9 months and still spitting up … lots

Dear Mamas,

My breastfed 9 month old still spits up a lot. Really a lot. When he was an infant he had lots of trouble with gas and would spit up breast milk after feeding.

Now he is a big eater and eats pretty much everything we do which is great, but could that be part of the problem? He sometimes eats as much as we do at a meal.

His spitting up is kind of projectile – covered my friend the other day when she was here and she says it’s too much. He does it every day, more than once. He eats salmon, veggies, fruit, you name it. He is also very big for his age, currently 27 ” tall and weighs 21 lb.

I cannot wrap my hand around his thigh but my husband is big so I’m not too worried. What do you think?

Thanks,

Lena

Dear Lena,

Here’s hoping your friend has a healthy sense of humor!

Spitting up (the fancy cocktail party name is gastroesophageal reflux) is very common during the first six months before babies sit up on their own and are still spending much of their time in a horizontal position. Most often it has no health implications and we call it a laundry problem, not a medical problem. During the second half of the first year it typically disappears, with the help of gravity and increased solid food.

It sounds like your guy is big, healthy and vertical but is still giving back a fair portion of what’s going in. He hasn’t had any trouble gaining weight, since he’s bigger than many of his 9-month-old peers, and you don’t mention any discomfort, breathing problems or coughing (these are signs we look for to rule out a significant health condition). So we’re left with a couple of likely possibilities.

First, chances are his esophageal sphincter, the valve connecting the esophagus to the stomach, is on the loose side, allowing food and gas to come back up more easily. This, combined with the fact that your guy is a BIG eater with a BIG appetite, sets the stage for what you describe as, “kind of projectile.”

The good news is that it doesn’t sound like he needs aggressive medical intervention (like surgery to tighten that valve), since he’s generally healthy, happy and growing. What he needs is a lifestyle change. Which is to say that you will need to change how he’s eating.

Here are a few things you can try:

Give your guy smaller meals; he doesn’t need to be eating as much as the adults at the table and overfeeding is probably contributing to the reflux. Based on his height and weight he’s getting more than enough calories, even with the volumes that are coming back up.

Keep him upright during and after meals and avoid spicy or carbonated foods.

Watch to see which foods in his diet tend to make the reflux better or worse, and eliminate the offenders.

If none of these measures are helpful, your pediatrician can prescribe medication to keep the GI tract moving in the right direction, but do try these simple fixes first. You’ll be surprised at how effective they are, and your friend may even come join you for coffee again.

Good luck!

~ The Mamas

 

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Rachel Zahn, MD is a pediatrician turned health writer who had three kids during medical school and pediatric training—crazy, huh?


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