Mar 12

Common Concerns About Feeding

Feeding a newborn involves more than just getting the milk into the baby.

Whether you are breastfeeding, bottle feeding mother’s milk or bottle feeding formula, it is likely that you have questions about burping baby, spit ups, how to deal with reflux or vomiting, and other issues.

High rates of breastfeeding now have raised questions too about common variations in baby’s oral anatomy like tight tongues and even teeth that come early.

Read on to learn more.

Burping, Hiccups And Spit Up

Burping

Young babies naturally fuss and get cranky when they swallow air during feedings.

Although this occurs in both breastfed and bottle-fed infants, it’s seen more often with the bottle.

When it happens, it may be helpful to stop the feeding rather than letting your infant fuss and nurse at the same time.

This continued fussing will cause them to swallow even more air, which will only increase their discomfort and may make them spit up.

A much better strategy is to burp your infant frequently, even if they show no discomfort.

The pause and the change of position alone will slow their gulping and reduce the amount of air they take in.

If your baby is bottle-feeding, burp them after every 2 to 3 ounces (60–90 ml).

If baby is nursing, burp them each time you switch breasts. Some breastfed babies don’t swallow very much air, and therefore they may not need to burp frequently.

Hiccups

Most babies hiccup from time to time. Usually this bothers parents more than the infant, but if hiccups occur during a feeding, change their position, try to get them to burp, or help them relax.

Wait until the hiccups are gone to resume feeding.

If hiccups don’t disappear on their own in five to ten minutes, try to resume feeding for a few minutes. Doing this usually stops the hiccups.

If your baby gets hiccups often, try to feed them when they are calm and before they are extremely hungry.

This will usually reduce the likelihood of hiccups occurring during the feeding.

Spitting Up

Spitting up is another common occurrence during infancy.

Sometimes spitting up means the baby has eaten more than their stomach can hold; sometimes they spit up while burping or drooling.

Although it may be a bit messy, it’s usually no cause for concern.

It almost never involves choking, coughing, discomfort, or danger to your child, even if it occurs while they are sleeping.

Some babies spit up more than others, but most are out of this phase by the time they are sitting. A few “heavy spitters” will continue until they start to walk or are weaned to a cup.

Some may continue throughout their first year.

It is important to know the difference between normal spitting up and true vomiting.

Unlike spitting up, which most babies don’t even seem to notice, vomiting is forceful and usually causes great distress and discomfort for your child.

It generally occurs soon after a meal and produces a much greater volume than spitting up.

If your baby vomits on a regular basis (one or more times a day) or if you notice blood or a bright green color in your baby’s vomit, consult your pediatrician.

While it is practically impossible to prevent all spitting up, there are things you can do to help decrease the frequency of these episodes and the amount spit up.

Make each feeding calm, quiet, and leisurely.

Avoid interruptions, sudden noises, bright lights, and other distractions during feedings.

Burp your bottle-fed baby at least every three to five minutes during feedings.

Avoid feeding while your infant is lying down.

Hold your baby in an upright position for 20 to 30 minutes after each feeding.

Do not jostle or play vigorously with baby immediately after feeding.

Try to feed your infant before they get frantically hungry.

If bottle-feeding, make sure the hole in the nipple is neither too big (which lets the formula flow too fast) nor too small (which frustrates your baby and causes them to gulp air).

If the hole is the proper size, a few drops should come out when you invert the bottle, and then stop.

Feeding your baby is one of the most important and, at times, confusing challenges you’ll face as a parent.

The recommendations apply to infants in general. Please remember that your child is unique and may have special needs.

If you have questions, ask your pediatrician to help you find the answers that apply specifically to you and your infant.

Tongue And Lip Frenulum Surgery

The fetus practices sucking before birth, and most babies suck a lot before birth and stretch out the normal connection between the tongue and the bottom of the mouth (called the frenulum).

However, some babies do not suck well before birth and are at risk of not breastfeeding well.

These babies may have a short tongue, a tight frenulum, a high or narrow palate, and they may need some time to learn to feed well.

While some babies that have the short or tethered tongue may benefit from a little snip of the frenulum, scientific studies have not shown that deeper cuts, repeated cuts, or any form of lip frenulum cutting has a benefit.

There are many other reasons that a baby might not feed well.

If your baby has feeding problems seek help early.

If tongue or lip surgery is recommended you might want to have a second opinion before you have it done.

There are many reasons not to do a procedure to cut a normal structure.

The AAP did a thorough study of all of the evidence and does not have a recommendation at the present time. There is much controversy here as there is with circumcision, and many fierce opinions.

If baby is feeding well and mother has no nipple pain, frenulum surgery is not needed – because there is no evidence that frenulum surgery helps with speech, voice, tummy troubles or prevents dental problems in the future.


Lisa Stellwagen MD, FAAP  Professor of Clinical Pediatrics at UC San Diego Health
American Academy of Pediatrics