Bringing up milk after feeds is very common in babies and is usually not a cause for concern. Regurgitation and posseting are terms used to describe the effortless, non-forceful return of milk out of your baby’s mouth. Nearly all babies posset small amounts of milk as they bring up wind, whereas regurgitation of larger volumes of milk usually indicates gastro oesophageal reflux. Vomiting describes bringing up milk in a more forceful way and is also very common in babies and also commonly due to reflux.
I see many babies in my NHS and private practice 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 she has burped, avoiding overfeeding and investing in a good supply of muslin cloths, will usually be all that is needed.
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.
In some babies that are vomiting a lot and showing symptoms of reflux, allergy to cow’s milk protein could be the underlying cause. Colic and crying, frequent and explosive poos or constipation, blood and mucus in the poo and eczema are all other indicators that this may be the issue. Excluding all cows’ milk based products from the mother’s diet, if breastfeeding, or using an alternative specialist formula, in formula fed babies, will be recommended for a trial period to see if the symptoms improve.
A review by your GP or paediatrician is important if your baby is vomiting frequently. They will check your baby is gaining weight, having frequent wet nappies and check that there are no worrying associated symptoms that might indicate an underlying problem. Things to look out for that need more urgent assessment include green or blood stained vomits, blood in the poo, a swollen tummy, drier nappies and projectile vomiting after every feed especially if your baby is losing weight. If your baby is vomiting and has a fever you should always take her to see a doctor as this may indicate a serious infection, especially in younger babies.
Most of the time, babies won’t exhibit any of these worrying symptoms and bring up milk whether forceful or not is likely to be due to reflux and will improve as your baby matures.