points.

5. Regurgitation from half to full volume of formula or breast milk in at least half of the feedings - 5 points.

Regurgitation with an intensity of 3 or more points requires a visit to a doctor.

Preventive measures against regurgitation in children

If regurgitation is physiological in nature, then it is not worth treating or correcting in this case. It is necessary to deal with the elimination of the cause, if possible, and carry out prevention.

Prevention of regurgitation in children includes the following measures:

1. Postural therapy: when feeding, it is necessary to hold the baby at an angle of 45 °, make sure that he completely grasps the nipple with the areola; after feeding, hold the baby in an upright position ("column") for 20 minutes - to drain the swallowed air. Due to this, the air that has entered the stomach will be able to go out. If nothing happened, then put the baby down and after a minute or two, lift him upright again.

2. Make sure that the opening in the bottle is not too large and that the nipple is filled with milk. Experiment with nipples - perhaps the other will be better. Milk should come out in drops, not a trickle.

3. Before you start feeding your baby, lay him belly down on a solid base.

4. After feeding, try to minimize the baby's physical activity, do not disturb him unnecessarily, and change clothes only if there is an emergency.

5. Avoid squeezing diapers or clothes on the abdomen of the child.

6. If the baby's appetite is good, then it is better to feed him often, but in small portions, otherwise, due to the large amount of food, the stomach may overflow, and this, as a result, leads to regurgitation of excess food.

7. The surface in the bed on which the baby lies should rise 10 cm at the head.

8. In addition, it is possible to use special "thickeners" of milk or anti-reflux mixtures, which the doctor will help you choose.

In the event that regurgitation begins to become more frequent or becomes abundant, or first began after six months of the baby's life, or does not subside by one and a half to two years of life, the child should be consulted by a pediatrician. With a high probability, additional help from a gastroenterologist will be needed.

In our Family Medical Center you can always find highly professional help.

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why baby spit up after feeding

If a child spits up after feeding, this is in most cases due to the anatomical immaturity of the upper digestive system. More often than others, premature babies, babies with congenital pathologies suffer from regurgitation. Sometimes the cause is the wrong breastfeeding technique.

Regurgitation in infants is perhaps the most common occurrence in modern pediatrics. More than half of children spit up at least once a day, which is almost always a physiological reaction.

As the baby grows older, spitting up less and less and by 6 months it practically stops doing it. However, sometimes the problem remains, and burping continues for up to a year. In such a situation, you need to make sure that the gastrointestinal tract is functioning normally and consult a doctor.

Why does the baby spit up after every feed

There is a very simple explanation for this. The esophagus of newborns is a funnel with a wide part at the top, and the sphincter at the transition to the stomach actually gapes and hardly retains food.

Normally, after food enters the stomach, the sphincter contracts and prevents it from “returning” into the esophagus. But in this case, when the stomach is full, part of the contents immediately comes out if the baby takes an inclined or horizontal position.

Babies have two more features: increased pressure over the lower esophageal sphincter, as well as a straight and sometimes obtuse angle of His, formed by the side walls of the esophagus and stomach. In adults, this angle is sharp, which also prevents the return of food eaten into the esophagus.

After feeding, do not put the baby on his stomach, it is better to hold him upright in your arms, trying not to put pressure on his chest. But if he still burps, you should not worry, this is a normal process. If in doubt, please contact our doctors. At a remote consultation, they will explain the causes of regurgitation, talk about pathologies. If necessary, they will tell you which specialists to go through.

A few more reasons why a child often spit up

Physiological belching after feeding is due to two factors: swallowing air (aerophagia) and increased intra-abdominal pressure. The first is usually associated with fast and greedy suckling, improper attachment of the baby to the breast, or the wrong position of the bottle when it comes to artificial feeding. An air bubble forms in the stomach, pushing out a small amount of milk or formula.

The same results are obtained by a quick change in the position of the baby's body after feeding, which will easily burp if it is immediately started to swaddle, shake, bathe or massage. After all, his stomach resembles an open bottle: tilted / turned over - the contents spilled out.

As for the increase in intra-abdominal pressure, it increases with a too tight-fitting diaper or tight swaddling, as well as against the background of increased gas formation, intestinal colic or stool retention.

Regurgitation in newborns after feeding may be due to the lack of a feeding regimen and overeating.

Baby burps an hour after feeding: what does it mean

The most common cause is constipation, which increases intra-abdominal pressure. Food moves slowly through the gastrointestinal tract, so the child can burp an hour or two after feeding.

Attention! Delayed regurgitation combined with delayed defecation may be a sign of a lazy stomach. But such a diagnosis should be made by a doctor.

5 causes of regurgitation in newborns after formula feeding

The selection of artificial nutrition is a purely individual process with an unpredictable result. There is no 100% guarantee that the mixture will suit the child, even if the brand is very popular.

Poor digestion of the mixture may well cause not only frequent spitting up, but also other digestive problems, including colic, constipation and allergic reactions. In addition, store-bought baby food has a denser texture than breast milk and lasts longer in the stomach. Therefore, the likelihood of its reverse promotion to the esophagus after feeding is higher.

Your baby may spit up after every feed because:

• the proportions of dilution of the mixture are violated;
• the feeding regime is not observed;
• the transition from breastfeeding to artificial feeding was too abrupt;
• the wrong bottle is selected;
• allergy.

Improper mixing ratio

Each manufacturer indicates on the packaging of the mixture how much water is required to dilute it, and what volume is suitable for the baby by weight and age. Sometimes mothers mistakenly or intentionally dilute food in a way that is not recommended, and the child eats more than normal. As a result, the surplus, of course, comes out.

Case study:

After 3 months, a breastfed child suddenly began to behave restlessly, sleep poorly, spit up after eating, weight gain became slightly below normal. From a conversation with the mother, the doctor learned that the baby was fed too often, the feeding regimen was not observed. After increasing the intervals between breastfeeding, the regurgitation stopped.

Refusal of night feedings is also undesirable: the daily volume of food is distributed during the daytime, which leads to stomach overload and regurgitation.

Feeding schedule not followed

Unlike natural, artificial feeding involves eating by the hour.

Baby food takes longer to digest, so the recommended interval between feedings is at least 3 hours. If you feed the child more often, he will “give out” the excess back, since the previous portion has not yet been absorbed.

Abrupt transition from breastfeeding to artificial feeding

When changing the diet, the child's body must first get used to, adapt to the new food. This applies not only to the transition from breastfeeding to artificial feeding, but also from one type of mixture to another.

Wrong bottle selected

This refers to the too wide neck of the container, because of which the child swallows a lot of air along with food. Its discharge will provoke regurgitation after feedings.

Allergy

An allergic reaction to cow's milk protein causes inflammation of the intestinal wall, which in turn leads to malabsorption. Carbohydrate metabolism worsens, since secondary lactase deficiency occurs against the background of an inflammatory reaction - a decrease in the synthesis of the lactase enzyme.

As a result, sugar is broken down incorrectly, increased gas formation occurs, and the baby spits up a fountain. In addition, the baby may feel discomfort at the beginning of feeding and react with an increase in nervous excitability during the period of increased intestinal motility. This also often leads to belching.

What does curd regurgitation mean

Belching with curdled milk after feeding only indicates that the food was in the stomach for some time and managed to curdle - it was fermented. The reason may be in a change in body position or indicate pyloric stenosis with profuse vomiting with a fountain.

Attention! When spouting against the background of pyloric stenosis, the child spits up profusely, the jet scatters to a distance of half a meter.

What to do

First you need to make sure that you really need to do something. Pediatricians are advised to determine the intensity and frequency of regurgitation on a five-point scale.

Now you can determine if there really is a problem. The criteria are:

• the baby is not yet a year old;
• he spits up 2 times a day for 3 weeks or longer;
• before burping there are no precursors, specific signs;
• during regurgitation, the tension of the anterior abdominal wall is not felt;
• there are no difficulties with swallowing, sucking, the child does not take any specific forced position;
• the baby does not begin to sweat a lot, turn pale after burping, and feels normal;
• he is active, has a good appetite, and is gaining weight appropriately for his age.

The above points indicate that everything is in order.

If the intensity and frequency of spitting up is 3 points or more, this is a reason to consult a doctor. Our doctors are ready to advise on all issues at any time of the day. At a remote consultation, possible causes will be identified, and a plan of further actions will be drawn up.

How parents determine the amount of rejected food

Normal regurgitation after feeding occurs in small volumes, within 1-2 tablespoons. You can determine how much food came out when you burp.

When the child burps into the diaper, you need to pour 1 tbsp nearby. l. water and compare the size of the spots. If they are almost the same, there is no reason to worry.

Alarm symptoms

Medical assistance is necessary if the child spits up a lot after feeding, while crying and acting up. A bad symptom is the requirement of supplementary feeding, that is, the baby remains hungry after he has eaten his portion.

Serious illnesses can present with symptoms such as:

• sudden weight loss, weight gain does not meet the standards;
• lack of stool;
• profuse vomiting with an admixture of bile;
• urination less than 8-10 times a day;
• continued spitting up after the child is one year old.

How to deal with regurgitation: a step-by-step guide

If the baby is spitting up after feeding breast milk or formula, you can start with a nutritional correction. When breastfeeding, it is important to ensure that the baby completely captures the nipple along with the areola. His lower lip is usually slightly twisted.

Step 1

It is better to feed the baby while sitting, holding the baby at an angle of 45-60 ° to the chest. In this position, the air freely leaves the stomach, due to which the likelihood of reflux of food into the esophagus is reduced. After eating, it is preferable to put it on its side in a crib: this way, when returning from the stomach, the masses will not enter the respiratory tract. If the child burped while lying on his back, you should lift him up and turn him face down.

Step 2

After the baby has eaten, it must be held upright (pose of a soldier) for at least 20 minutes.

Step 3

You can partially remove the air from the stomach before feeding, putting the baby on the stomach for 10-15 minutes. With a tendency to intestinal colic, a light massage of the abdomen, which is done in between meals, will help.

Step 4

Even if the child is constantly spitting up, this is not a reason to transfer him to artificial mixtures. But a clear feeding regimen is desirable after a more or less strict period of time. In addition, mom should follow a hypoallergenic diet and exclude foods that can provoke flatulence - cabbage, legumes, black bread.

Step 5

For artificial babies, it is preferable to use a special anti-colic bottle and a nipple with a special design. The bottle has a valve that prevents you from swallowing air while eating. It is also necessary to make sure that the milk does not flow like a river, but slowly drips, that is, the hole in the nipple must have the appropriate diameter.

Step 6

When buying a mixture for a spitting up baby, it is better to consult a pediatrician. He may recommend a hypoallergenic formula or a formula that does not contain bovine protein. For some children, the so-called anti-reflux mixture is suitable.

Step 7

Normally, complementary foods are introduced from the 4th month of a child's life, but in the presence of regurgitation, it is allowed to include food thickeners in the diet after the 1st month. It can be mixtures with rice flour, rice porridge without milk. But they are used in an amount of a maximum of 1 tsp. in one feeding.

Step 8

Do not swaddle too tightly, massage, and generally somehow disturb the child after eating. You can only lightly pat him on the back, putting him on his knees, to prevent spitting up.

Step 9

Is the child overeating? To check this, you just need to weigh it before feeding and after. And it does not matter what he eats - mother's or artificial milk.

FAQ

What symptoms should you call an ambulance for?

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If, after spitting up, the child does not breathe or has lost consciousness; lips and face take on a bluish tint; reflux - gastric contents - has a green or brownish color, which may indicate intestinal obstruction, gastric bleeding.

Why does a baby spit up breast milk, but formula does not?

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If everything is in order with the calculation of “doses”, and there is no overfeeding with breast milk, most likely it is lactose intolerance. To clarify the diagnosis, it is necessary to take tests.

Should I supplement my baby if he burps?

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No, by no means.

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