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Newborn and Infant Care

Newborn throwing up/digestive system

09/01/2009

Question:

My granddaughter is 42 hours old and has been throwing up. Not spitting up. My daughter has two other children and I myself had four children, so we`re not new to this. We have become concerned. My daughter will follow up with her doctor however. Should there be alarm, The throw up was dark at the hospital. Now it`s not dark. However the baby not keeping anything down. Wondering how alarmed we should be. Is this a formula issue? Or something more like digestive tract issue. What should the doctor be doing. And how do we know if its something more to this than just formula. Also what about dihydration. I have another granddaughter who died in Jan 2009 from dihydration. So yes quite frankly we are parranoid. Thank you.

Answer:

In general, spitting up is VERY common in infancy. It has to do with the immaturity of the muscles and the nervous system in the infant. There can be a wide range of what is "normal" for spit-ups, however, the bottom line is whether or not baby is gaining weight. As long as baby is gaining weight and there is no indication of pain with the spit-ups, it is considered to be physiologic, that is, within "normal" for spit-ups. Please remember, babies loose up to 10% of there birth weight within the first week of life and usually regain this weight with a week of hitting their lowest weight. This said, there are a couple things that lead to excessive spitting:

1.) overfeeding 
2.) poor burping

A newborn should be receiving about 2 ounces of formula every 2-3 hours. Make sure that the nipple slowly releases the formula with sucking. If you hold the bottle upside down, it drip every 2-3 seconds, not pour in a stream. Then, hold baby upright (in your lap or over the shoulder) for burping. Most babies give up their burp easily, but just as with everything else, each infant is individual and some require more forceful pats on their backs than others. Of interest, spit-ups tend to be less with breast fed infants. Any direct concerns should be directed to your pediatric health care provider.

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Response by:

Sarah Sauntry, RN, MS, CPNP-PC
Assistant Professor of Clinical Nursing
College of Nursing
University of Cincinnati