12 reasons why a child spits up

It is forbidden to leave newborn babies in a supine position immediately after feeding, since if this process occurs, then the contents from his stomach can enter the respiratory system, which can cost the baby's life. Therefore, the best sleeping position for such crumbs is on the side.

Most often, the child spits up due to the physiological immaturity of the digestive tract. So, in newborns, the stomach volume is too small and has a different shape from adults. In addition, the angle at which the esophagus flows into the stomach in young children is duller (closer to 90 ° C), while at an older age and in adults it is more acute, which also provokes this phenomenon. The sphincter between these two organs is immature (weak) and, therefore, an abandonment occurs, and the esophagus in newborns is thicker and shorter.

Maturation of the gastrointestinal tract occurs on average up to four or six months of age.

This process is considered physiological when:

occurs 2-3 times a day;
content volume is from 5 to 30 ml;
no gagging;
the baby's condition does not worsen and he feels good both before and after the occurrence of this phenomenon;
steadily gaining body weight;
does not lag behind in physical and neuropsychic development;
empties the bladder enough times (at least 8-10 times per day).

Spitting up in newborns is a fairly common occurrence, so do not immediately panic and “ring the bells”, but pay attention to this process, record their frequency and report them to the pediatrician and nurse's patronages - this is a must!

Causes

There are a lot of reasons for the development of this phenomenon. They can be:

general immaturity of the child's body (often found in the newborn period of a baby's life), as well as weakness of the muscles of the sphincter of the stomach;

Long-term constipation contributes to bloating, which can lead to regurgitation and vomiting.

overfeeding the baby. In the event that he overeats, then the volume of food eaten may exceed the volume of a child's stomach and the consequence of this may be its exit;

When feeding the baby on demand, but with increased lactation from the mother or feeding the baby with mixtures, but if their volume is not correctly calculated, this phenomenon may also occur.

swallowing air during feeding (aerophagia). This condition occurs if the baby sucks quickly and greedily, as well as in the case when his mother incorrectly applies to the breast or holds the bottle with the formula incorrectly. All these moments contribute to the formation of an air bubble in the stomach and pushing the eaten food out of it;

If the child has swallowed air, then as during feeding, he can become restless, stop eating, cry, twist his head in different directions, and after him.

a quick change in the position of the baby's body immediately after he has eaten. This condition can often occur if he is shaken, diaper changed, bathed, massaged, etc.;

When a child is bottle-fed, a specially developed "antireflux mixture" may be recommended by the pediatrician.

increased pressure in the abdominal cavity (in case of colic, flatulence, constipation, as well as tight swaddling, tightening the diaper too tightly, etc.);
lactose deficiency. There is a protein in breast milk - lactose (it is broken down in the stomach by special enzymes - lactase). With a lack of these enzymes or the absence of their production, milk intolerance arises, which is manifested by frequent and profuse regurgitation, as well as loss of body weight. This pathology requires the mandatory appointment of a special lactose-free mixture.

If a child spits up like a fountain, then the reason for this may be overfeeding, aerophagia, overwork, improper body position, and dyspepsia, pathology of the central nervous system, malformations of the gastrointestinal tract, staphylococcus infection.

Prevention. Tips for parents

In 45 - 65% of healthy newborn babies, this regurgitation may occur, which is physiological and disappears on its own. But there are times when doctors prescribe a dietary correction to reduce the degree of their manifestation.

In order to prevent this condition, it is recommended:

lay the baby on his stomach before each feeding;

In the case of frequent episodes of this phenomenon, the pediatrician may recommend an increase in the number of feedings by one or two compared to how the child should eat at a particular age (while reducing a single portion of milk / formula).

baby position during feeding, it should be semi-vertical, while it is better to take breaks and keep it in a "column" (that is, in an upright position);
correctly latch on the baby to the breast (the nose should not rest against the breast, and the mouth should grab the nipple and areola);

If the child is "artificial", during feeding, the nipple must be filled with the mixture completely.

eliminate factors that can increase abdominal pressure or cause constipation. For this purpose, it is not recommended to swaddle the baby tightly, in addition, a nursing mother should monitor her diet and exclude from her diet foods that can increase flatulence (beans, cabbage, etc.);
do not overfeed the child. For "artificial people", the pediatrician must correctly calculate the amount of one-time and daily feeding. Breastfed children are recommended to be weighed periodically both before and after eating;
for babies who are bottle-fed, choose the right hole in the nipple (it is better to give preference to anti-colic bottles and anti-reflux mixtures), and also adhere to the correct posture during this procedure;
with difficult nasal breathing must be removed from the nasal passages of the crust or discharge from them;
after the child has been fed, you should not toss him for 30-40 minutes, turn over or play active games with him;
try to feed your baby in a relaxed and calm atmosphere;
do not force the child to eat, if he doesn't want to;
feeding should be done in small portions, so that the tummy does not overflow;
sleep should be on the right side or back and in no case on the stomach. In the event that the baby spits up in a dream, it is necessary to raise the head end;

Children under one year old are not recommended to sleep on a pillow, but in this condition it should be used only for a short period of time (15-30 minutes) so that the child does not regurgitate and aspirate vomit during sleep.

change of diaper or clothes must be done before meals, to shake and twist the baby less.

Pathological conditions of newborns, accompanied by regurgitation

But, unfortunately, this process is not always physiological and in some cases requires a mandatory consultation with a doctor, followed by drug or surgical treatment.

If the child spits up after each feeding, then this can contribute to the baby's underweight, metabolic disorders, and the development of inflammatory processes in the esophagus - esophagitis. If regurgitation is constant and profuse, there is a large loss of water (dehydration).

This condition can also occur due to pathological reasons:

abnormalities of the gastrointestinal tract. Examples are pyloric stenosis, diaphragmatic hernia, chalasia of the cardia, congenital short esophagus;

Pyloric stenosis is a narrowed pyloric section of the stomach. The maximum number of cases when it is detected occurs within two to three weeks from the moment the baby is born (more often in boys). This anomaly is characterized by persistent and prolonged regurgitation, lack of weight gain and weight loss.

perinatal lesions of the central nervous system (with severe course of both the prenatal period and difficult labor, as well as low Apgar scores, increased intracranial pressure). At the same time, the baby may be restless, his hands, chin, etc. may shake, and there may also be other neurological symptoms;
infectious processes (sepsis, meningitis, hepatitis), which are accompanied by lethargy, discoloration of the skin, monotonous crying;
hereditary metabolic disorders (phenylketonuria, galactosemia, adrenogenital syndrome);
kidney pathologies (renal failure);
poisoning with various substances.

According to this information, there are three main causes of pathological regurgitation: congenital abnormalities of the gastrointestinal tract, neurological causes, and indigestion in a child.

Congenital pathologies of the gastrointestinal tract

These include:

diaphragmatic hernia. This disease is congenital and is a consequence of the underdevelopment of the connective tissue structures that strengthen the diaphragmatic opening. Clinical manifestations of the disease occur two to three weeks after the baby is born. They are characterized by persistent, prolonged regurgitation that appears immediately after eating, weight loss of the child;

This diagnosis can be confirmed or refuted by X-ray examination.

pyloric stenosis, pylorospasm. Because of these pathologies, there is a disturbed flow of gastric contents into the duodenum. Clinical manifestations do not appear immediately after birth, since the volume of milk entering the body is small. Regurgitation appears at the end of the first - beginning of the second month of a baby's life. They can acquire a fountain-like character, have a curdled consistency and a sour smell;

The diagnosis can be confirmed or denied by endoscopic examination of the stomach.

chalasia of the cardia, that is, relaxation of the cardiac sphincter of the stomach. Since this sphincter does not close completely, gastric contents are thrown into the esophagus. Clinical manifestations occur immediately after birth. Confirmation of the diagnosis is carried out by X-ray examination of the stomach;

Why does a baby spit up after breastfeeding with cardia chalasia? The answer to this question is obvious - regurgitation has an unchanged consistency (in the form of milk or a mixture), since they appear immediately after feeding and the food does not have time to be digested yet. In a horizontal position, they are stronger. Additional symptoms may include: sluggish sucking, rapid fatigue of the baby, poor monthly weight gain, restless sleep.

congenital short esophagus, that is, the length of the esophagus does not match the chest. Because of this, part of the stomach is displaced to the diaphragm.

It is very important to properly latch the baby to the breast to prevent air from entering the stomach. The posture for feeding must be correct and during this process the mother needs to control so that the baby grabs not only the nipple, but also the areola.

Neurological causes

The most common cause of regurgitation in children under one year old is considered to be perinatal encephalopathy. It is a consequence of acute or chronic oxygen starvation of the fetus or trauma during labor.

When the baby is born prematurely, the development of the sphincter is not over, and therefore the baby can spit up up to six months, until the postnatal formation of the gastrointestinal tract ends.

Pathologies that have formed perinatally include: impaired functioning of the central nervous system, disturbed sleep, increased intracranial pressure, high excitability of the vomiting center, etc.

Due to difficult childbirth, the baby may experience damage to the cervical spine. With these injuries, a consultation with a neurologist is required, followed by treatment in the form of massages, physiotherapy, and medications.

Indigestion in a child

They can have both functional and organic genesis. In the first variant, physical ailments are caused not by a disease of the organ, but by a violation of its function. In the second variant, the structure of the organ is damaged, which can manifest itself as both minimal enzymopathies and gross developmental anomalies.

The leading place among children of the first months of life is occupied by functional disorders. Their percentage is 55 - 75%. This type of disorders occurs due to: transferred antenatal and postnatal hypoxia, morphological and functional immaturity of the gastrointestinal tract, a later stage of development of the autonomic, immune and enzymatic systems of the digestive tube, nutritional discrepancy with the age of the child, violation of feeding rules, lack and excess of drinking.

Most often, parents have to deal with these disorders by the time the early neonatal period ends. The greatest number of functional disorders occurs in the firstborn in the family, as well as in children born due to in vitro fertilization. In more rare cases, their occurrence is possible in a large family.

Regurgitation in newborns is one and a half times more likely to occur if the child is artificially fed than naturally.

In the event that the baby is premature or immature, then the percentage of the likelihood of these digestive disorders increases. And all due to the fact that such children produce intestinal hormones more slowly, motor processes in the stomach and duodenum are not coordinated, and the reaction of the central nervous system to the occurrence of pain is slowed down. Therefore, they have these processes longer and more pronounced.

With an untimely diagnosis of functional changes and improper treatment of these digestive disorders, although they are not of an organic nature, more serious diseases can occur at an older age. So, for example, regurgitation can lead to esophagitis or gastroesophageal reflux disease.

If the baby has an uncoordinated regurgitation syndrome, then otitis media, sinusitis, iron deficiency anemia, gastroduodenitis may develop later.

When is it worth contacting a specialist for spitting up in a child?

With this condition, medical intervention and medical advice are not always required, but in some cases it is simply mandatory for:

pronounced anxiety of the child;
the presence of blood or bile in the vomit;
severe abdominal pain (in young children, it is manifested by strong crying and severe anxiety);
persistent repetitive gushing regurgitation;
swollen and visually enlarged abdomen;
lethargy and severe irritability of the child;
poor appetite and regurgitation immediately after eating a large volume (more often occurs with pyloric stenosis);
spitting up too often (at intervals of five to ten minutes) after receiving the mixture or milk;
poor monthly weight gain or lack thereof;
avoiding breast milk or formula.

If a child spits up after each feeding and a large volume, in addition, he has increased excitability, poor weight gain, you should immediately consult a doctor to rule out congenital pathology.

Other alarming symptoms accompanying regurgitation

Additional symptoms that may accompany this process may be:

violation or cessation of breathing;

If a child breathes faster at rest (newborns more than 130-140 times per minute), his nasolabial triangle turns blue, the chest is drawn in during inhalation, the sternum sinks, the color of the skin has changed (it has become white or with a grayish tint, or cyanotic) , holding your breath, you should immediately call an ambulance.

stool change. It can be with mucus, blood, or mucus and blood. It is possible to change its color to green, black or another color, as well as smell;
the appearance of seizures;
bloating and painful colic;

Signs of an "acute abdomen" can be: bloating, increased anxiety of the baby, piercing and prolonged crying, increased regurgitation and absence of stool.

repeated vomiting "fountain";
blood and bile in vomit;
prolonged vomiting lasting more than a day;
signs or symptoms of dehydration. In children under one year old, they can be talked about with dryness in the oral cavity, absence of tears (except for those children who have not yet opened the opening of the lacrimal canal), retraction of the fontanelle, rare urination;
shrill, prolonged crying of a child, pronounced anxiety;
lethargy of the baby.

How to tell the difference between regurgitation and vomiting?

According to scientific studies, it has been found that babies who eat formula have more severe regurgitation than those who receive breast milk. This is due to the fact that the absorption and elimination of the mixture from the body is more difficult.

The concept of vomiting should be understood as a reflex return of gastric contents (in some cases, the duodenum) into and out of the oral cavity. This process is accompanied by nausea.

It is exclusively the doctor who should differentiate what is the norm and what is the pathology!

Symptom.	Regurgitation.	Vomiting.
Process.	Physiological.	Pathological (can threaten the life and health of the child).
There is.	Most often immediately after feeding or within an hour after a meal.	After a long period of time.
Volume.	As a rule, in small portions and infrequently (does not exceed 25% of the volume of food eaten). It is no more than two tablespoons.	Large volume (equal to the amount of food eaten or even more). It makes more than 25% of what the baby ate.
Smell.	Sour.	Unpleasant (due to gastric juice and bile).
Consistency.	Liquid (in the form of milk or curdled milk / mixture).	Cheese or thicker (it looks like partially or completely digested food with the addition of mucus and bile).
Well-being.	Not broken.	Weakness, fatigue, heart palpitations may increase, the skin turns pale, the temperature of the arms and legs decreases.
Desires.	None.	There is gagging. The abdominal muscles and diaphragm are involved in this process.
Temperature rise.	Doesn't arise.	An increase in temperature may occur, and with dehydration - its decrease.
Behavior.	Doesn't change.	Becomes capricious, lethargic, whiny.
Periodicity.	No more than two or three times a day.	More than twice after one meal.

It is necessary to closely monitor the well-being of the child in order to timely see and help the doctor in differentiating the diagnosis, and also promptly seek his help.

Required examination methods

First of all, in order to make a diagnosis and find out the reason for the appearance of regurgitation, it is necessary to carefully collect an anamnesis (find out hereditary predisposition, the frequency of their occurrence, volume, consistency, behavior, general condition of the child, etc.), as well as make a thorough physical examination of the baby (assess its general condition, skin color, abdominal condition).

When making a diagnosis, it may be necessary to consult not only a pediatrician, but also a gastroenterologist, surgeon, neurologist, endocrinologist.

If the baby has persistent regurgitation, then the diagnosis should begin with an endoscopic examination of the upper gastrointestinal tract, that is, esophagogastroduodenoscopy. In most cases, it is this method that allows you to verify the diagnosis.

Potassium, sodium, chloride, protein, liver markers are produced to assess the presence or absence of dehydration.

The use of antireflux mixtures, if indicated and recommended by a doctor, is allowed from the neonatal period.

To verify the diagnosis of regurgitation, produce:

twenty-hour daily pH-metry;

Thanks to this method, you can determine the total amount and duration of this process, monitor the level of acidity in the esophageal tube.

esophagogastroduodenoscopy;

This research method can be performed with targeted biopsy of the esophagus. It is necessary to assess the state of this organ, the consistency of the sphincter of the cardiac part of the stomach, etc. Thanks to the histological examination, you can quickly find out how pronounced the inflammatory process is.

esophagotonokymography. Thanks to this research method, it is possible to determine the tone of the lower esophageal sphincter, assess the motor function of the stomach, as well as the amplitude of contractions;
X-ray of the gastrointestinal tract without contrast;
scintigraphy;

With this method, it is possible to assess whether the esophageal clearance is slowed down or not.

X-ray of the organs of the gastrointestinal tract with contrast;
Ultrasound of the abdominal organs, brain;
fibrogastroduodenoscopy;
coprogram;
MRI and CT of the brain.

In severe cases, for an accurate diagnosis, electroencephalography, echo-electroencephalography, and lumbar puncture may be required.

Regurgitation treatment

Therapy for this condition depends on the cause that caused it. Most often, preventive measures can be dispensed with, and in some cases, not only medication, but also surgical treatment may be required.

The main points of therapy should be aimed at:

clarification of the rules for caring for such a child and psychological support for parents. The doctor should explain to the mom and / or dad in an accessible way why this process is taking place, as well as calm them down and concisely explain the rules of behavior with the baby and caring for him;

Parents of children with frequent regurgitation are advised to keep a diary of the frequency of their occurrence throughout the day - this will help the pediatrician in making a diagnosis and prescribing the correct therapy.

postural therapy. It is very important to monitor the position of the baby's body during the day and night, so as not to provoke the regurgitation process. Such treatment is aimed at reducing the degree of reflux, reducing the risk of aspiration, and improving the clearance of the esophageal tube from gastric contents;
diet therapy. "Antireflux mixture" is selected taking into account the age of the baby, the number of episodes of regurgitation, their severity and body mass index;

For this purpose, an increasing number of mixtures are made every year, containing thickeners obtained from locust bean gum and rice starch. An interesting fact is that the use of such "antireflux mixtures" in our country dates back to the times of the USSR.

drug therapy. It is carried out in most cases: prokinetics (Cerucal, Raglan, Prepulside, Motilium), antacids (Maalox, Fosfalugel, etc.), proton pump inhibitors (Ranitidine, Famotidine), antispasmodics (Riabal, etc.). The duration of treatment, the dosage of drugs and the frequency of their use are selected individually for each child by the doctor;
ozokerite, UHF inductometry. These procedures are prescribed to make the neuromuscular structures mature faster;
surgical treatment. This therapy is prescribed for malformations of the digestive system.

If a child is breastfed, but he has indications for the appointment of an "antireflux mixture", then the use of it by the baby should be before breastfeeding in the amount prescribed by the doctor!

In the event that a pediatrician suspects pyloric stenosis in a child, he should send the baby for a consultation with a pediatric surgeon, and also further examine him. If the cause of regurgitation lies in neurological pathology, then consultation of a neurologist is mandatory, and if in endocrinological - an endocrinologist.

Conclusion

"Why does the baby spit up?" There are a lot of reasons for the development of this pathology. They can be both physiological and pathological, easily amenable to corrective therapy or not at all.

"The best defense is an attack", so if you notice that your baby has frequent regurgitation, then be sure to consult a doctor, as they can threaten the life and health of the child! However, one should not immediately panic, because this process may be physiological, but it is imperative to track the frequency of their occurrence and report them to the pediatrician.

When prescribing therapy, perform it, and then you will make life easier not only for your baby, but also for yourself. Because only with proper treatment and individual selection of medications, it is possible to prevent the transition of physiological regurgitation to pathological. Be healthy! Take care of your children and see a doctor in a timely manner, and do not miss monthly preventive examinations.

Bibliography

Babaeva A.R., Rodionova O.N. Functional diseases of the gastrointestinal tract: current state of the problem // Bulletin Vol. GMU. 2006.
Ivashkin V.T.Gastroenterology. Clinical guidelines. M .: Geotar-Media, 2006.
Anetova. E. S., "The syndrome of regurgitation and vomiting in children" // Lectures on Pediatrics, M. 2002.
Kon 'I. Ya. "Specialized products of medical nutrition: characteristics and use in young children" // Children's doctor. year 2000.