Most babies who spit up are perfectly healthy and do not require special foods. Small, frequent feedings or holding the baby upright for a bit after eating will usually be enough to keep the food down. However, a small percentage of babies spit up frequently or have more severe symptoms. This may be from gastroesophageal reflux disease (GERD) or another problem, such as a food allergy or food intolerance. In cases of problematic reflux, the baby’s doctor may recommend a special diet to help reduce the symptoms.
Both mothers and babies benefit from breastfeeding. If your baby is spitting up occasionally during or after breastfeeding, this is probably perfectly normal and doesn't indicate a problem. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition -- NASPGHAN -- reports that similar numbers of breast-fed and formula-fed infants experience reflux. However, the amount of time reflux episodes last may be shorter in breast-fed infants. This could mean less discomfort for your baby. If reflux symptoms are bothersome, your doctor may recommend changing your feeding position or a change in your own diet. If your baby’s reflux does not improve, your doctor may recommend supplementing feedings with a special formula or a thickened formula to help reduce the reflux.
Extensively Hydrolyzed Formula
According to NASPGHAN, cow’s milk protein sensitivity sometimes causes unexplained crying and reflux in infants. Cow’s milk is the most common protein source used in infant formula and causes one of the most common food allergies. According to the World Allergy Organization, about 2 to 5 percent of infants have cow’s milk allergy. Extensively hydrolyzed formula (Nutramigen, Similac Expert Care Alimentum) may be recommended if cow's milk allergy is suspected in a baby with reflux. This type of formula is produced using a process that breaks down milk proteins into smaller fragments that are less likely to trigger an allergic reaction. Partially hydrolyzed formula, which contains larger protein fragments, is not recommended for babies with cow's milk allergy, according to the American Academy of Pediatrics.
Amino Acid-Based Formulas
A small percentage of children with cow’s milk allergy continue to experience symptoms with extensively hydrolyzed formula. For these babies, an amino acid-based formula (Neocate, EleCare, PurAmino) may be recommended. These formulas, also called elemental formulas, are milk-free and contain nonallergenic amino acids -- the building blocks the body uses to make the proteins it needs. There are no whole proteins in elemental formula, so it doesn't provoke allergic food reactions. The authors of a June 2007 "Clinical and Experimental Allergy" research review on elemental formulas concluded they are safe, and improve symptoms and growth in babies with cow’s milk allergy who did not tolerate extensively hydrolyzed formula. However, additional long-term research is needed.
Acid reflux occurs when some stomach contents flow back up into the esophagus. For babies with frequent reflux, doctors sometimes recommend thickening the formula to reduce the likelihood of back-flow into the esophagus. This involves adding rice cereal to the formula you are already feeding the baby or using a prethickened formula (Enfamil AR, Similac for Spit-Up). According to May 2013 GERD management guidelines from the American Academy of Pediatrics, thickening formula appears to decrease the number of times a baby spits up. However, thickening should only be done if recommended by your baby’s doctor, because there are potential risks associated with thickened formula, especially for preterm infants.
Warnings and Precautions
Isolated spitting up is common in babies and typically doesn't require a change in diet. Specialized formulas are relatively expensive, so you want to be sure they are necessary for your baby before making a switch. If reflux is associated with other problems -- such as keeping your baby from resting or gaining weight normally -- talk with your pediatrician. Seek medical care right away if your baby experiences:
- breathing difficulty or wheezing
- forceful vomiting, especially if yellow, bloody or foul-smelling
- diarrhea, constipation or bloody stools
- fever or a decrease in usual activity.
- Pediatrics: Breastfeeding and the Use of Human Milk
- Journal of Pediatric Gastroenterology and Nutrition: Pediatric Gastroesophageal Reflux Clinical Practice Guidelines
- Pediatrics: Gastroesophageal Reflux: Management Guidance for the Pediatrician
- World Allergy Organization: Diagnosis and Rationale for Action Against Cow's Milk Allergy Guidelines
- U.S. Food and Drug Administration: Role of 100% Whey Protein Partially Hydrolyzed in Infant Formula and Reducing the Risks of Allergy in Humans
- PubMedHealth: The Efficacy of Amino Acid-Based Formulas in Relieving the Symptoms of Cow's Milk Allergy: A Systematic Review
- Pediatrics: Hypoallergenic Infant Formulas