Baby Spitting Up Curdled Milk: What’s Normal, Causes And Treatment

As a new parent, you may worry if your baby spitting up curdled milk. However, milk gets curdled when mixed with stomach acid, which is normal during digestion. Occasionally, babies may spit up curdled or undigested milk as they have an immature digestive system.

Excessive spitting up of curdled milk or any stomach contents is a cause of concern. You may consult a pediatrician in such cases since it could be due to underlying causes that may require medical or surgical care.

Keep reading this post to explore the possible causes and tips to manage the spitting up of curdled milk in babies.

Possible Causes Of Spitting Up Curdled Milk

Babies may spit up curdled milk occasionally without apparent causes. However, excessive spitting up of curdled milk can be due to any of the following reasons (1).

1. Acid reflux

Acid reflux can be a common cause of spitting up curdled milk in newborns and young babies. Immature gastroesophageal sphincterⁱ  A ring-like muscle responsible for closing or contracting bodily passages and openings. may cause stomach contents to come up through the esophagus and reach the mouth.

Feeding in an upright position, feeding less and more often, and keeping the baby in an upright position for 20 minutes after feeding may help reduce the instances of spitting up refluxed curdled milk in some babies.

Some babies with severe acid reflux may require food thickeners for breast milk or formula. You may seek a pediatrician’s advice to choose the best method to manage acid reflux in your baby. Some may require medications to prevent acid reflux.

Experts say

The American Academy of Pediatrics recommends that parents whose babies have dysphagiaⁱ  Difficulty in swallowing. or acid reflux may thicken the baby food with oatmeal instead of rice, as there are concerns about arsenic in rice (1).

2. Food intolerance or allergy

Lactose intolerance or milk allergy could cause frequent regurgitation of curdled milk in some babies. A dietician may assist you with allergy investigations and whether you need to cut out certain food groups during breastfeeding.

If formula feeding, switching to specific formulas, such as low-lactose formula or hypoallergenic formula (hydrolysateⁱ  By-products of hydrolysis, a process where a chemical reacts with water to form one or two more substances formula), may improve the baby’s condition.

Some babies may spit up curdled milk if they are drinking cow’s milk. Eliminating cow’s milk from the diet could resolve this problem. You must only introduce cow’s milk once the baby is older than 12 months.

Quick fact

Around five percent of babies have a condition called Cow Milk Protein Intolerance/Allergy, which makes it difficult for them to handle milk or soy formula (1).

3. Pyloric stenosis

Pylorusⁱ  A valve that connects the stomach to the duodenum is the outlet of the stomach. Pyloric stenosis is a condition where the pylorus is narrowed and obstructed. It occurs in two to five of every 1000 live births per year, as reported by the National Institutes of Health (NIH). The condition interferes with the movement of food from the stomach to the intestines. It can cause the baby to regurgitate curdled milk from the stomach.

Babies may have projectile vomiting of curdled milk, no bowel movement or constipation, and weight loss due to pyloric stenosis. You may seek medical care for diagnosis and treatment.

Jessica, a mother to two children, shares her child’s encounter with pyloric stenosis. She says, “After feeding him (Sam) that day (when he was three and a half weeks old), he threw up all over me. He was convulsing, with curdled breastmilk gushing out of his mouth until my clothes were soaked. I think it happened once more that day and continued to happen two to three times a day through the weekend.

“We called our clinic and talked to the doctor on call. We described the vomiting as “projectile” because it was forceful and traveled a few inches from his mouth, and we said it was at least two to three ounces. My husband had read about pyloric stenosis and was concerned that he might have it. The doctor said that it sounded like normal baby vomiting, it probably wasn’t as much volume as we thought it was, and that babies with pyloric stenosis have vomit that projects six feet across the room. She said that if his vomiting started shooting that far out of his mouth, or if he became lethargic or otherwise seemed unwell, we should let them know.”

However, Sam was also losing weight and had a bowel movement once every three to four days. Finally, when the ultrasound was done, the result indeed showed pyloric stenosis and Sam underwent laparoscopic pyloromyotomy (i).

4. Overfeeding

Babies fed more than the required amount tend to spit up curdled or regular milk since their stomach is full. The gastroesophageal sphincters may open due to pressure and cause the backflow of stomach contents in overfed babies.

5. Immature gastrointestinal system

Immature or underdeveloped gastrointestinal structures and functions can be a reason for frequent spit-up in many babies. Newborn babies and premature babies are more likely to have an immature GI system.

6. Feeding position

Babies fed in lying down positions may quickly spit up when compared to babies who are mostly fed in an upright position. Milk tends to move down promptly in an upright position, and the position may also help keep the esophageal sphincters closed.

Breastfed babies may benefit from being fed in a laid-back breastfeeding position which can help pace the milk flow.

7. Swallowing air

Some newborns vomit as a result of swallowing air because of a fast milk flow or suboptimal latch to the breast or bottle teat while feeding. The gastroesophageal sphincters may open for burping, and babies may spit up milk or curdled milk along with burp.

Try to identify and avoid the possible causes of spitting up curdled or regurgitated milk. Seek medical care if the baby continues to spit up curdled milk despite interventions.

Quick tip

To prevent spit-ups from swallowing air, burp the baby during and after feeds. Changing their milk bottles also helps reduce their ability to suck air (1).

8. Feeding Too Quickly

Feeding your baby too quickly may also cause spitting up of regular or curdled milk. This usually occurs with bottle-feeding, where the milk flows constantly due to gravity, unlike breastfeeding, where the milk flows only when the baby sucks. A fast flow from the bottle can cause the baby to consume milk faster and swallow too much air. You may consider bottle-feeding your baby milk in small amounts more frequently. Bottle-feed the baby in an upright position, and consider slow-flow bottle nipples (1).

What Does Normal Baby Spit-up Look Like?

It is normal for babies to have some spit-up, and normal spit-up can be whitish in breastfed and formula-fed infants. Older infants eating solid foods may have spit-up of other colors, depending on what they eat. Sometimes, babies may spit up saliva or stomach acid that may look like a clear fluid.

A red color and coffee-ground color may indicate bleeding in the stomach or upper gastrointestinal (GI) tract, and yellow or green color can be due to bile or phlegm. You may seek medical care if spit-up has these colors.

What Makes The Milk Curdle?

The curdling of milk in your baby’s stomach occurs when the stomach acid mixes with the breast milk or formula milk but does not digest it fully (2). If your baby is spitting up milk several minutes after feeding, then the spitted milk will be curdled, having a cheese-like consistency. If your baby spits milk during or immediately after feeding, the consistency of the milk will be the same as the consumed milk.

When To Call A Doctor?

You may contact the healthcare provider if your baby spits up excess curdled milk or spits up frequently. You may seek medical care for both curdled spit-up and normal spit-up.

Seek medical care if your baby has any of the following conditions with excess spit-up (3).

• No weight gain
• Forceful spit-up or vomiting
• Green or yellow fluid
• Blood in spit-up or coffee-ground appearance of the spit-up
• Refuses to eat or drink
• Blood in stool
• Breathing problems after spit-up
• Dehydration
• Continuous or frequent crying

Stopping or reducing breastfeeding or changing to formula feeding without consulting a pediatrician is not an ideal decision. Spitting up curdled milk can be due to various reasons. The doctor will diagnose the underlying cause and commence the necessary treatment for relief.

Tips To Reduce Spitting Up Curdled Milk

The following tips may help to reduce spitting up curdled milk in babies (1) (3).

• Feeding in an upright position or laid-back breastfeeding position may help to minimize spit-up.

• Do not overfeed since babies tend to spit up more when the stomach is full.

• Feed the baby at a slower pace or in smaller amounts to allow enough time for the baby to digest the milk.

• Do not let the baby lay on their stomach immediately after feeding.

• Manage milk flow or adjust feeding positions if you have an oversupply of milk.

• Avoid dressing the baby in tight clothes that may put pressure on their belly while feeding.

• Feed in regular intervals; long gaps between feedings may increase stomach acid build-up.

• Look for baby cues, such as turning the head away from the nipple or bottle, to know if your baby’s stomach is full (4).

• Choose the bottle’s nipple that matches your baby’s feeding pace (5).

• Consider giving the anti-colic bottle to your baby (5).

• Give medications on time if prescribed.

• Modify the diet of infants who are on solid food as per recommendations.

• Breastfeeding mothers may modify their diet as per recommendations.

• Discuss the necessary surgery with your doctor if spitting up is due to certain conditions, such as pyloric stenosis.

Spitting up of curdled milk can be avoided in many babies. However, if your baby tends to spit up more than usual, you may seek medical care.

Infographic: What To Do When A Baby Spits Up?

Babies can spit up with or without underlying conditions. Carefully observing the frequency, timing, and quantity of spitting up and associated symptoms helps you find the causes. You may seek medical attention if it is frequent and severe. Go through the infographic to know possible causes of spitting up and what to do for your baby.

Illustration: The Bridal Box Design Team

Image: Dall·E/MomJunction Design Team

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Regina KincaidRM, IBCLC

     

Regina qualified as a midwife in 2005 in Germany and has since worked in maternity care in England and Ireland. She achieved stage 1 of the UNICEF Baby Friendly accreditation as infant feeding lead midwife at Ealing Hospital in London and worked in the lactation team of the National Maternity Hospital in Dublin, Ireland.

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