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Why does my bottle-fed newborn spit up so often?
Q: I bottle-feed my 1-month-old son. He takes a long time to burp and even after he burps he spits up milk if I lay him flat on his back. Should I lay him on his belly? How much should I feed him at each feeding? At night can I wait longer than five hours between his feedings? If he wants more after I feed him, what should I do?
A: Shazia, spitting up is very common for infants. Although it’s messy, it usually doesn’t cause discomfort or interfere with the baby’s growth. Babies tend to spit up when their stomach is too full, if they’ve swallowed too much air, if they haven’t had a chance to burp or if they are bounced or laid down after feeding. Spitting up is usually caused by immaturity of the stomach muscles, and most babies outgrow it by 6 months of age. If your baby seems very uncomfortable after feeding or is forcefully vomiting rather than spitting up, be sure to talk with your doctor.

Here are some things you can do to help reduce spitting up:

  • Check to see that the hole in the nipple of the bottle is the right size. The bottle should drip a few drops when you hold it upside down and then stop. If the hole is too small, your baby may get frustrated and gulp air. If the hole is too big, the milk may be coming out too fast for him to swallow.

  • Try to feed your baby before he is overly hungry. If he is too hungry, he may gulp more air.

  • Try to make feeding a calm and unhurried time. Avoid distractions and interruptions while feeding your baby.

  • When you feed your baby, hold him in a semiupright position, not lying down.

  • Burp your baby in the middle and end of the feeding. To burp him, hold him upright over your shoulder, supporting his head and back with one hand while you gently rub or pat with the other.

  • Keep your baby in an upright position (e.g., over your shoulder or in a baby seat) for 15 to 30 minutes after the feeding.

  • Always put your baby to sleep on his back to reduce the risk of sudden infant death syndrome. If your baby spits up while lying down, prop up the head of the cot by putting blocks under the front legs.
At one month of age, most bottle-fed babies drink about 4 ounces every four hours. But don’t force your baby to eat a certain amount at feedings. Follow your baby’s signs for when he’s hungry and when he’s full. If he is fidgety or sleepy during a feeding, he may be telling you he’s had enough. If he drains the bottle and continues to root and smack his lips, he may still be hungry.

Over the next few months, your baby will begin to drink a little more at each feeding and stretch out the time between feedings a little more. When your baby begins to sleep five to six hours at a stretch at night, you don’t need to wake him up to feed him. If he’s hungry, he’ll wake up and tell you. If he’s able to sleep longer, enjoy the extra sleep yourself!