differentiating "normal" spitting up from "allergic" spitting up/reflux

[riomidwife]

Ladies, in your opinion, when does normal infant spit up head into the realm of food reactions? My first was so refluxy I have no idea what is typical (beyond 6-8 weeks when I stop seeing babies in my practice). When do you think it warrants investigation in terms of frequency, quality, other signs and symptoms....Thank you!

[Letitia]

That's something I wondered about myself.

Both my kids spat up a lot and for a long time.  My younger is 2-1/2, so it's been long enough that my memory isn't totally clear, but with the first especially I wondered if she would be given a diagnosis if I mentioned it to her pediatrician.  I never mentioned it because both of them grew well and were generally healthy.  I think they probably spat up maybe 6 times a day?  Sometimes quite a large amount.  My partner was worried with our first that she was spitting up her whole feed, but somewhere we heard to spill just one ounce of fluid on the counter and see how much that looks like (it looks like a lot).  Doing that was very reassuring.  There was no way she was spitting it all up.  They both spat up until they were well over a year, and after they started eating solids it seemed more with breastmilk than with other food.

The key for me in not mentioning it to the pediatrician was that they both seemed to be doing so well, and my first was an especially happy, easy baby. 

[CrunchyChristianMama]

For my girls, who both responded horribly to dairy, the spit up became curdled and smelly and was accompanied by extra fussiness and trouble sleeping.

[tanyalynn]

I don't know either.  It's only in retrospect that I realized that DD's spitting up wasn't within the range of healthy--but she was my first kid, and I knew next to nothing about babies.  I think she was over a year the very last time she spit up, and she was getting over half her calories as solids at that point.  But as for how much (if any) spit up is normal at, say, 3 or 4 months?  I don't know.  With DD, I had some other things that didn't seem blatantly *bad* but they were atypical, and together, I think I should've clued in--lots of blowout diapers (color was fine though), and too much afternoon/evening crying, and too much trouble napping.  So taken together, I think, again in retrospect, it's clearer, but at the time, well, hard to discern.

[tanyalynn]

Originally Posted by CrunchyChristianMama 

For my girls, who both responded horribly to dairy, the spit up became curdled and smelly and was accompanied by extra fussiness and trouble sleeping.

That's not how spit up always is?  (see, like I just wrote, I didn't know much about babies).

Maybe it was a clue that sometimes the spit up was quite a while after a meal?  That's what you mean by curdled, right?  Because it had been in the stomach for a while.  Huh.

[riomidwife]

Yah I don't know, sometimes my daughter's spit up occurs right after a meal and it is more or less the same as breastmilk, and in those cases I chalk it up to guzzzling too much leche at one time. Other times it happens oh, a short while after nursing, and is worse if she's curled up or her belly is compressed at all (in a wrap, or when i'm peeing her, etc). And then sometimes she will spit up much later and it will be very translucent, almost clear, and thin.

My firstborn had so many other issues with gas, fussiness, sleeping, etc., that it was clear in retrospect that he had something going on. With this one, I just wonder.

[omelette]

I had 2 spitters.  Both spat up huge amounts and were able to get great distance with their spit ups too, total projectile spits.  I changed my clothes 3-5 times/day and their clothes all day long.  Both gained weight well though.

With my first he was labeled a happy spitter but it was an issue at night b/c he would choke on his spit-up - this I think is worth requiring further investigation.  For us we were provided with a 45% angle wedge which solved the choking and wakefulness at night.

My 2nd spat up and was what would be labeled colicky.  This combo I think is worth investigating too b/c he was obviously screaming for a reason and it seemed related to the spitting, gassiness, foul poops etc.  He was also spitting up undigested breastmilk after a 3 hr period.

[rhesp1212]

I think "happy" spitting up right after eating is considered normal....air bubbles, chugging too much too quickly, etc. can all lead to spitting up. If they are fussy when spitting up, that's another story. For us, DS would spit up hours after he ate and large quantities, which was a HUGE sign that something was wrong...indeed he had a tremendous list of food sensativities that we late discovered. If the child is acting in discomfort (fussing, not sleeping well, crying alot, arching back, etc.) then I would consider it an issue to be investigated.

[riomidwife]

Originally Posted by omelette 

I had 2 spitters.  Both spat up huge amounts and were able to get great distance with their spit ups too, total projectile spits.  I changed my clothes 3-5 times/day and their clothes all day long.  Both gained weight well though.

With my first he was labeled a happy spitter but it was an issue at night b/c he would choke on his spit-up - this I think is worth requiring further investigation.  For us we were provided with a 45% angle wedge which solved the choking and wakefulness at night.

My 2nd spat up and was what would be labeled colicky.  This combo I think is worth investigating too b/c he was obviously screaming for a reason and it seemed related to the spitting, gassiness, foul poops etc.  He was also spitting up undigested breastmilk after a 3 hr period.

Did either child have food allergies or sensitivities as they grew older?
 

[kjbrown92]

My dd1 spat up a little after some meals, not all, and not much, and probably not after a few months. At least I don't remember her spitting up much. But then DS came along and I knew it was different. He projectile vomited during and after every meal. I would call anything that gets distance vomit, not spit up. And it was copious amounts, enough to soak all my clothes and his. At 2 weeks old he was vomiting bile, which the pediatrician said was normal. After already having "normal", I knew it was not, went off milk, and it went completely away. Every time I ate something (usually out, something I "thought" was safe), he vomit again during and after every meal for 4 days. I went through a lot of spitclothes, and a lot of clothes, for both of us. My DH couldn't believe the distance he got on some of them. We called him an olympic vomiter. Then dd2 came along, and it was back to some spit-up, not much, not that often (though she did have food intolerances as well, it wasn't until she had things directly that she reacted).

[omelette]

Originally Posted by riomidwife 

Originally Posted by omelette 

I had 2 spitters.  Both spat up huge amounts and were able to get great distance with their spit ups too, total projectile spits.  I changed my clothes 3-5 times/day and their clothes all day long.  Both gained weight well though.

With my first he was labeled a happy spitter but it was an issue at night b/c he would choke on his spit-up - this I think is worth requiring further investigation.  For us we were provided with a 45% angle wedge which solved the choking and wakefulness at night.

My 2nd spat up and was what would be labeled colicky.  This combo I think is worth investigating too b/c he was obviously screaming for a reason and it seemed related to the spitting, gassiness, foul poops etc.  He was also spitting up undigested breastmilk after a 3 hr period.

Did either child have food allergies or sensitivities as they grew older?
 

Yes,  my eldest is not allergic to but does not do well with cow's milk or wheat and he is allergic to strawberries.  My youngest is 15 months and we are still trying to figure it out.  He's been labeled with food protein induced colitis by the allergist but we've cut out the major food culprits a long with a ton of other food (he only has 7 foods in his diet right now) and the problem is still not solved.  He's no longer spitting up but he still has big tummy trouble and strange poops.  We are off to the gastro-intestinal clinic at the end of the month to explore things a little further.

[baby viEn]

My 1 moth old spits up often..she doesn't cry but i'm still worried.. She is bottle fed.. I taught she doesn't like it if the milk is cold already, so we tried to always feed her lukewarm milk but still she spat up..Her stomach is growling (i mean noisy of gas) she also has a foul smelling poop.. never gone to her pedia yet.. I just observed that she is not sleeping well if she is gassy ( she is gassy OFTEN).. I always let her burp after every feedings still gas and spit ups!

is this alarming now..we will see her pedia this friday maybe..

[mckittre]

What if a spitting up baby seems fairly happy (sleeps well, not much crying), but is very slow to gain weight?  My 2 month old has only been gaining around 3.5 - 4oz a week, which the doctor is somewhat concerned about.  I'm pretty sure I'm making enough milk, but she does spit up a lot more than her brother did (sometimes right after a feeding, sometimes later, varying amounts, sometimes it doesn't seem to bother her, sometimes it makes her fussy).

Does that sound like a food intolerance?  I'm going to try going off dairy for awhile at the doc's suggestion, but don't know if I should expect changing my diet to have an impact or not.

[tanyalynn]

My DD never seemed distressed by the spitting up, but I am convinced that it was a baby type of symptom of her food intolerances (vs the toddler or older kid symptoms). 

Just remember that soy and dairy are very cross-reactive, so at a minimum, don't add in a lot of soy when you cut out dairy (not saying cut out soy, just keep it in mind).

[crunchy_mommy]

I've always wondered this too... DS is 2 now and only vomits maybe 1-2 times a month, most often in the car (carsick). But from the time he was born 'til he was I-don't-remember-how-old (maybe 9mos???) he spit up constantly. All day & all night long. Before feeds, after feeds, mid-feed... there was just a constant stream of massive amounts of spit-up. We carried burp rags everywhere but it was kind of a joke because no matter how big the rag was, our clothes were always soaked and we had to change him & ourselves anyway. I have never gone through so many shirts in one day in my life... And it was definitely more than an ounce or two!! I had to be on alert all night long because I had to flip him over every time he spit up so he wouldn't choke. I never slept.

At the time the pedi (who we no longer see) called him a 'happy spitter' but that was ironic -- he was the unhappiest baby I've ever seen, and spitting up larger amounts than anything I'd seen then or since. However the spitting up itself didn't seem to bother him, so that's how he was labeled 'happy spitter'. In retrospect, I'm sure my HUGE oversupply (that I didn't get totally under control even with 12-hour block feeds, until I eliminated gluten from my own diet when he was 18mos old!) was a large part of the problem but I still think something more was/is going on with him. I really wish I had investigated a little further because I will always wonder if there was something more I could have done for him. I am still not sure if he is reacting to things and feel really frustrated with myself.

So I guess that's the key -- if you sense something is wrong, even if someone else is telling you it's normal, then it may be worth investigating so you don't have those kind of regrets down the line.

[riomidwife]

Originally Posted by tanyalynn 

My DD never seemed distressed by the spitting up, but I am convinced that it was a baby type of symptom of her food intolerances (vs the toddler or older kid symptoms). 

Just remember that soy and dairy are very cross-reactive, so at a minimum, don't add in a lot of soy when you cut out dairy (not saying cut out soy, just keep it in mind).

I was not aware of that. What is the soy-dairy reactive relationship based on?