Almost every new parent worries about their baby's hiccups and spitting up. In most cases, both are completely normal and require no treatment. Understanding the difference between normal infant behaviour and something that needs medical attention saves enormous anxiety.
Hiccups: Why They Happen and What to Do
Hiccups in babies are caused by spasms of the diaphragm — the dome-shaped muscle under the lungs. Babies hiccup frequently because their diaphragm and nervous system are immature and still learning to coordinate. Hiccups are common after feeding, during feeding, and spontaneously. They do not hurt your baby (despite looking uncomfortable) and resolve on their own.
What helps: Continue feeding through hiccups if your baby is comfortable. Burp mid-feed. Some parents find that a short break from feeding and a burp resolves hiccups quickly. If bottle feeding, check the nipple flow — too fast a flow can cause hiccups from swallowing air. No intervention is necessary for hiccups that resolve within 10 to 15 minutes.
Spitting Up: Normal vs Concerning
The valve between the oesophagus and stomach (lower oesophageal sphincter) is immature in young babies and does not fully close, allowing stomach contents to flow back up easily. This causes positing or spitting up, which is normal in the first year and typically peaks around 4 months before improving as babies sit and stand upright more.
Normal spitting up: occurs during or after feeding, small volume, baby is happy and gaining weight, the spit-up does not seem to hurt. The test: if your baby is a happy spitter who gains weight normally, it is a laundry problem, not a medical problem.
Concerning spitting up (reflux): baby cries during or after feeds, arches their back, refuses to feed, is not gaining weight adequately, spit-up is forceful (projectile vomiting), green or yellow colour, or there is blood in spit-up. These signs suggest gastro-oesophageal reflux disease (GORD) which needs medical evaluation and possibly treatment.
Managing Normal Spitting Up
Keep baby upright for 20 to 30 minutes after feeding. Feed smaller amounts more frequently if bottle feeding — large volumes overwhelm the immature valve. Burp thoroughly after every 60 to 90ml of bottle feed. Avoid tight nappy waistbands immediately after feeding. Position the cot mattress on a very slight incline (a rolled towel under one end of the mattress, never a pillow under the baby).