If your baby is nursing well, growing, i.e. gaining weight, getting longer, and seems content during and after nursing, this spitting up a lot can be perfectly normal. Breast milk reflux is not the same thing as Acid Reflux Disease where one might expect some evidence of heart burn and/or some evidence of impaired growth or recurrent respiratory symptoms, like cough or wheeze.

Heartburn burns. It is painful. Baby's with acid reflux disease with heartburn cry during nursing and shortly thereafter. They may arch their backs, stiffen and squirm, and constantly pull off the breast. They may not settle in to comfortable soothing feeding.

Baby's get most of their breast volume in the first 5-10 minutes. Suckling after that time is important for satisfaction and nurturing. Some babies naturally only nurse 5-10 minutes and are perfectly content and satisfied; others need 20-40 minutes to be equally content. Happy babies that constantly spit, reflux or bubble have functional gastro-esophageal reflux and nothing needs to be done other than monitor their comfort and growth. 90% will cease this refluxing by 12-18 months of age with no treatment at all.

Keep your well checkup appointments so you and your pediatrician can monitor this situation, the baby's comfort and satisfaction and the baby's growth.

There are some simple interventions that might diminish the spitting, but no guaranty. One might try different burping positions; you might try not jiggling the baby around excessively during and after nursing (treat the baby like T&T and move him/her slowly after nursing to the infant seat inclined at a 30 degree angle. The baby should sleep on the back not the tummy to minimize the chances of SIDS.

The issue of the baby "eating too much" is probably not a real concern for a nursing baby. A bottle fed baby has a hard time saying no to gravity and the fluid flow, but a breast fed baby is well in control of the flow of breast milk, once the let down reflex and milk production is established.

The issue of your milk supply is a simple one_more or less. If you feel your milk supply is diminishing, the baby needs to nurse longer and frequently and your breast will make more milk. If your baby is content with 5-10 minutes of nursing, and you feel less full after nursing compared to when you put the baby on the breast, all is probably well. My prediction is that a happy content baby who is nursing well and spitting often WITHOUT EVIDENCE OF PAIN OR WEIGHT LOSS, will probably spit whether you nurse 5 minutes or 40 minutes. Painless spitting can be perfectly normal. You may want to expect it and make appropriate use of a towel when nursing.

Now all this being said, we have been talking about spitting, what the British call bubbling. Recurrent forceful vomiting, shooting some distance from the baby in the first 8-10 weeks of life is a different animal and should be discussed carefully with the baby's doctor.

Please enjoy your nursing experience. If the baby's spitting is as comfortable as I've outlined above, it will be much better by 12-18 months of age.

Regards,

Dr. T

Marc Tanenbaum