"My Newborn Spits Up Frequently During Feeds - What Should I Do?"
Lindsay Sinopoli - CCSC, CLC, NCS- 6 days ago
- 4 min read
Updated: 6 days ago
First, let's acknowledge something important: some spit-up is completely normal!
Newborns' digestive systems are still developing, and their stomach sphincter (the muscle that keeps food down) is very immature at birth. However, frequent or excessive spit-up might signal underlying feeding challenges that deserve attention. Let's walk through some of the likely causes of your newborn spitting up frequently during feeds:
Culprit Number 1: Overactive Letdown
When milk flows too quickly, it's like trying to drink from a fire hose! I had an overactive letdown with all 3 of my babies, which led to my first 2 being misdiagnosed with reflux and colic (as well as many soaking wet feedings and excess loads of laundry...)
An overactive letdown and reflux in newborns present very similarly, with some important distinguishable nuances and very different management recommendations, so it's key to work with a lactation specialist with experience in this area, before a prescription for medication that may not be necessary.
Signs of overactive letdown include:
Coughing or spluttering during feeds
Pulling away frequently
Clicking sounds while nursing
Signs of stress during feeding
Taking in excess air while trying to manage the flow
Green, shiny stools (milk moving too quickly through the digestive system)
Frequent diaper blowouts
Gassy, uncomfortable baby
Milk spraying when baby unlatches
Choking or gulping sounds during feeding
When milk flows too rapidly, it rushes through the stomach so quickly that the lactase enzyme doesn't have time to properly break down the milk sugars. This can lead to digestive discomfort and those telltale green, shiny poops, as well as frequent mis-diagnoses of lactose intolerance.
Helpful Feeding Positions:
The "Down Under" Position:
Lie back at a 45-degree angle
Place baby on top, tummy-to-tummy
Let gravity help slow milk flow
Perfect for overactive letdown
Allows baby more control over milk flow
Bonus: the gentle pressure on baby's tummy will help reduce swallowing air and uncomfortable gas
The Koala Hold
Baby sits straddling your thigh
Spine straight, facing your breast
Excellent for babies with reflux
Helps manage fast letdown
Great for older babies with head control
Best Practices for Comfortable Feeds and to reduce excess spit up:
Taking Breaks Between Sides
Allow baby to pause and digest
Burp between sides
Watch for fullness cues
Don't rush to switch sides
Let baby set the pace
Watch for signs of Overfeeding:
Frequent spit-up
Uncomfortable, arching back
Refusing feeds but crying
Excessive wet/soiled diapers
Rapid weight gain
Post-Feed Care - Why avoid immediate diaper changes?
Allows milk to settle
Reduces likelihood of spit-up
Keeps baby calm and comfortable
Gives time for proper digestion
Maintains upright position
Instead:
Hold baby upright for 15-20 minutes
Gentle patting or circular back rubs
Keep movements minimal
Wait for baby to become more alert
Then proceed with diaper change if needed
Culprit number 2: Ineffective Latch
An ineffective latch means that the way in which your baby attaches to and draws milk from your breast is not as effective as it could be, and is usually too shallow. An ineffective latch isn't just uncomfortable – it can lead to serious complications for nursing mothers:
Air intake during feeding
Inadequate milk transfer
Clogged milk ducts
Risk of mastitis if not addressed
Nipple pain and damage
An ineffective latch can quickly spiral into clogged ducts or mastitis if left unmanaged. If you notice hard, tender spots in your breast or flu-like symptoms, contact your healthcare provider immediately.
"Spread the hips to open the lips"
A common phrase I love and use frequently in lactation support is "spread the hips to open the lips" - this simple technique can transform a shallow latch into a deep, comfortable one.
When positioning your baby to feed, ensure their body is turned fully toward your breast (tummy-to-tummy), and bring both feet into the palm of one hand, gently pressing on the soles of their feet to spread their legs wider, like a frog position. (using the football hold with baby's feet pressed against the back of an armchair or couch can be a game changer here, with their tummy turned towards your torso)
This natural reflex causes baby to open their mouth wider, achieving a deeper latch. When combined with the "nose-to-nipple" position (baby's nose aligned with your nipple before latching), this technique helps baby take more breast tissue into their mouth, reducing nipple pain and improving milk transfer.
Consider scheduling an observed feeding with a lactation consultant if:
Spit-up seems excessive or projectile
Baby seems uncomfortable during or after feeds
You're experiencing nipple pain
Baby isn't gaining weight appropriately
You're feeling anxious about feeds
The early days of breastfeeding your newborn can feel overwhelming. Between postpartum hormone changes, sleep deprivation, and the pressure to "get it right," it's easy to feel discouraged when challenges arise. Remember: seeking help isn't a sign of weakness – it's a sign of wisdom and love for your baby. It truly does take a village!
Need support with your breastfeeding journey? As a certified lactation counselor, I'm here to help you and your baby find comfort and confidence in your feeding relationship, let's work on this together Mama!
