Is spitting up a problem?

The photo above, is of a 6 month old baby who is clearly spitting up. He is in good general health and happy, he is gaining weight well, and spitting up in the photo. Should the parents worry? Should they get him “anti-spit up” formula?

We will suggest that spitting up breastmilk is not only not bad, but may, in fact, be good for the baby, as long the baby is generally well, generally content, and growing and developing normally (as most are).

Why is it good to spit up? The real question is “how does breastfeeding protect a baby against infection?” One of many ways: Breastmilk protects by lining the mucous membranes (outer layer of the intestinal tract, respiratory tract, eustachian tube) of the baby’s body with a constantly renewing barrier made up of multiple anti-infectious factors. (note: some anti-infectious factors in breastmilk are absorbed through the intestinal wall into the baby's body).

This barrier prevents bacteria, viruses, and fungi from passing through the lining of the gut (and other mucus membranes) and entering the baby’s body (the cavity of the intestinal tract and respiratory tract are considered outside the body, therefore “outer”). When the milk travels from the stomach to the anus, the milk flows relatively slowly, and the barrier is renewed from stomach to the anus. But from the baby’s mouth to his/her stomach, the milk descends quickly, so spitting up gives the barrier two chances to form, on the way down to the stomach and on the way back up.

What about milk going down the “wrong way” into the trachea and possibly into the lungs? What is said about spitting up is also true of “choking” or coughing while breastfeeding.? (However, too often, when a baby pulls off the breast and is upset because flow is slow, this is interpreted as “choking”). On the other hand, if the baby “chokes” because the flow is rapid, it usually means the baby is not latched on well.

Still, when the baby coughs or “chokes” at the breast, it may mean that a little milk has entered the trachea and the coughing is a protective mechanism. The baby’s respiratory lining is thus coated with the immune factors present in breastmilk and protects the baby from invasion by bacteria and viruses and fungi. Everyone worries about aspiration, but the quantity the baby inhales is almost always very small and breastmilk is “respiratory tract friendly”. What are the problems due to aspiration as physicians think of it?

1. Infection. But breastmilk is full of immune factors that help protect against infection (and many are being discovered all the time). It is not the same as inhaling pond water, which is clearly a very serious problem, or even regurgitated stomach contents, which can be serious if a lot is inhaled. Many people inhale tap water from time to time when they drink it (and do not get sick).

2. Inflammation may occur with aspiration if the liquid contains irritating components. However, breastmilk not only contains immune factors protecting against infection but also contains anti-inflammatory factors which diminish inflammation. And breastmilk itself is not irritating. Unlike formula.

Frequently, far too frequently, breastfeeding babies who “choke” while breastfeeding are subjected to a “feeding study” and fed with a bottle containing something that is not breastmilk. This bizarre test is supposed to prove whether the baby is aspirating or not while breastfeeding. But this type of feeding with a bottle containing some special fluid, which probably does not even look like breastmilk, and feeding with a bottle does not duplicate breastfeeding in any way shape or form and therefore tells us nothing about what goes on when the baby is breastfeeding. Yet, if the baby inhales some fluid into the trachea (the radiologists will see it on the monitor), the mother is told she must take the baby off the breast, thicken her expressed milk with a special product (in some cases, not even use her breastmilk but rather formula) and feed this concoction to the baby with a bottle. It makes no sense, and we do not agree with this approach to what is, essentially, a normal phenomenon.?

At the breastfeeding clinic we see babies from time to time who have lived this “feeding study”. Recently, we had just such a case. The parents panicked when the baby “choked” while breastfeeding and the parents called an ambulance that brought the baby to the children’s hospital. The baby was not in any distress when the baby arrived at the hospital and was clearly in good health. But the baby had the “feeding study” and was found to aspirate some fluid. The mother was told to thicken her milk and feed by bottle. She did not like this advice, wanting to breastfeed. She made an appointment and was seen with the baby at our clinic.

We watched the baby at the breast (a far better “feeding study” than the one at the hospital) and observed that the baby drank very well at the breast. True, the baby “choked” because of a poor latch due to a very tight tongue tie which resulted in his not being able to handle the flow. After the tongue tie was released and the mother instructed on how to position and latch the baby on well, no more problem with handling the flow of milk. Unfortunately, few mothers are willing to defy the advice of the staff of a world famous children’s hospital, especially when the “feeding study” “proved” the baby was aspirating.

Please consider buying and recommending my new book: What Doctors Don’t Know About Breastfeeding.

Print version and ebook version on Amazon:?https://www.amazon.com/dp/B09WC2HCC6

Print version on Praeclarus site:?https://stores.praeclaruspress.com/what-doctors-dont-know-about-breastfeeding-by-jack-newman-and-andrea-polokova/?showHidden=true

#spittingup #aspirationbm #tonguetie #goodlatch