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I have had quite a few questions recently about puking babies.  “My baby won’t stop puking! My baby projectile vomited all over me! My baby spits up constantly!”  As I gather more information from people I usually see that even though their babies have been spitting up or vomiting, it is usually just a few times a day.  As a new mum it can be especially scary when our little babies spit up or projectile vomits all over the place and extra special when it happens all over us!  What is normal though? How can you tell when your puke machine needs further investigation from a doctor or paediatrician?

Let me begin by saying I completely understand how scary it is when your baby is spitting up, especially when it’s large amounts.  The last thing you want as a mum is a vomiting baby, especially when it’s all over your new white shirt that you just happen to be wearing at the time. 

Most babies will go through different periods of time where they spit up a bit here and there.  Some babies are just “pukers” and will spit up ALOT with nothing actually being wrong with them.

Here is a checklist to go through when you notice your baby is spitting up frequently…

1. Check your very awesome and reliable motherly instincts.  When you look at your baby how do you feel she is doing? Does she look like she is in pain? Does she look like she is really upset, or did she just spit up and get on with her day doing those very important things like looking around, falling asleep and pooping.  If you take a moment to really observe her you might be surprised how much she can, and will tell you.

2.  Is she happy after she spits up (or you might describe it as a puke)? If she seems content after she spits up then she probably is! She will let you know if shes not which I’m sure you are very aware of.  Babies who are in pain might bring their knees up, arch their backs, scrunch their little faces and seem generally unhappy or unwell (read: CRY)!  Babies will sometimes get very gassy as well but again, if they are gassy and then smile at you or go to sleep there is not much to worry about at that point, this could still be just normal baby gassiness and does not mean you have to stop eating broccoli or beans.

3. Is your baby gaining weight and getting “enough”? Sometimes mums worry that their baby is not getting enough since they just watched them spit it all up!  There are many ways you can check to make sure your baby is getting enough and gaining weight besides weighing them which is the obvious one! One way is to do a nappy count.

Is your baby peeing and pooping frequently?

Nappy Count:
From when your milk comes in (usually about three days after the birth of your baby) you should see 6-8 wet cloth nappies and 5-6 wet disposable per day. Your baby should also be having 2-5 poops per day (at least the size of a tablespoon or so) for the first few months.  After about six weeks or so many babies will start to poop less frequently sometimes even skipping days.

Is your baby feeding 8-12 times per 24 hours? If yes then great! Even if she is spitting up a few times per day (or night) she is most likely getting adequate nutrition because of her frequent nursing sessions.

4. Rule out Gastroesophageal Reflux (GERD).  Usually a baby with gastroesophageal reflux will show one or many of the following symptoms; frequent burping or hiccupping, frequent spitting up or non-projectile vomiting, frequent night waking, poor weight gain, difficulty swallowing, sudden or inconsolable crying, arching during feeding, constant nursing, or disinterest in nursing (Barmby, 1998).  It is important to note that your baby might have frequent spitting up issues BUT if she is gaining weight, generally happy and breastfeeding well then it might just be a plain old case of what I like to call, “baby puke machine syndrome.”  In other words, your baby is little and new and is just a bit of a puker…this too shall pass once she has grown up a bit.

5. Also rule out pyloric stenosis (narrowing of the muscular wall of the tube that passes from the stomach into the intestines).  A baby who occasionally projectile vomits most likely will NOT have this condition! A baby who has this will start vomiting after a feed here or there and then it will become more frequent and will not be gaining weight.  This is the crucial piece of information here! If you have a puker who at times will vomit here or there but is gaining weight then it is unlikely to be this condition.

6. For a baby who is vomiting because of a stomach bug, it is important to continue to breastfeed them for as long and as often as they want.  Even if they continue to vomit after a feed, breastmilk is digested twice as quickly as formula so your baby will have absorbed some of your milk even if they vomit quickly after they have eaten.  I remember an ever so pleasant moment in time when my oldest boy (who was only two years old) and I were both sick at the same time with a stomach bug.  We were taking turns throwing up! Lovely thought isn’t it?! I was so relieved that although he was as sick as a dog and not eating any solids during this time (just my milk) I knew he was getting exactly what he needed.  He would vomit very soon after he had breastfed but he recovered very quickly (much more quickly then I did!) and was never dehydrated or lethargic. and did not have a fever.  I did not have to give him any sort of electrolyte drink either as my milk was the best electrolyte drink on the market!

7.  Look out for signs of dehydration.  As stated in La Leche League (2003) the following are signs of dehydration in your baby, “listlessness and sleeping through feeding times, lethargy, weak cry, skin loses its resilience, dry mouth, dry eyes, less than the usual amount of tears, minimal urine output (less then two wet nappies in a twenty four hour period), the fontanel on baby’s head is sunken and fever” (p. 335).

So what is a mother to do with her little puke machine?!

You have ruled out stomach bug, GERD and pyloric stenosis so now what?

Often times women will discover that it actually has more to do with the fact that their milk supply is massive! Their babies are getting so much milk all at once it just comes right back up.  They are squirting milk left right and centre, they have a very strong let-down (when the milk starts to come out from the breast) and their baby gets a bit cranky at the breast and tends to have a “love/hate” relationship with them and your breasts start to feel more like a fire hose!

This my friends is over-supply or sometimes called an, “over-active let-down.”  Have no fear! I have experienced this will all three of my babies.  It is easily fixed and the older they get, the less problems they have with your fire-hose boobs.  I will be doing a whole post in the near future on this topic alone since it is so common but I will just quickly mentions the following tips if you think this might be your problem!

Try “block feeding.”  This is when you feed your baby on the same breast for a couple of feeds or over a few hours.  Do not go by the clock, go by the feel of your breasts.  Although they are never empty, they will feel less full.  When your breast has been well drained (after a couple of feeds or several hours) then switch to the other side.  Hand express on the other side for comfort if it gets engorged.  After doing this for a few days your breasts will adjust to the change and you should see your let-down is not as strong and your baby happier at the breast.  You can also hand express a little bit out when you have that extra strong let down at the beginning of the feed for a few minutes and then pop her back on.  This way she is able to feed after the initial strong flow.  I will be including a link in this post to a video on my YouTube channel soon, which shows a woman hand expressing.

You can also try to feed your baby in a position where her head is higher than her bum.  Some mums have found this helpful.  If you prefer lying down to breastfeed, you can always sit her up right after you have fed her.  This way if reflux is the problem, she might feel more comfortable being upright.  If you had reflux during pregnancy then you could understand why! Being upright can take away the burning, uncomfortable feeling.

Occasionally a baby will be sensitive (or in rare cases actually allergic) to something you are eating or drinking.  The most common sensitivity or allergy for a baby is dairy.  If you feel as though this could be the case, you can try eliminating dairy COMPLETELY from your diet for at least one month.  It can take at least this amount of time for it to leave your system.

Remember above all, trust your instincts!  If you are really worried then go see your GP or care provider.  If you think something serious is going on after going through this checklist then listen to your instincts.  You know your baby best. Please Contact Me set up a consultation via Skype if you have questions.

Barmby, L 1998, ‘Breastfeeding the baby with gastroesophageal reflux’, New Beginnings, Vol. 15 No. 6, November-December 1998, pp. 175-76.

La Leche League International 2003, The breastfeeding answer book, Schaumburg, Illinois

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