Newborns Vomiting Post-Feeding: What's Normal And What's Not?

It is very common for newborns to be sick after feeding, with around 30% of healthy babies experiencing regurgitation during their first year. This is because their digestive systems are still developing and learning how to process milk. In most cases, this is nothing to worry about and will stop after the first few months. However, if your baby frequently has trouble keeping milk down, it is important to consult a doctor.

Reflux, when milk comes back up the food pipe, is common and usually improves by age 1

It is common for newborns to be sick after feeding, and there are several reasons why this might happen. One of the most common causes is reflux, which occurs when milk travels back up the food pipe (oesophagus) towards the baby's throat and mouth. This can cause painless spitting up, but it may also irritate the throat and lead to gagging and vomiting. Reflux usually starts before a baby is 8 weeks old and typically improves by the time they turn one.

Reflux in newborns is often due to the immaturity of the lower oesophageal sphincter, a valve at the bottom of the food pipe that acts as a door to the stomach. In newborn babies, this valve may not be fully developed, allowing milk and stomach acid to occasionally come back up. As the baby grows, this valve gets stronger, reducing the likelihood of reflux.

Reflux in babies usually resolves without treatment. However, there are some measures that parents can take to help manage it:

• Feed the baby in an upright position and keep them upright for as long as possible after feeding.
• Wind the baby before and after feeds.
• Feed the baby smaller amounts more frequently.
• Avoid tight clothing or outfits that are tight around the waist.
• Use a slow-flowing teat for bottle-feeding to prevent the baby from guzzling milk too quickly.
• Consult a healthcare professional about special infant formulas designed for babies with reflux.

While reflux is typically harmless, parents should contact a healthcare professional if they have any concerns or if their baby exhibits any of the following symptoms:

• Difficulty feeding or refusing to feed
• Regularly bringing up milk and appearing uncomfortable after feeds
• Not gaining weight or losing weight
• Vomiting that is forceful or projectile
• Blood in vomit or stool
• Swollen or tender tummy
• High fever
• Persistent diarrhoea or signs of dehydration
• Excessive crying and distress

Gastroenteritis, an infection of the gut, is an unusual cause in breastfed babies

It is fairly common for babies to be sick after feeding. This is usually due to the baby swallowing air during feeding, which is more common in bottle-fed babies. This is completely normal and will usually stop after the first few months. However, persistent vomiting can sometimes indicate something more serious, such as gastroenteritis.

Gastroenteritis is an infection of the gut, usually caused by a virus or bacteria. It causes diarrhoea and sometimes vomiting, and can lead to dehydration, especially in young babies. It is important to recognise and treat gastroenteritis quickly, particularly as it can be extremely contagious. The risk of dehydration from diarrhoea and vomiting is usually greater in younger children. Babies under 6 months old can become ill quickly and need extra fluids to replace those lost through vomiting and diarrhoea.

Gastroenteritis is an unusual cause of sickness in breastfed babies. In infants, the virus is usually of the rotavirus type, although enteroviruses and adenoviruses can also be the cause. It can also be caused by food poisoning via bacteria of the Escherichia coli or Salmonella type present in baby food.

If your baby has gastroenteritis, it is important to continue to breastfeed or bottle feed as usual, offering small amounts but more frequently. Oral rehydration solutions (ORS) are recommended to prevent dehydration, as they contain water, carbohydrates, and mineral salts. Broths are also a good way to keep your baby hydrated. If your baby has started eating solid foods, consider giving them potatoes, carrots, apple puree, or bananas, as these foods can slow down or stop diarrhoea.

Swallowing air during feeding is more common in bottle-fed babies

It is normal for newborns to be sick after feeding, and this is usually nothing to worry about. Mild vomiting is common in babies and improves over time. Their tiny stomachs can only hold a small amount of milk, so it doesn't take much for them to fill up and bring up excess milk. This is known as "possetting".

Swallowing air during feeding is one of the reasons why babies vomit, and this is more common in bottle-fed babies. This is due to the air retained inside the baby bottles. When a baby is feeding frantically, they are more likely to swallow air, which can lead to gas and colic. This can be prevented by ensuring the baby is not desperately hungry before feeding and using an air-free feeding system or a bottle with a smaller teat.

Bottle-fed babies can also swallow air due to the way the milk is delivered. They can drink faster from a bottle, and the milk is always available, making it easier to accidentally overfeed them. This can be avoided by feeding smaller amounts more often and ensuring the baby controls the flow and pace of their drinking.

Swallowing air can lead to bloating, gas, abdominal pain, burping issues, and acid reflux. To prevent this, it is recommended to feed the baby in an upright position, which helps keep food and acids in their stomachs.

Food allergies or milk intolerances can cause vomiting

It is fairly common for babies to be sick and vomit, especially when they swallow air during feeding. This is completely normal and will usually stop after the first few months. However, persistent vomiting can sometimes indicate something more serious, such as gastroenteritis, a gut infection caused by a virus or bacteria.

Food allergies and milk intolerances are among the possible causes of vomiting in newborns. While it is uncommon for babies to be allergic to cow's milk, it may happen in up to 7% of babies under one year old. Most children outgrow a milk allergy by the time they are five years old, but it can cause vomiting and other symptoms in babies.

A cow's milk allergy might cause vomiting right after a feed or several hours or days later. If your baby has an allergy, they might also experience other symptoms of an allergic reaction, such as difficulty breathing, itchy hives, swelling, redness, coughing, congestion, stomach pain, and nausea.

Food intolerances are different from food allergies as they do not involve the immune system. They can cause gastrointestinal symptoms, including vomiting, diarrhoea, stomach pain, abdominal pain, and gas. Food intolerance symptoms typically develop hours to days after a baby eats a particular food.

If your baby is frequently vomiting, or if you are concerned about possible allergies or intolerances, consult a healthcare professional for advice and guidance.

Congenital pyloric stenosis, a birth condition, can cause projectile vomiting

It is common for newborns to be sick after feeding, and this usually stops after the first few months. However, if the vomiting is persistent, it may be a sign of something more serious. One such condition is congenital pyloric stenosis, a birth condition that can cause projectile vomiting.

Congenital pyloric stenosis is a narrowing of the opening from the stomach to the first part of the small intestine, known as the pylorus. This condition results in projectile vomiting, which is more forceful than the usual spitting up or gastroesophageal reflux seen in newborns. The vomiting typically occurs after feeding, and the typical age for symptoms to appear is between two and twelve weeks old.

The cause of pyloric stenosis is not well understood, but several risk factors have been identified, including birth by cesarean section, preterm birth, bottle feeding, and being first-born. The condition is more common in males, with a ratio of 4:1 compared to females, and it affects approximately 1 to 2 per 1,000 babies.

Diagnosis of pyloric stenosis can be made by feeling an olive-shaped mass in the baby's abdomen, often confirmed with ultrasound imaging. Treatment typically involves correcting dehydration and electrolyte imbalances, followed by surgery or, in some cases, medical management with atropine.

While it is normal for newborns to spit up or vomit occasionally, congenital pyloric stenosis can cause persistent and forceful projectile vomiting. If you suspect your baby may have this condition, it is important to seek medical advice as early diagnosis and treatment can help manage the condition effectively.

Frequently asked questions