What is posset?
Dear Mirror Doctor, Please can you explain why babies bring up milk after feeds and what can be done to improve it?
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Any tips for a young mother with such a baby?
Carly, Tema.
Almost all babies spill or spit up milk.
The scientific name for this spit-up of milk is posseting.
Most inexperienced mothers will complain that their babies are always vomiting.
This spilling of milk happens when some of the undigested milk in the baby’s stomach passes up into their food pipe or oesophagus - the tube that leads from the mouth to the stomach - and spills into their mouth.
They then spit it out.
Normally, there is a valve between the oesophagus and stomach that prevents food from coming back into the mouth after eating known in medical terms as regurgitation.
This valve is very short and immature after birth and although it is designed to prevent regurgitation, it usually takes time to mature before it can function efficiently.
In addition, the baby’s stomach is very small so fills up very easily.
This small stomach size is further compounded by an oversupply of maternal milk in the first few weeks.
Furthermore, babies spend a lot of time lying down and it doesn’t help that they have a liquid diet as well.
Posseting peaks between the age of one to four months and this is because, from one month, the baby receives bigger feeds beyond his needs as supply and demand evens out.
Once the milk supply settles down usually from three months, posseting naturally improves.
Every baby is different so there is no guarantee as to when possets stop.
Usually though, by 18 months, it would have stopped completely.
From four months, as the sphincter muscle matures, and as they eat more solid food and spend more time in an upright position, there is marked improvement in posseting.
Posseting causes no pain or discomfort and there are no other symptoms other than effortless regurgitation of milk after feeds.
Baby should continue to be fed normally and once the baby is gaining weight, no need to worry at all.
Babies also bring up milk at other times as well such as:
• Each time their position is changed.
• When they are being picked up
• When they are having nappy changes and
• When they are settling and asleep
All these notwithstanding, posseting can be helped by:
• Feeding the baby in a position where they aren’t lying down, for example, straddle hold or laid-back.
• Keeping baby upright and still after feeding.
• Hold the baby carefully on the shoulder after a feed.
• If burping baby, do so very gently and keep baby straight rather than bent over.
• Use an upright baby carrier instead of one where the baby is curled up.
• When changing the baby’s nappy, keep the baby’s head higher than its body and roll the baby's bottom sideways rather than lift it.
In general, though, possets are helped by feeding the baby with smaller feeds.
This puts less pressure on the muscle that closes off the top of their stomach, so milk is less likely to come back up.
If a mother produces a lot of milk, the baby could be fed on the same breast twice in a row when there is only a short gap between feeds.
Posseting can be hard work, emotionally and physically.
It can make it hard to leave the house because there may be the need for a complete change of clothes when out.
Useful tips for parents with a posset baby include;
• Have small towels or clothes ready to put over your shoulder when holding the baby.
• Put large soft bibs over the baby’s clothes.
• Hold the baby carefully and keep them upright where possible. Choose calmer rather than active baby games.
• Carry extras in a bag and the car: clothes for you and your baby, towels, wipes, a bag for the soiled clothing etc.
If posseting is associated with a baby who refuses to feed or is fussy when feeding, projectile vomiting, unsettled and not gaining weight, then it may not be posset but something that needs to be checked out at the paediatrician’s office.
The Mirror Doctor is a member of the Paediatric Society of Ghana and the Director of Medical Affairs, Korle Bu Teaching Hospital
