Young babies naturally fuss and get cranky when they swallow air during feedings. Although this occurs in both breastfed and bottle-fed infants, it’s seen more often with the bottle. When it happens, it may be helpful to stop the feeding rather than letting your infant fuss and nurse at the same time. This continued fussing will cause her to swallow even more air, which will only increase her discomfort and may make her spit up.
A much better strategy is to burp her frequently, even if she shows no discomfort. The pause and the change of position alone will slow her gulping and reduce the amount of air she takes in. If she’s bottle-feeding, burp her after every 2 to 3 ounces (60–90 ml). If she’s nursing, burp her when she switches breasts. Some breastfed babies don’t swallow very much air, and therefore they may not need to burp frequently.
Most babies hiccup from time to time. Usually this bothers parents more than the infant, but if hiccups occur during a feeding, change his position, try to get him to burp, or help him relax. Wait until the hiccups are gone to resume feeding. If they don’t disappear on their own in five to ten minutes, try to resume feeding for a few minutes. Doing this usually stops them. If your baby gets hiccups often, try to feed him when he’s calm and before he’s extremely hungry. This will usually reduce the likelihood of hiccups occurring during the feeding.
Spitting up is another common occurrence during infancy. Sometimes spitting up means the baby has eaten more than her stomach can hold; sometimes she spits up while burping or drooling. Although it may be a bit messy, it’s usually no cause for concern. It almost never involves choking, coughing, discomfort, or danger to your child, even if it occurs while she’s sleeping.
Some babies spit up more than others, but most are out of this phase by the time they are sitting. A few “heavy spitters” will continue until they start to walk or are weaned to a cup. Some may continue throughout their first year.
It is important to know the difference between normal spitting up and true vomiting. Unlike spitting up, which most babies don’t even seem to notice, vomiting is forceful and usually causes great distress and discomfort for your child. It generally occurs soon after a meal and produces a much greater volume than spitting up. If your baby vomits on a regular basis (one or more times a day) or if you notice blood or a bright green color in your baby’s vomit, consult your pediatrician.
While it is practically impossible to prevent all spitting up, the following steps will help you decrease the frequency of these episodes and the amount spit up.
- Make each feeding calm, quiet, and leisurely.
- Avoid interruptions, sudden noises, bright lights, and other distractions during feedings.
- Burp your bottle-fed baby at least every three to five minutes during feedings.
- Avoid feeding while your infant is lying down.
- Hold the baby in an upright position for 20 to 30 minutes after each feeding.
- Do not jostle or play vigorously with the baby immediately after feeding.
- Try to feed her before she gets frantically hungry.
- If bottle-feeding, make sure the hole in the nipple is neither too big (which lets the formula flow too fast) nor too small (which frustrates your baby and causes her to gulp air). If the hole is the proper size, a few drops should come out when you invert the bottle, and then stop.
- Elevate the head of the entire crib with blocks (don’t use a pillow) and put her to sleep on her back. This keeps her head higher than her stomach and prevents her from choking in case she spits up while sleeping.
Feeding your baby is one of the most important and, at times, confusing challenges you’ll face as a parent. The recommendations apply to infants in general. Please remember that your child is unique and may have special needs. If you have questions, ask your pediatrician to help you find the answers that apply specifically to you and your infant.