Still Spitting up at 4.5 Months.. Normal?

Updated on April 20, 2010
S.O. asks from Ashburn, VA
14 answers

My daughter is 21 weeks and still spitting up quite often and quite alot (about 1 tblsp). She has been on Zantac since she was 8 weeks and I thought the spitting up would be better by now. I give her cereal in her bottles and even tried the SImilac RS Formula but the poor thing still spits up. I am contemplating taking her to a specialist. Any thoughts? Or, good specialists in the area that you can recommend?

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L.O.

answers from Detroit on

this is normal.. a lot lot lot of babie spit up. she will outgrow this in time ..

my duaghter spit up for 6 months.. we gave her zantac because she was so fussy and miserable.. but she still spit up the spitting up stopped once she started eating solid foods..

my son spit up for 14 months... every single day .. he was a puking machine... we tried zantac,, preavacid.. neither drug worked and he was happy just a puker.. he puked after he was eating table foods.. it gradually got better adn then stopped..

dont worry about it.. if she is happy and gaining weight .. I wouldnt even give her medicine as itreally doenst do much. they just outgrow it in time..

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J.S.

answers from Minneapolis on

My daughter was BF, but she spit up regularly between feedings until she was about 9 months old and was eating more volume of solid foods.

I never medicated her, as the spitting did not seem to bother her, it was what I called more of a "laundry issue" than a medical one.

Jessica

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A.S.

answers from Washington DC on

First of all, I didn't even know that they had Zantac for babies! I am lactose intolerant, and two of my sons were diagnosed so as soon as we made the switch from breast milk to a formula. They were put on the Isomil Soy formula. I'm surprised that that has not been suggested to you, as milk and whey protein allergies to formulas are very common. If the spit up is slimy, it's definately an allergy! Curds in the spit up mean indigestion, which again, could be a lactose intolerance. Hope this helps!
Ange

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C.W.

answers from Washington DC on

Both my kids spit up, A LOT. For my son, it lasted until he was about a year old. It gets worse when they start to crawl, because they are on their bellies and you can't control not putting them on their bellies as much. My son ate fast, and looking back, I think that his speed and the position that I fed him in had a lot to do with it. He also had reflux, so we had him on zantac, and then axid for a while. My daughter was on prevacid and alimentum formula, but that formula is very very expensive, so if your daughter is gaining weight and isn't uncomfortable, I would let it go. Put lots of bibs on her (we went through several a day), try to keep her upright for an hour after feeding and feed her in an upright position. my pediatrician said it best, "some babies just spit up more than others."

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L.M.

answers from Washington DC on

It is not advisable to put cereal in your baby's bottle. That was started many yrs. ago, and found to have some challenging effects. It is very hard for babies to digest grains so early.
I'd suggest taking your baby to a chiropractor. They DO help with spitting up and reflux. If you need a referral in your area, please feel free to contact me.
Best of luck,
L. M

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J.P.

answers from Chicago on

I have a 5.5 month old, no reflux, but she's a champion spitter just like her brother was. She has no problems, it doesn't bother her, but some days she spits up multiple times after/between feedings. Other days, it's minimal. My son spit up until he was about 10 months old, I think. I'm hoping she stops before then. I'm tired of smelling spit-up on my clothes and hers!

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J.J.

answers from Wichita Falls on

i have a friend whose baby is 8 months old and still spits up alot....sometimes quite a bit! as long as it doesnt really seem to be bothering her too much, i wouldnt worry about it. you could ask her pediatrician about it though if you are really concerned

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K.K.

answers from Washington DC on

have you talked with your pediatrician about giving cereal in the bottle? especially to a child so young? the cereal might actually be contributing to the spit up -- her system is still too immature to be processing anything other than breast milk or formula. also, cereal in a bottle can be a choking hazard. if I were you, I'd stop worrying about medications and go back to feeding her what her system is set up to handle.

fwiw, a tblsp of spit up is not that much. seriously. I know it looks like a lot when it's coming out, but if you figure she's drinking, what 4-6oz at a time at this point? that's totally normal and totally fine.

my kids all spit up for months and months. babies do that. my twins even stopped for several months and then randomly started doing it again when they were around a year. it was annoying, but normal and not a problem. as others have said, as long as they're gaining weight and not having other issues, the spit up is just a part of mommying an infant.

good luck!

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B.P.

answers from Washington DC on

In my experience with my two children, the spitting up you're describing may be just normal. There may be other symptoms or concerns you didn't describe, but I'll just say that both of my kids were BIG spitters. They spit up just about every time they had a bottle until they were approaching one year old. And sometimes it seemed like quite a bit. We kept cloth diapers in almost every room of the house so there would always be something handy to mop up the mess!

If there's some obvious discomfort or other signs of digestive issues, etc., then address it. But if it's only the spit up, it may be nothing more than what babies do.

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C.J.

answers from Danville on

Hi S.,
I didn't have time to read all the responses so I hope I am not repeating anything. Try keeping her in an upright position after she has finished eating. Keep her upright longer than you normally would. Since she seems to have issues with digestion (your using Zantac) extra precautions should also be taken to help her with digestion.

If you are not doing this, which is something that is done during the first few months, give her half a bottle, burp her, then give her the other half. Even if she doesn't burp, give her time to digest the first half of her bottle before she completely finishes the bottle.

As far as putting cereal in her bottle, make sure that it is mixed up really well with the milk.

Be blessed!!!

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V.C.

answers from Washington DC on

My daughter had terrible reflux and had to sleep in her swing for the first 4 months and a proped up mattress after that. She was breastfed but clearly geting uncomfortable so we gave her Zantac at 5 weeks. She magically improved between 6 and 7 months when she learned how to sit upright. I think all that was needed was tightening of her abdominal muscles to close the sphyncter at the base of her esophagus. By then she was still on the original Zantac dose, so we simply let her outgrow the dose and complete the Zantac at 7 months. After 8 months the spitting up was gone for good.

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J.K.

answers from Washington DC on

I think you should see a pediatric gastroenterologist. I really like Dr. Lee, Duffy, etc- in Fairfax.
Regular pediatricians prescribe the low doses of meds.
My kids had reflux severely. I would get into the pediatrician first, and ask for an additional med (combination therapy) because it can take up to 4 months to get into a pedi gastro doc.
ALSO - something you can do to help immediately is to burp her after every two ounces. It is a pain, but it helped me a lot!
feel free to contact me with any questions.

To all the other mommies on here that have spitters- I hope you find this article helpful. Untreated GERD can lead to esophageal ulcers - which are very painful and detectable by an endoscopy.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
FROM THE WALL STREET JOURNAL:

Baby Crying? Doctors Say It May Be Acid-Reflux Disease
July 22, 2008; Page D1

Olivia Manganello was 1 month old when she started screaming, usually right after she nursed. Her family tried switching to formula, then different formulas, but nothing helped. Finally a pediatric gastroenterologist diagnosed gastroesophageal reflux disease (GERD) and put Olivia on Pepcid. "In two days, she was a completely different baby," says her mother, Trina Chiara of Avon, Conn.
READING ON REFLUX


• Pediatric/Adolescent Gastroesophageal Reflux Assoc. information site: www.Reflux.org
• "The Reflux Book" by Beth Pulsifer-Anderson, 2007
• "Colic Solved" by Bryan Vartabedian, MD, 2007
• "Why Is My Baby Crying?" by Barry M. Lester, Ph.D., 2006

Years ago, babies like Olivia were dismissed as having colic. Sometimes Valium was prescribed for their moms. Now, infants are increasingly being treated for GERD, paralleling a rise in chronic heartburn in adults. Use of proton-pump inhibitors (PPIs), the strongest acid-blocking drugs, in infants soared 750% from 1999 to 2004, according to a study of four major health plans. Some experts worry that GERD is being overdiagnosed in infants; others say it isn't being taken seriously enough.

Even the terminology is confusing. Most babies have reflux -- spitting up some liquid, since the valve separating the stomach from the esophagus isn't fully closed. It usually doesn't hurt. Experts like to say these "happy spitters" are a laundry problem, not a medical problem, and no treatment is needed. Most babies outgrow this simple gastroesophageal reflux (or GER) by the time they're about 7 months old.
MORE

• Join a discussion about colic, or reflux, in babies.
• Read more about Pager and the diagnosis of GERD.

GER becomes more-serious GERD if the infant won't eat and stops gaining weight, vomits blood and is extremely irritable. He may be highly sensitive to stomach acid -- "just like some adults get heartburn and call 911," says Beth Anderson, founder of the Pediatric/Adolescent Gastroesophageal Reflux Association (Pager), an information group for parents. GERD babies may also choke or aspirate liquid. Acid-reducing drugs -- which run the gamut from over-the-counter antacids to H2 acid suppressors to PPIs -- won't stop the reflux but can cut the acidity, and thus the irritability, if acid is causing the problem.

Most experts think colic is a separate issue, though it's still vaguely defined as at least three hours of crying at least three days a week for at least three weeks. Doctors theorize that it may be because of a milk allergy, gas or food not moving smoothly through immature intestines. Some 20% of babies get colic, and it's generally gone in three months -- but those can be miserable.

What's tricky is that colic and reflux can occur together. "Those babies are sometimes put on acid-reducing medications, but they don't get better," says Jeffrey S. Hyams, a pediatric gastroenterologist at Connecticut Children's Medical Center in Hartford, and Olivia Manganello's doctor. "There's no medicine for colic except time and Mother Nature."

Doctors can check for abnormal acid by putting a thin tube down a baby's nose, and rule out anatomical problems with a barium X-ray. But many simply put babies on acid-reducing drugs first to see if they improve.

Critics say that leads to overtreatment. "It's the 'get the mom off my back approach,'" says Vikram Khoshoo, a pediatric gastroenterologist at West Jefferson Medical Center in New Orleans. He says 80% of reflux babies get better with time and measures such as thickening formula with cereal, avoiding cigarette smoke and reassurance.

Bryan Vartabedian, a pediatric gastroenterologist at Texas Children's Hospital, had an epiphany when his own irritable baby improved dramatically when she was treated for reflux. He thinks about half of what's considered colic may actually be undiagnosed GERD. "We should be looking for signs of treatable conditions so babies aren't suffering needlessly," he says.

Is there any harm in putting a baby on drugs for GERD if it is just colic? None are specifically approved for infants. In older children, side effects are generally mild, like nausea and diarrhea; PPIs have been linked with a risk of bone fractures in adults. But few long-term studies have been done.

Left untreated, some babies outgrow GERD, but doctors worry if it prevents an infant from eating. "Babies need to gain weight," says Dr. Hyams. "If they don't, there's something wrong."

--------------------------------------------------------------------------------

When Beth Anderson organized a meeting of other parents of babies with acid reflux in Washington, D.C., in 1992, she thought she was starting a small support group, not a national organization. The Pediatric Adolescent Gastroesophageal Reflux Association (Pager), as it's now known, has mushroomed along with the diagnosis of GERD. The group's Web site, www.reflux.org, got 2.3 million hits in March, and has 61,000 searchable posts.

Pager fields inquiries from parents at both ends of the misery spectrum -- from parents worried about a little bit of crying to those whose infants have very severe symptoms. "We don't advocate medications," says Mrs. Anderson. "Our position is that if the parents think their child is in significant pain, they need to talk to their doctor." She advises parents to keep track of their baby's behavior and report objectively. "If you say, 'my baby cries all the time,' the doctor may not take you seriously. If you say, 'my baby cried six hours yesterday and six hours the day before,' then they know it's time to do something."

Some parents in Pager say it took awhile for doctors to take their concerns seriously. Melissa Willard of Easley, S.C., says her daughter, Maggie, started choking her first night in the hospital, and made strange nasal noises -- "like she was starting a car." But she was repeatedly told it was "normal baby stuff." The turning point came when Mrs. Willard's obstetrician heard Maggie sputtering and diagnosed reflux. A pH probe confirmed it. Maggie took Zantax for several months and no longer needs it.

Some parents who were told their babies were "just colicky" have seen them grow up to have fullblown GERD or food allergies. Erica Hale of Salt Lake City, Utah, says her son, Isaiah, sometimes cried "20 out of 24 hours" when he was an infant. Though he did outgrow it when he was 4 months old, the distress returned in elementary school. Now age 11, Isaiah is taking Prevacid and has been diagnosed with a gluten intolerance. "When we went over the symptoms with him, he said he'd had this for as long as he could remember," says Mrs. Hale. Meanwhile, she says, "I think we've all got post-traumatic stress from that four months of screaming and no sleep."

Indeed, months of crying and sleeplessness can take a huge toll on the family, whether it's due to reflux or colic or another cause. "You can talk to parents 25 years later and they'll remember it like it was yesterday," says Barry Lester, director the Colic Clinic at Brown University's Center for the Study of Children at Risk in Providence, R.I. The clinic treats entire families, not just the infant, including consultations with a psychologist or social worker.

"The big danger is in thinking the drug is a magic bullet," Dr. Lester says. "The crying may go away, but the damage to the family dynamic may not."
• Email [email protected]____.com a discussion on colic and reflux.

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S.H.

answers from Richmond on

My son didn't respond to Zantac at all but once put on Pepcid he did wonderfully. It might be worth a med switch! Also, we sucked it up and put him on Nutramigen formula. Expensive but worth it. I found it (sealed and with good exp. date obviously) on Ebay cheaper than in the stores. I've also heard good things about Target's version of it but was afraid of fillers.

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S.M.

answers from Mobile on

As far as I know, if they are "happy spitters," no pain & gaining weight, then there isn't an issue. That being said, I feel for you. I thought my older son spit up a lot, and he grew out of it around 7mths. I never put him on medication, and just dealt with having to clean up a lot. He's now 2yo.

My younger son will be 7mths this week, and he is still spitting up a TON. He made me realize how much worse it could have been for my older son. Connor, my younger son, has never been without a bib. He goes through about 15 bibs & 10-15 burp cloths a day. This hasn't changed from when he was little. I avoid changing his outfits unless really necessary because he'll likely throw up as soon as I change him (from lying down to sitting again). We just got a prescription for prevacid today. He had been given a prescription for zantac, and it didn't seem to make a difference so I stopped using it. This will be the first time he's been on medication for several months. I though he was a happy spitter, and I didn't want to give him medication unnecessarily. But, it seems to have gotten worse over the past week, and it has started to interfere with his sleep. He spent his first three months only sleeping in his carseat because he would choke & spit up a ton lying down. Even in his crib, he still spits up a fair amount, but it has been easier to deal with.

Anyway, from my understanding, time is really the answer. As they become more upright (sitting/walking) it is supposed to improve. For many, they improve by 6mths, and others up to a year. (For a few, it takes longer than a year.) You can always check with your pediatrician to check the zantac dosage, or whether a different medication would be helpful. I've asked a few questions on this, so I recommend checking out others responses to my questions. (I think you just click on my name to get to my questions - ?) Good luck!

***
I just wanted to add that we started the prevacid last night, and I thought it would take a while, but today has been so much better. He's still spitting up but not nearly as much - it seems so different and he seems happier.

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