It’s 2AM and you just wrapped up the bleary-eyed night feed. By some miracle, your little one drifts off to sleep quickly. In her crib, no less! But not even twenty minutes later a new complication keeps you from precious sleep. Once again, your baby spits up when laid down.
And she’s screaming again.
This scenario was pretty much my life for the first few weeks of my daughter’s life. Laying her down was almost like watching a bottle tip over. She just couldn’t seem to hold her milk inside. When your baby spits up while sleeping, it can be concerning and downright frustrating.
In this post, we’re going to look at a few reasons why laying your baby down results in fountains of undigested milk, as well as a few of of my favorite tips to help minimize these occurrence.
Notice I said, “minimize.” Because, Mama, I’m going to be real with you; spit happens and sometimes there’s nothing we can do about it. Let’s do what we can to make it better, yeah?
Oh, and don’t miss the special FAQ section at the end of the post! I have a feeling it’ll also answer some of your safety concerns as well.
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10 Possible Reasons Why Your Baby Spits Up When Laid Down
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Normal Infant Reflux
The official term for spit up is “gastroesophageal reflux.” (GER). You’ll also hear it called infant reflux. GER is not to be confused with GERD, which we’ll talk about in a minute.
Basically, it’s when the contents of your baby’s stomach just kind of slip out and escape his mouth. Look, I know you’ve probably heard this before, but spit up is a pretty normal thing for babies. In fact, over half of babies spit up.
Infants are born with an underdeveloped sphincter at the end of their esophagus. This sphincter is a little touchy and, it opens at the worst times. When there’s pressure on your baby’s tummy, if he’s jiggled the wrong way, or when your baby is laid flat on his back.
If you’re newborn is spitting up while sleeping, this may just be a normal occurrence that will resolve itself with time.
Have you ever refilled a bottle with just a little too much water and made a terrible mess? That’s kind of what’s happening when your baby overeats. If his stomach becomes too full, it kind of spills over.
Don’t be concerned or feel guilty. This is a self-regulating mechanism babies come equipped with.
Overfeeding is most common with bottle-feeding. When a baby is finished breastfeeding, he simply unlatches from the breast and moves on. Breastfeeding mamas have no clue how much baby has eaten, so they often move on too.
With bottle-feeding, you can see how many ounces your baby has consumed. If he isn’t drinking as much as “usual,” you might be tempted to offer him more. And more. And more…until he ends up spitting up while he’s sleeping.
The solution for this is pretty simple: if your baby is hydrated and happy but drinks a little less than usual, don’t sweat it. Just like adults, a baby’s appetite can range from day-to-day.
Having said all that, I want to note that breastfeeding moms can overfeed their babies too.
As a new mom, I was told that my baby’s feeds should take about 20 minutes. Sometimes they only lasted 10 minutes. I was terrified that she wasn’t eating enough, so I’d offer the breast over and over again, even though she clearly told me she was done. Understandably, she spit up a little afterward.
This is just a cautionary tale: trust your baby. He knows when he’s full.
An overactive letdown or “forceful letdown” can actually cause spit up for many reasons. For one, it quickly fills your baby’s stomach and unsettles it. For another, your baby is much more likely to develop gas bubbles when he’s choking on your jet propulsion milk. And gas bubbles cause spit up (more on that later!)
Overactive letdowns can also cause an imbalance of foremilk/hindmilk. This can upset your little one’s stomach.
If your baby spits up when laid down frequently and you suffer from an overactive letdown, try to let your initial letdown flow into a burp cloth.
Keep in mind, formula moms, that a bottle nipple that has the wrong flow can do this as well.
A bad latch can cause air to enter your baby’s tummy. These bubbles can increase spit up. A bad latch is particularly common with new moms, but not always. Some babies stuggle to latch on correctly. Remember your baby is learning how to latch effectively too!
If you’re struggling with getting the hang of breastfeeding, my girl Stacey offers a fantastic breastfeeding class that can show you how to get the best latch, protect your milk supply, and so much more!
Eating Too Quickly
Is your little guy guzzling down milk? This could be one reason why your baby spits up while sleeping. Eating too quickly increases your baby’s chances of swallowing air (remember, air bubbles in the tummy can cause more spit up and even painful gas).
I know you’re thinking about it, so let’s address it.
Yes, reflux can be a sign that your baby is allergic to something in his formula or breastmilk. The most common perpetrator is cow’s milk when it is either used as a base in formula or there are trace amounts in mommy’s breast milk.
You should be relieved to know that this allergy is relatively uncommon though. A cow’s milk protein allergy only affects about 2-6% of babies.
In addition to reflux, you should also keep an eye out for these signs:
- Blood in stool
- Pain (Your baby will arch)
- Colic symptoms (intense, purple-faced crying that can go on for hours. My daughter was not allergic to cow’s milk but she was definitely sensitive to it. When she consumed it in my breastmilk, she voiced her displeasure very loudly…)
Burping Too Much
Okay, this one surprised me! I had always been told that I needed to burp my baby vigorously after a feeding. After my second daughter, I found out that burping too much and too soon can actually cause spit up. I know, it’s confusing.
If you’ve noticed a correlation with your baby spitting up when laid down and vigorous burping then try other techniques to help move your baby’s gas. Try massaging her back or switching positions and patting lightly. If your baby is hard to burp, I wrote an entire post that might help!
I wanted to separate this out from GER because any parent of a GERD baby will tell you it’s just not the same. GERD is more severe than GER. Where infants experiencing reflux might happily go about their day, GERD is painful for the baby and her parents.
Your baby will avoid eating, because the excruciating reflux afterward programs his little brain to think that eating is a painful event. Your baby will be irritable because his little throat is raw and his tummy hurts.
A few other symptoms of GERD include:
- Wet burps and hiccups (don’t take this out of context though. Lots of babies with GER do this as well)
- Arching (from stomach pain or chest pain)
- Consistent disturbed sleep (at my daughter’s worst, painful reflux woke her up about a half hour after she fell asleep)
- Crying during feeds
- Hunger strike
When your baby’s reflux seems to cause him pain, it’s time to see his pediatrician.
Pressure on Your Baby’s Tummy
Remember how some things can cause that under-developed sphincter to open? Pressure on your baby’s stomach is a trigger. Tight diapers, clothes, swaddles, even laying a baby on his tummy can do it.
How to Stop Your Baby From Spitting Up When Laid Down
Hold Your Baby Upright After the Feeding
I know, this is tricky when your baby probably falls asleep while he’s nursing. However, if your newborn is spitting up while sleeping during the day, this is an easy thing that can help.
I adore an eat-play-sleep schedule. It goes like this:
Feed your baby immediately upon waking. Try to keep him awake for the full feeding. Then, play! For newborns, your play time is pretty short (probably like 5-10 minutes) but it will gradually increase. Then, when your baby is displaying sleepy cues, lay him in his crib.
Nighttime is a little more difficult because when your baby is done feeding, you really want to put him back in his crib while he’s still groggy. There’s a fine balance between keeping your baby upright for GER and desperately needing him to go back to sleep.
If it helps, here was my plan of attack: After my daughter’s nighttime feed, I gave her some gripe water, changed her diaper, re-swaddled, rocked, and then laid her down. This only amounted to 5-10 minutes upright, but I think it helped.
Switch Feeding Positions
When your baby is spitting up when laid down, changing his feeding position can help a lot!
My lactation consultant recommended it for breastfeeding, but you can totally apply this to bottle feeding. Simply make sure your baby’s head is higher than her stomach. So, if you’re nursing, you might try the football hold or nursing while you are partially reclined.
Offer a Pacifier
Pacifiers get a lot of hate, but I don’t think they should. They’re linked with a decreased chance of SIDS and they offer comfort to an infant in pain.
If your baby is spitting up when laid down and suffering from reflux pain, try offering her a dummy. A study in 2000 suggested that a pacifier may decrease your baby’s reflux pain and encourage milk to move downward into the stomach.
Let Her Nap in a Swing (Supervised Only)
If your baby is spitting up and exhausted, try letting her nap in a swing for some short-term relief. Sleep begets sleep. If your baby is getting the sleep she needs during the day, she’s less likely to wake at night.
Having said that, please don’t let your baby sleep in a swing at night. Lay your baby flat on his back, in a crib or bassinet, where he’s safest.
Try Gas Drops or Gripe Water
You’ve probably heard that gripe water can soothe a baby’s stomach. But have you tried giving it to your baby before her feeding?
My lactation consultant taught me this cool trick for our reflux troubles. She recommended giving our baby a couple gripe water drops before a feeding to coat the stomach.
If you think your baby’s spit-up is caused by gas, you can also administer gas drops.
Burp Every Couple Ounces or After Switching Breasts
I learned this trick from Taking Cara Babies and it made a HUGE difference for my daughter. The idea is that burping your baby consistently decreases the chance of an air bubble to push up spit-up later.
Feed Every 2-3 Hours
As babies grow, the time between feeds lengthens. Having said that, if your baby constantly suffers from reflux, you might find it beneficial to give him smaller feeds. I’m not suggesting snack feeds (Some moms do. I’m adamantly against them.)
I would try shortening the time between your baby’s feeds to about 2-3 hours and see if that helps.
It can be frustrating feeding your baby every two hours while other babies his age are eating every 3, but keep in mind that this is just for a season. Your baby will grow out of reflux soon!
Speak to a Lactation Consultant or Pediatrician
If your baby is showing signs of GERD, please mention it at your next checkup or make an appointment. If your baby’s reflux is severe enough, your ped may prescribe acid-blocking medication (do not give your baby any antacids your doctor hasn’t prescribed!)
A lactation consultant can also give you tips and tricks that can minimize your baby’s reflux without medication. Changing positions, adjusting your baby’s latch, and switching up your feeding routine can make a world of difference!
A Few Final Things You Should Know About Spit Up
Alright, now that you have a fair idea of what spit up is, possibly why your baby spits up when laying flat, and how to decrease it….let’s talk about some of the burning questions every parent has about spit up.
Is it Spit Up or Vomit?
Spit up is usually chill. It just comes up and your baby is usually pretty oblivious.
Vomit is a different story. It’s messy. It smells. You can hear your little one retch it up. That’s because vomiting involves forcefully purging the contents of his stomach.
Vomit is also usually accompanied by other symptoms like fever, crying, and a loss of appetite.
If you’ve accidentally fed your baby old or expired formula, there’s a good chance he’s vomiting, not spitting up.
When Does Your Baby Stop Spitting Up?
Every baby is different, but you should notice some dramatic improvement around 4-5 months. My daughter’s daughter’s reflux improved when she was around 4 months.
Having said that, some babies still suffer from infant reflux up to about 12 months.
I know your heart is probably sinking right now. How in the world are you going to survive this?
Please don’t be discouraged. There will be nights where your baby won’t have any reflux at all. You will have some relief in between. And eventually, you’ll also learn what little things you can do to minimize spit up sessions.
Will My Baby Choke If I Lay Him On His Back?
Not likely. The AAP says that laying your baby on his back should not increase his chances of choking.
This is another cool thing that Taking Cara Babies explained that relieved me by about a thousand percent. When your baby spits up, the liquid goes back into his stomach, rather than his lungs. His little body actually has a mechanism that protects his airway.
(You can learn more about that in this article if you want to. Cara also discusses reflux and infant sleep in her newborn sleep training courses).
Should I elevate my baby’s head when he has reflux?
Nope. The AAP actually addresses this specifically. Studies have not proven that elevating your baby’s head can reduce reflux. Your baby also has a greater potential of sliding down his crib into a position that may be extremely dangerous.
Unfortunately, as a new mom, I used an infant wedge and experienced this exact scenario. She rolled all the way down her crib and smushed her little face into the side. Thankfully, I noticed her position before anything tragic could happen.
At the end of the day, using a crib wedge is your choice, but after experiencing this close call myself I chose not to.
Should I Feed My Baby Again After He Spits Up?
Spit up can be nerve-wracking because it looks like a lot. Seriously. Having said that, it’s really not.
If you spill a tablespoon of water on your counter, you’ll notice that it seems like a ton of water when it’s actually a small amount.
If your baby is happy and not showing hunger cues after he spits up, he probably doesn’t need to be fed again.
Conclusion: What to Do When Your Baby Spits Up While Sleeping
This stage of motherhood is tricky. Every day your baby seems to be pulling out new tricks to keep you on your toes. I know how it is, Mama, and let me reassure you: You will get through this!
View this as analytically as you can. Try a few new things and see what helps. And, please, do not feel silly about approaching your pediatrician about your baby’s GER. He’ll know exactly what questions to ask and how to determine if this is regular spit up or something more serious that needs to be addressed.
Experienced moms, what tips helped you the most? Let us know below!
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