Ask the Doctor: Why is my baby spitting up breastmilk?

A mother should hold the baby upright during feeding and also get burped regularly during and immediately after feeds. PHOTO | FILE

My seven-month-old son still spits up milk after breastfeeding. Is this normal? Also, is it an indication that I will get pregnant soon? Laura Ongom

Dear Laura,

Even without any disease condition, babies may bring milk back from the stomach and out through the mouth, during or soon after feeding. This so-called milk reflux does not usually affect the health of the baby, mostly stopping by 18 months of age.

In infants, the ring of muscle between the oesophagus and the stomach (the cardiac sphincter) is not yet fully developed, hence allowing milk, which had already reached the stomach to flow back up and out of the mouth during and after feeding. 

Eventually, the sphincter will mature and open only when the baby swallows milk and will remain tightly closed when not swallowing. This way, milk is appropriately kept in the stomach as required to effect proper digestion.

Sometimes, the reflux may be caused by medical problems, including a milk allergy or lactose intolerance as well as pyloric stenosis (the muscle at the end of the stomach refusing to open properly to allow stomach contents to properly get into the intestines). 

It may also be caused by the cardiac sphincter opening unnecessarily, hence allowing stomach contents to move up to the mouth. Then, the reflux, apart from appearing together with other symptoms, is likely to affect the health and growth of an infant requiring treatment. 

Being premature, or if the baby consumes an almost completely liquid diet, or when the baby lies flat most of the time, are also likely causes of a milk reflux. 

Before you visit an infant’s doctor for treatment, or to get advice about the baby's breastfeeding position, a mother should hold the baby upright during feeding and also get burped regularly during and immediately after feeds. 

For those who are fed on cow milk, smaller but more often feeds should be preferred and after feeding, the baby should be put to sleep flat on their back instead of the sides.

What causes recurrent UTIs?

Although I do not have any signs of disease, every time a urine test is done, it is positive for a Urinary Tract infection (UTI). Even after treatment, the test still comes back positive. Should my husband get treated as well? Nkabona

Dear Nkabona

A UTI affects the urinary system (kidneys, ureters, bladder and urethra), and is largely caused by bacteria from the anus.

Much as it can affect anybody, women usually suffer the most from UTIs due to their anatomy that has a short urethra, which is located closer to the anus. Here, there are lots of bacteria that may easily enter through the urethra and cause a UTI.

It is good for one to often pass urine through the urethra so that this urine flushes out the germs and keep one from getting a UTI. Women usually either hold their urine too long or do not take enough fluids to help them urinate often. 

Also, women’s hormonal fluctuations during their menstrual cycle, menopause and pregnancy (including blockage of urine drainage during pregnancy) may increase the likelihood of UTI infections.

Much as their occurrence increases with a woman’s increased sexual activity, UTIs are not considered sexually transmitted. So, treating your husband together with you is unlikely to lessen the frequency of infections.

Symptoms of a UTI may vary, but usually include painful urination, frequent but passage of a small amount of urine, a sudden urge to pass urine, lower abdominal pain and cloudy urine, among others.

A number of people, including those with diabetes, may have a UTI but without symptoms (asymptomatic urinary infection) and this could have been the reason you were found to have a UTI but without associated symptoms.

When one often suffers from a UTI, it is necessary to do a urinary culture and sensitivity on the urine so that more effective drugs are given since resistance by germs to many antibiotics is now common.

A clean catch urine sample, where the middle urine is collected may also be necessary to reduce vaginal fluid contaminated urine which may falsely indicate the presence of a UTI whereas not.