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Baby Spitting Up Constantly? Here’s When to Worry · Baby's First 100 Days with Dr. Roma Franzia

• 0:00
  SPEAKER_00: If your baby spits up after almost every feeding, especially if it comes out the mouth and the nose, it can look terrifying.
• 0:09
  SPEAKER_00: And this is where parents get confused because sometimes a baby can spit up what looks like an unbelievable amount and can be completely fine.
• 0:19
  SPEAKER_00: Other times the spit up itself may not look nearly as dramatic, but it can be part of a bigger feeding picture that makes me much more concerned.
• 0:29
  SPEAKER_00: I'm Dr.
• 0:30
  SPEAKER_00: Roma Francia.
• 0:31
  SPEAKER_00: I've cared for tens of thousands of newborns over more than 30 years.
• 0:36
  SPEAKER_00: And by the end of this video, I want you to know what normal baby spit up can actually look like, what you can do to reduce it, and the signs that make me say, okay, this is more than just a messy shirt.
• 0:51
  SPEAKER_00: Let's dive in.
• 0:52
  SPEAKER_00: The first thing to understand is that babies are very good at spitting up.
• 0:57
  SPEAKER_00: You finish the feeding, put the baby over your shoulder, and suddenly there is the milk everywhere.
• 1:04
  SPEAKER_00: Your shirt, their clothes, the floor.
• 1:07
  SPEAKER_00: Sometimes it even comes out their noses.
• 1:10
  SPEAKER_00: And the first time that happens, especially with a newborn, it is very easy to think something is terribly wrong.
• 1:19
  SPEAKER_00: But there is a very simple reason babies do this so much.
• 1:23
  SPEAKER_00: The muscle between the tube that goes into the stomach called the esophagus and the stomach is still developing.
• 1:31
  SPEAKER_00: It's a valve, not a door that opens and shuts.
• 1:35
  SPEAKER_00: So milk goes down into the stomach, and then that little muscle that's not developed yet can allow milk to come up and go down.
• 1:44
  SPEAKER_00: So sometimes the milk just comes right back up.
• 1:47
  SPEAKER_00: That is called gastrostomic esophageal tube from the mouth to the stomach reflux.
• 1:55
  SPEAKER_00: And it's very common in infancy.
• 1:57
  SPEAKER_00: As that muscle gets stronger and babies spend more time upright, the reflex generally improves, often noticeably by around six months when they can sit on their own.
• 2:10
  SPEAKER_00: And it continues to get better throughout the first year of life.
• 2:15
  SPEAKER_00: But knowing that reflex is common does not answer the question every parent actually has.
• 2:21
  SPEAKER_00: How do I know what my baby is doing is normal?
• 2:25
  SPEAKER_00: And this is where the amount of spit up can fool you.
• 2:29
  SPEAKER_00: The amount of your baby's spit up can be very misleading.
• 2:33
  SPEAKER_00: Parents will come into my office and say, Dr.
• 2:36
  SPEAKER_00: Roma, she spit up the whole bottle.
• 2:38
  SPEAKER_00: And I will ask the whole bottle?
• 2:40
  SPEAKER_00: Because when milk spreads across a shirt, a blanket, and your shoulder, it looks like an enormous amount.
• 2:48
  SPEAKER_00: It may look like everything you just fed them came right back out.
• 2:52
  SPEAKER_00: But that visual alone does not tell me very much.
• 2:56
  SPEAKER_00: Even milk coming through the nose can look much worse than it actually is.
• 3:01
  SPEAKER_00: Babies have protected reflexes that help keep their airway clear, and spit up may come through the nose, the mouth, or both.
• 3:10
  SPEAKER_00: You wipe the milk away, keep the baby upright, and then I want you to look at what happens next.
• 3:17
  SPEAKER_00: Because what the baby does after the spit up starts giving me much more useful information.
• 3:24
  SPEAKER_00: And before we get to the signs I watch for, there are a couple of very simple things parents can do that may reduce how often this happens.
• 3:35
  SPEAKER_00: Sometimes we're helping the milk come back up.
• 3:38
  SPEAKER_00: Think about a newborn stomach right after feeding.
• 3:42
  SPEAKER_00: It's full.
• 3:43
  SPEAKER_00: And because that muscle on top is still immature, milk can come up, come down, come up, come out, and it's very easy for spit up to happen.
• 3:55
  SPEAKER_00: This is why I want you to pay attention to how we handle the babies immediately after we feed them.
• 4:01
  SPEAKER_00: When you pick up your baby, I prefer you putting your hands under the baby's arms rather than squeezing around the abdomen.
• 4:09
  SPEAKER_00: And when you burp, place your baby upright so that the stomach isn't bent over, encouraging more spit up.
• 4:19
  SPEAKER_00: I really prefer the over-the-shoulder for burping.
• 4:22
  SPEAKER_00: And then when you're done, place your baby in the car seat angle where the head is above the stomach.
• 4:30
  SPEAKER_00: Gravity will help hold all the milk in the stomach so it can't easily come up after a feed.
• 4:37
  SPEAKER_00: You do not have to force a burp.
• 4:40
  SPEAKER_00: I recommend trying to burp your baby after a feed for a few minutes.
• 4:45
  SPEAKER_00: If your baby is uncomfortable halfway through the feeding, you can then try there as well.
• 4:52
  SPEAKER_00: But if your baby doesn't burp, then your baby most likely didn't swallow enough air to come out as a burp after the feed.
• 5:01
  SPEAKER_00: So it doesn't mean that you're failing.
• 5:04
  SPEAKER_00: Not every feeding produces a burp.
• 5:07
  SPEAKER_00: If the baby is comfortable after a few minutes, stop.
• 5:11
  SPEAKER_00: I see parents patting and patting and patting because they believe that a burp has to come out before they are allowed to move on.
• 5:19
  SPEAKER_00: And I also do not like interrupting a baby who is happily eating just because someone told you they need to burp every certain number of ounces.
• 5:29
  SPEAKER_00: They do not use the natural pauses.
• 5:32
  SPEAKER_00: If you're breastfeeding and switching breasts, try then.
• 5:35
  SPEAKER_00: If your baby pauses during the bottle, try then.
• 5:39
  SPEAKER_00: But again, look at your baby.
• 5:41
  SPEAKER_00: If your baby's comfortable, you do not need to manufacture a problem.
• 5:46
  SPEAKER_00: And there is no other very simple thing I tell parents with babies who spit up frequently.
• 5:52
  SPEAKER_00: After feeding, I like to keep the baby's head higher than the stomach, holding them upright or on your shoulder, or placing them in a car seat or a bouncy chair where their head is above the stomach.
• 6:07
  SPEAKER_00: The gravity will help hold the milk in the stomach rather than having it, if a baby lies down flat, come right out the nose, mouth, or bulk.
• 6:16
  SPEAKER_00: I recommend this position for 30 minutes after feeding.
• 6:20
  SPEAKER_00: And eventually, as your baby's stomach muscle on or the sphincter on top gets stronger, then you won't have to do this position after feeds.
• 6:31
  SPEAKER_00: If you have a baby who spits up after almost every feed, this is the one easiest thing you can change.
• 6:38
  SPEAKER_00: If you're a new parent and this kind of practical information is helping you understand what your baby is actually doing, subscribe.
• 6:47
  SPEAKER_00: I'm going to keep sharing the same little things I teach families in my practice every day because the more you understand what is normal, the less frightening all of this becomes.
• 6:59
  SPEAKER_00: So when do I actually start to worry?
• 7:02
  SPEAKER_00: Now we can finally answer the big question, and here is what surprises parents.
• 7:08
  SPEAKER_00: I do not decide how concerned I am by the size of the spit-up.
• 7:14
  SPEAKER_00: I look at the baby, especially around the feeding.
• 7:17
  SPEAKER_00: Let me give you two very different pictures.
• 7:20
  SPEAKER_00: One baby eats, the baby spits up all over, everybody changes clothes, and five minutes later the baby is completely content.
• 7:30
  SPEAKER_00: Overall, the baby is comfortable and gaining weight.
• 7:34
  SPEAKER_00: This baby is generally happy.
• 7:37
  SPEAKER_00: That baby can make an unbelievable mess that may be much more of a laundry problem than a medical problem.
• 7:45
  SPEAKER_00: But now picture a different baby.
• 7:47
  SPEAKER_00: Every feeding seems uncomfortable.
• 7:50
  SPEAKER_00: The baby becomes very fussy during or immediately afterward.
• 7:55
  SPEAKER_00: The baby arches the back.
• 7:57
  SPEAKER_00: The baby pulls away, refuses to continue feeding.
• 8:01
  SPEAKER_00: Maybe the baby is not gaining weight the way we expect.
• 8:05
  SPEAKER_00: Now I am looking at this very differently.
• 8:09
  SPEAKER_00: The amount coming out could actually be smaller than the first baby.
• 8:13
  SPEAKER_00: But this baby is telling me something the first baby was not.
• 8:18
  SPEAKER_00: Feeding itself is becoming a problem.
• 8:20
  SPEAKER_00: That is when I want to look more closely.
• 8:23
  SPEAKER_00: And this is really the simplest way I want you to think about spit up.
• 8:28
  SPEAKER_00: So if your baby spits up constantly, here is how I want you to think about it.
• 8:33
  SPEAKER_00: First, understand some spitup is simply part of having an immature digestive system.
• 8:40
  SPEAKER_00: Second, do what you can to make it easier for milk to stay down.
• 8:44
  SPEAKER_00: Handle the baby gently after feeding, especially no pressure around the abdomen.
• 8:50
  SPEAKER_00: Avoid squeezing the abdomen to pick up.
• 8:53
  SPEAKER_00: Don't wear tight clothing.
• 8:55
  SPEAKER_00: Try over-the-shoulder burping position.
• 8:58
  SPEAKER_00: Do not force burping when the baby is already comfortable.
• 9:02
  SPEAKER_00: And remember, gravity is your friend.
• 9:05
  SPEAKER_00: Then watch your baby around those feedings.
• 9:07
  SPEAKER_00: If the baby eats comfortably, gains weight, and is gently happy.
• 9:12
  SPEAKER_00: That picture is very reassuring.
• 9:15
  SPEAKER_00: If they are repeatedly miserable during or after feeding, arching, refusing to eat, or not gaining weight well, that is when I want you to talk to your pediatrician about what is going on.
• 9:28
  SPEAKER_00: The big thing I want you to take away is that normal newborn behavior can look incredibly dramatic.
• 9:35
  SPEAKER_00: Spit it can come through the nose and the mouth or both.
• 9:40
  SPEAKER_00: It can cover the entire shirt.
• 9:42
  SPEAKER_00: The mess itself does not always tell you how serious the problem is.
• 9:47
  SPEAKER_00: Look at the baby around feeding.
• 9:49
  SPEAKER_00: That is where the useful information is.
• 9:52
  SPEAKER_00: And if your baby is fed, changed, and still crying or seems uncomfortable and you're not sure what's actually going on, watch my video next on the five point checklist I use to figure out why a baby is crying and what to do next.