My Baby the Puke Machine...Is All This Spit-Up Normal?!

Another example on this blog of my exceptional artwork.

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.




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.

 

My baby is broken! Please fix him!

THE CRYING BABY

You have tried it all. Breastfeeding, rocking, pacing the halls, passing him back and forth, crying yourself, sitting, standing, tearing your hair out, and he is still crying!  What is a mum to do?  Us mothers have one fundamental question, "is my baby normal?" Is it normal for my baby to be cranky, to breastfeed constantly, to only sleep when I'm carrying him? etc. etc. etc.....and the reality is, yes! It is normal for your baby to be cranky at times for no apparent reason.  Does that make you feel better or worse?  :)  I remember my mum calling the hours in the later afternoon the "witching hour."  You know that time when you have your baby on your hip or in a sling while trying to make dinner, sweep up all the crumbs off the floor, put that last load of laundry on and try to get one piece of food in your mouth before you starve to death?

Before I had children I had all of these ideas as to what parenthood would be like. Remember before you had children? That distant past that seems blurry now due to your sleep deprivation?  Remember looking at those other parents as a young twenty year old thinking, "wow, when I'm a parent I will NEVER do that! How horrible!" and now you find yourself doing that same exact thing....this is what happens! No one imagines themselves looking at their baby thinking, "why are you so cranky?! I'm a horrible mother, I can't even settle my own baby!"  Yet, these are thoughts we all have from time to time. And it's normal.

Every month when I have my Boobies By the Beach group meet up (a breastfeeding group for mums to get together and chat about all things breastfeeding) almost every time there will be this wonderful moment when one mum will hear another mum's story and say, "my baby does that too! Oh good, it's normal!"  This is especially important for issues regarding normal breastfeeding behaviour, sleep and cranky babies.   Hearing that someone else has a baby that does the same thing as your baby creates an instant feeling of relief.

From my own experiences (and talking with many mums over the past nine years since having my first born, very high needs cranky baby) I have learned a thing or two about crankiness....there is light at the end of this long dark cranky tunnel!  One of my friends coined the term, "the circuit" as a way to describe what she did when her babies were upset.  The idea is that you keep going through the list until, voila! The baby will stop crying! You will then fall into a heap on the couch and cry yourself to sleep from happiness that your baby is finally content.

1. Breastfeed your baby.  I can't tell you how many times this one will work! Babies breastfeed for many different reasons besides hunger.  One of them being comfort. This is always my "go to" step.

2. Carry your baby. On your hip, in a sling, hanging like a star fish in a Baby Bjorn. However you want to do it! Just carry them. Many babies like to breastfeed while being walked around in a sling. One of my friends had to breastfeed her baby while walking. ALL THE TIME. It's amazing her legs didn't fall off.  Come to think of it, she looks extremely fit and healthy and this must be the reason why.  It's a great way to get some exercise!

2. Swaddle your baby. Now this is a popular one which many people will suggest. Just so you know, two out of three of my babies HATED being a burrito. So not every baby will like it.

3. Pass your baby onto your husband, partner, friend, neighbour, random stranger in the park (just kidding!)  so you can get a break. You will feel better knowing that although they are crying, at least they are being held.

4. Go for a walk outside with your baby.  Sometimes just a change in scenery is enough.

5. Get into the bath with your baby. You can also try breastfeeding in the bath. Some babies love it.

6. Back to step one!

and around and around it goes until eventually one of these steps will work! Of course if one of these just isn't feeling right for you or your baby then skip it. Also, add whatever else you can think of to the list and please add to the comments below so we can all share what has worked for us.

Even after having my third baby (who is now just six months old) I still think, "but I just breastfed you five minutes ago!" before putting them back on.  Yet I know that often babies will do this. They will pull off, get cranky, want to be walked around and then five minutes later get back on the breast and fall asleep happily. What is the deal!? Well, they have a biological need to be with their mums and breastfeed. ALOT. I think it's helpful to know that it's normal, and you'll get through this long dark cranky tunnel. 




*About half way through this blog post my little baby woke up after a tiny mini half hour nap (oh those dreaded nano naps!), I picked him up, took off his nappy and before I knew it he was peeing all over me.  I then had to strap him to my back and finish typing this while standing.  So I guess not being able to finish a post without the baby waking up, wanting to be held and peeing on me is normal as well....* 

For more information on how to tell your baby is getting enough milk and is not cranky because they are hungry, visit this page for my post on Milk Supply 

For more information on getting baby to nap longer, head over to my post on naps - Nap Time


*Some babies get cranky for serious reasons including; an allergy to something you are eating which is going through your milk, reflux and other various medical conditions or breastfeeding issues. Trust your instincts.  If you feel as though there is something serious going on then please contact me via email or phone or contact your GP.*