FREQUENT SPITTING UP/VOMITING

A very common sign of Neonatal Abstinence from any substance exposure is frequent spitting up/vomiting or regurgitation. This is seen when the baby spits up food during and often after feeding. Some caregivers/parents report spitting up even up to 30 minutes after feeding. The frequent spitting up can result in poor weight gain. Some things that you may also see with the spitting up are choking, wheezing, and/or fussiness during or after feeding.

NOTE: The Following Videos found in this kit under the Parenting Tips from Specialists will provide more information and/or demonstration that might be useful for some of the interventions recommended here.

NAS: Early Interventions

NAS & Feeding

Sucking & Feeding Devices

NAS & Muscle Tone

STRATEGIES BY DISCIPLINE

NEURODEVELOPMENT

  • First consider all the physical reasons for spitting up/vomiting.

  • Keeping them calm during feeds will help. You may want to swaddle during feeding to decrease fussiness or motor movements so the baby can focus on sucking. (the Ollie swaddle was specifically designed with the NAS baby in mind as it offers moisture wicking and stretch with pliable restriction). Make sure to use safe swaddling instructions offered by the manufacturer.

  • It is important that the environment is not over stimulating for the baby during the feeds. Make sure that it is quiet (no tv etc in background) and low lighting and only engage during breaks (burping, brief stops etc) in the feed so as to not require to much of your baby during sucking and swallowing.

  • If your baby has spitting up, constipation and nasal congestion it may be a sensitivity to the formula, and you may want to talk to your baby’s doctor about a formula change.

MEDICAL

  • It is important to determine the root cause of the regurgitation or vomiting with the help of your baby’s doctor.

    • Your baby’s doctor will want to know:

      • when (around the feed) the vomiting is happening and how often (after every feed, only in the morning…)

      • is there a position the baby is in when more vomiting occurs and other positions where it occurs less often.

      • does it mainly happen if your baby is handled?

      • Is it forceful (projectile) or not?

      • Does your baby also have constipation or diarrhea?

  • If your baby is vomiting/regurgitation or spitting up after feeds it will be important to discuss sleep positions with your baby’s doctor. They sometimes recommend a small wedge under the mattress to elevate your baby’s head, so they don’t choke on their spit ups. If there is a great deal of spit up/vomiting they may recommend side sleeping with an elevated head.

  • Check to see if your baby is gaining weight. If the baby is not gaining weight, you should call your baby’s doctor for assistance.

  • You may want to talk to your baby’s doctor about potential allergies OR food sensitivities.

  • Your baby’s doctor MAY recommend that you shorten the feeding intervals and lessen the amount at each feed to help the baby spit up less.

  • You may need to put the infant on a schedule with frequent, less amount feeds; you may need to wake them to feed. Consult with the baby’s doctor.

NURSING

  • It is important to determine the root cause of regurgitation/vomiting. If you are unsure or they continue to have spit ups, you need to call your baby’s doctor’s office. Especially if they are not gaining weight.

  • Monitor your baby carefully during feeding to make sure they don’t gag or choke. Also keep your baby in an elevated position for at least 30 minutes after feeding.

  • Your baby may have a food sensitivity and you should ask about changing formula with the baby’s doctor.

OCCUPATIONAL THERAPY

  • Swaddle your baby during feeding to decrease involuntary movement which helps to decrease spitting up. Swaddling also helps to organize and calm your baby so that he/she can fully focus on suck/swallow and breathing. Make sure it is not too tight (fabric should provide stretch so it doesn’t harm shoulders or hips) but provides flexible restraint. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in for sleep if the baby can roll over.

  • Elevate with a small include (wedge under the mattress) where your baby lies down so that the acid (spit up) can travel back down to the tummy, thus preventing the burning to the esophagus and reducing the amount of vomit/spit up.

  • Keep the baby upright for 30 minutes after feeds. This will help food to settle into the tummy and reduce the risk for reflux episodes. Do not put the baby to bed right after feeding. When the baby lies down, food is more likely to travel back up the throat. So, aim to make your feeds at least 30 minutes before sleep time.

  • Use slow flow bottles to help your baby with their swallow difficulties.

  • Use a Pacifier to offer your baby a way to learn to coordinate their sucking.

SPEECH PATHOLOGY

  • The baby will likely need smaller and more frequent feeds to help them keep their food down.

    • Also do more frequent burping to assist with digestion.

    • Always make sure the head is higher than the hips when feeding and for at least 30 minutes after a feed.

    • No bouncing during or right after feeds.