Baby Bringing Up Milk Straight After Feed

Most babies regurgitate small amounts of milk after a feed — it is completely normal and not usually a cause for concern. It's a natural part of their digestive process as their tummies are still developing, and will typically get better on its own.

Regurgitation of small amounts of milk is considered harmless in healthy infants. It is often a result of swallowing air while feeding or the immaturity of the muscles that control the flow of food in their digestive system.

However, if your baby is bringing up larger volumes of milk or appears to be uncomfortable or in distress after a feed, it may indicate an underlying condition such as gastro-oesophageal reflux or cow's milk protein allergy.

Reflux, also known as gastro-oesophageal reflux or GORD, is a common condition in babies.

Reflux happens when the muscular valve at the end of your baby's food pipe, the oesophagus, — which is still developing when they are little — allows milk (or food in older babies) and some stomach acid to travel back up again.

Common symptoms of reflux in babies can include:

• Frequent regurgitation of milk during or just after feeds
• Irritability during or after feeds
• Crying
• Hiccuping or coughing
• Gulping or swallowing after feeding or burping
• Appearing unsettled during feeding

Although most cases of reflux in babies are not serious, it can sometimes lead to complications. Constant regurgitation of stomach contents can result in discomfort, pain and disruption of sleep for the baby.

We see many babies referred due to concerns regarding reflux. It is normal and very common in both breast and formula-fed babies.

In most cases, symptoms are mild and can be managed without medicines. Holding your baby upright after feeding, ensuring they have burped, avoiding overfeeding and investing in a good supply of muslin cloths will usually be all that is needed.

In some babies that are vomiting a lot and showing symptoms of reflux, allergy to cow’s milk protein could be the underlying cause.

Cow's milk protein allergy (CMPA) can cause immediate symptoms such as facial swelling, rashes and hives, or delayed symptoms such as those described below.

A delayed milk allergy occurs due to inflammation and irritation in the lining of the gut, resulting in a range of symptoms including:

• Symptoms similar to colic
• Crying persistently and being unsettled
• Frequent diarrhoea and explosive poos
• Blood or mucus in their poo
• Vomiting/regurgitation and reflux
• Skin problems such as eczema, rashes or hives

In severe cases of immediate type CMPA symptoms include swelling around the face, red itchy rash on the face and body, shortness of breath or difficulty in breathing. These symptoms require immediate medical attention.

Excluding all cow’s milk-based products from the mother’s diet, if breastfeeding, or using an alternative specialist formula in formula-fed babies, will typically be recommended for a trial period to see if the symptoms improve.

Sometimes, babies may bring up curdled milk, which can be a normal occurrence and not necessarily a cause for concern.

Curdled milk in spit-up may appear like small clumps or lumps and it may have a cottage cheese-like consistency or appearance. It can be white or yellowish and have a sour smell. This is caused by the action of stomach acid on the milk — making it curdle.

While spit-up may appear curdled, it is not always indicative of a health concern. In many cases, it is a normal process that babies go through as their digestive system develops.

If your baby is otherwise happy, healthy and gaining weight appropriately, occasional curdled spit-up is usually not a cause for alarm.

However, if your baby is showing other signs of discomfort, such as excessive crying, poor weight gain or other unusual symptoms such as green vomit or blood in vomit, it's important to speak to your paediatrician for further evaluation and guidance.

It's not uncommon for babies to gag during feeding, though it can seem like a cause for concern. However, it's important to understand that babies are born with a ‘hyper-gag reflex’ — a protective mechanism designed to prevent choking.

This exaggerated reflex can sometimes cause babies to gag or cough during feeding, but it is generally a normal part of their development.

If your baby does gag during feeding, the first step is to stop feeding and remain calm. It's important to remember that most episodes of gagging or choking are resolved quickly, especially if it is due to liquids.

You can gently position your baby upright with good head and neck support, as this can help them manage the issue and clear their airway more easily.

Prevention is key when it comes to managing gagging during feeding. Ensuring that your baby is in an appropriate feeding position, such as semi-upright with their head slightly elevated, can help reduce the risk of choking.

Keeping an eye on the flow of milk during feeding, as well as pacing the feeding and allowing your baby to take breaks, can also help prevent episodes of gagging or choking.

If your baby consistently chokes during feeds, it's important to consult your paediatrician for further evaluation. They can provide personalised recommendations based on your baby's needs and ensure that your baby is feeding safely.

Childhealthy also offers first aid training classes to provide parents with the skills they need to assist their choking baby or child.

As a parent, it's natural to be concerned about your baby's nutrition and whether they are getting enough milk during feedings.

If your baby is putting on weight, you usually don’t need to do anything and can be reassured that symptoms gradually improve over the first year.

Thickening milk may help with frequent regurgitation, and if discomfort during and after feeding is a problem, your GP or private paediatrician may recommend trying an anti-reflux medication. If medicines are prescribed, their use should be reviewed regularly aiming to stop when symptoms are stable.

If you notice any of the following signs, it's a good idea to contact your paediatrician for further guidance:

• Poor or slow weight gain
• Infrequent stools
• Feeding duration (consistently too short or too long)
• Sluggishness or excessive sleepiness
• Dark urine colour

Most of the time, babies won’t exhibit any of these worrying symptoms and bringing up milk, whether forceful or not, is likely to be due to reflux and will improve as your baby matures.

Remember, every baby is different, and it's normal for breastfeeding patterns and behaviours to vary. But if you have concerns about your baby's milk intake, it's always best to consult your paediatrician.