Tell the Difference Between Baby Spit-up or Vomit

One’s normal, one’s not—which is which? Get the lowdown on spit-up

Your baby just spit up. Or maybe vomited. You’re not sure which it was or whether you should be worried. Baby spit-up isn’t usually an issue. 

Also known as reflux, spit-up is simply the flow of food from your little one’s stomach to their mouth.  

It’s common, not painful, and might happen from time to time until your baby is about a year old. Baby spit-up is often just the result of a still-developing digestive system or overfeeding. 

The difference between spit-up and vomit is outlined below. If you have further questions or concerns, contact your healthcare provider.  

What is spit-up?

Spitting up is a common occurrence in healthy infants early in life. This is partly because of immaturity of their digestive system. It’s relatively harmless and usually resolves as the digestive system matures, when your baby reaches 12 to 14 months of age.     

Spit-up is sometimes called by other terms like “regurgitation” and “gastroesophageal reflux.” They’re just fancier ways of saying spit-up, with a minor difference. Regurgitation and reflux refer to the backwards movement of the stomach (gastric) contents up into the esophagus—and at times into the mouth. When the contents of your baby’s tummy spill out of their mouth, it’s called spit-up.

 Why do babies spit up? 

At birth, your baby’s tummy is about the size of a small marble. After 3 days, it is about the size of a ping-pong ball, but still can’t hold much.¹ Until they are about 4 months old, most babies’ tummies can hold only small amounts of milk at a time. Too much milk during feedings can cause your baby to spit up or be fussy.  

Babies also have less developed muscles in the upper esophagus, which makes it easier for fluids to flow back up from the stomach.  

Spitting up can also happen when your baby burps (called a wet burp) or swallows too much air.  It isn’t painful to your baby, and most babies don’t even realize they have done it.

As long as your baby is healthy and gaining weight, spit-up should be seen as just a normal part of infancy. 

How much spit-up is normal? 

It may look like a lot when it’s on your shirt, but the amount of liquid your baby spits up isn’t as much as you think. Usually, it’s just 1 or 2 tablespoons at a time. If your baby spits up more than this—or if their spitting up is the effect of respiratory events like choking, coughing, or wheezing—ask your pediatrician if there is a reason to be concerned. 

How can you lessen spit-up?

To help your baby spit up less often, here are a few things you can try: 

• Hold baby in a more upright position while feeding 
• Burp baby after every 1 to 2 ounces while feeding 
• If you bottle-feed your baby, make sure the hole in the bottle’s nipple is not too large. If milk drips out when you turn the bottle upside down, replace the nipple with a smaller one 
• Keep your baby upright after eating.  Laying them flat on a full stomach can lead to spit-up 
• Avoid too much activity for your baby immediately after eating 
• Feed your baby less food, but more often 

How much and how often to formula feed 

Your newborn will probably be hungry 6 to 10 times in a 24-hour period. As a baby grows, so does their stomach, so your baby should begin to eat more at each feeding and eat less often, as the chart below shows.

Number and volume of feedings during the first year

^2-4

The best way to feed your baby is to allow them to take as much as they seem to need. If your baby’s fussy and has not been fed in more than 2 hours, it is probably time for a feeding.  

How is baby spit-up different than vomit?

When spitting up begins to make your baby uncomfortable, and more liquid than usual comes up with greater force, this is probably vomit. When a baby vomits more than once, it’s usually caused by a virus. Viruses usually aren’t dangerous, but they can cause your little one to get dehydrated. If your baby is less than 1 year of age, they are at more risk for dehydration. Consult your healthcare professional immediately if you think your baby might be dehydrated.  

How can you tell if your baby is dehydrated, and how can you help?

When your baby has a sudden bout of vomiting along with diarrhea, it usually means they have a virus. A virus usually isn’t dangerous, but it can lead to dehydration, which can be a serious problem. It’s important to know these signs of dehydration in your baby: 

• Fewer wet diapers than normal 
• Seems very tired or weak 
• Has tearless, sunken eyes
• Has dry skin and little saliva  

The younger your baby, the more concerned you should be about dehydration.  There are things you can do to help when your baby is ill. Replace the fluids your baby is losing by giving them small, frequent feedings. In some cases, an oral rehydration solution such as Pedialyte^® may be recommended. Check with your healthcare provider for advice. 

When should you be worried about your baby vomiting? 

Although it can be alarming, an occasional vomiting episode is usually nothing to worry about. However, if your baby vomits often, this can be a sign of reflux disease, intestinal obstruction, infection, or a protein allergy. Get in touch with your pediatrician if your baby’s usual spit-up: 

• Increases in amount or force 
• Causes choking or respiratory difficulty like wheezing or coughing 
• Leads to other issues including discomfort, fussiness, poor weight gain, or weight loss 
• Is accompanied by a fever, diarrhea, bloody mucus, or a bloated tummy 
• Is green
• Is “projectile,” meaning very sudden and with great force  

Repeated vomiting in babies between 2 weeks and 4 months of age can be a sign of a blockage at the stomach. Contact your healthcare professional if your baby vomits repeatedly. 

Would switching baby formulas help with baby’s tummy troubles?

Consult your pediatrician before changing your baby’s formula. 

Similac^® offers several easy-to-digest formulas designed to be gentle on your baby’s tummy. For help choosing a formula, check out our Tummy Trouble Tool.

Questions about formula feeding? See our Frequently Asked Questions.

References: 1. Spangler AK, et al. J Hum Lact. 2008;24(2):199-205. 2. Behrman RE, et al. Nelson Textbook of Pediatrics. 16th ed. Philadelphia: WB Saunders Co; 2000:165. 3. Samour PQ, et al. Handbook of Pediatric Nutrition. 3rd ed. Sudbury, MA: Jones and Bartlett Publishers; 2005:90. 4. Fomon SJ. Infant Nutrition. 2nd ed. Philadelphia: WB Saunders Co; 1974:24.  

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Baby Spitting Up Curdled Milk: Causes and Treatments

Don’t you sometimes wish that your newborn came with an instruction manual? It would take the guesswork out of some of those pressing questions of the first few weeks: Are they eating enough? Crying too much? Too hot? Too cold? Why are they spitting up when I feed them?

Let’s focus on that last one for a minute. It’s important to remember that for the first few months, spitting up is very normal for babies. And even if the consistency of what comes out seems a little different than what went in, it’s still generally nothing to worry about.

Here’s why your baby might be spitting up curdled milk — and what you can do about it.

Babies spit up all the time because of their undeveloped digestive system. It happens when milk or food comes back up the baby’s esophagus from the stomach. (The esophagus is the organ connecting the stomach to the mouth).

Spitting up and vomiting are separate actions. Vomiting requires force and can be painful in babies. When it comes to spitting up, however, it’s likely your little one won’t even notice when they’re doing it.

Normal spit-up for breastfed and formula-fed babies will usually look quite similar to the milk or formula that the baby just had — more about the curdling in a minute.

Your baby will be relatively comfortable and content during and after spitting up — they may even look pleased with themselves! If they’re not done eating, they’ll have no problem accepting more food after a spitting session.

Spit-up, just like vomit, can contain stomach acid. Babies’ spit-up becomes curdled when milk from breastfeeding or formula mixes with the acidic stomach fluid.

Time also plays a role here. Immediate spit-up after feeding will probably look like regular milk. If your little one spits up after some time as passed, it’s more likely to look curdled milk.

There are a few possible reasons why your baby may be spitting up curdled milk:

Difficulty with digestion

Your baby may have trouble digesting breast milk for a few reasons. The most common — at least for newborns — is just that their digestive system needs more time to develop.

Some babies may have an allergic reaction to cow’s milk or formula that contains cow’s milk. Rarely, they may have lactose intolerance or a milk protein allergy. But keep in mind that these come with other symptoms, like diarrhea. Talk to your pediatrician if you suspect an allergy or intolerance.

Your pediatrician may recommend a shift in your baby’s diet to reduce spit-up. Options include:

• soy protein formula
• extensively hydrolyzed formula (EHF), a type of formula that contains broken-down proteins from cow’s milk that are unlikely to cause allergic reactions
• amino acid-based formula (AAF), or an alternative formula for babies that have trouble with EHFs

Keep in mind, though, that babies typically grow out of digestive problems with age.

Acid reflux

Babies may have acid reflux, especially if they’re newborns. Acid reflux happens when stomach acid travels up the throat from the stomach. It can be painful.

Before switching formulas (or switching from breastfeeding to formula), try these home remedies:

• avoid feeding your baby too fast or too much at once
• feed your baby in an upright position.
• if you’re breastfeeding, avoid foods like citrus, tomatoes, spicy foods, carbonated drinks, and foods high in fat (these can affect your breast milk and lead to reflux)

Pyloric stenosis

Pyloric stenosis is rare, affecting about 3 out of 1,000 babies in the United States. The pylorus is the lower part of the stomach that food and other substances pass before entering the small intestine.

The muscles in the pylorus may become enlarged in infants, which causes the pyloric channel to narrow and prevents food from leaving the stomach. Most babies that experience pyloric stenosis are 3–5 weeks old and require treatment and surgery.

Some signs of pyloric stenosis include projectile vomiting of milk, weight loss, and constipation. Pyloric stenosis is a serious condition that requires immediate treatment.

There are several reasons that may lead to your baby spitting up stomach acid. Spit-up may appear curdled if your baby hasn’t digested milk from feeding. This isn’t always a health concern, but it’s important to pay attention to any changes in your baby’s spit-up.

Talk to your baby’s doctor if you are concerned about your baby’s spit-up or have questions about healthy feeding alternatives.

Why does the baby spit up after feeding?

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Regurgitation is a common condition in newborns and infants and is most often a normal variant. However, it is not uncommon for parents to worry if their baby is spitting up frequently, believing that it is due to nutritional or health problems in general. Sometimes these fears are not unfounded, and regurgitation really has a pathological origin. What is its cause and when should you really consult a doctor about this?

Regurgitation – Return of a small amount of food (uncurdled or partially curdled milk) from the stomach up the digestive tract: into the esophagus and further into the oral cavity. According to statistics, at least 1 time during the day, at least 50% of babies from 0 to 3 months old can spit up, more than 60% of children 3-4 months old, and in 5% of children spit up continues up to the year ¹ .

Regurgitation in newborns is considered a physiological process. It is caused by a number of factors, including:

• Features of the structure of the upper digestive tract in babies
• In newborns and infants up to a year of life, the stomach has a spherical shape. It holds a small amount of food, besides, the release from it into the duodenum is slower in comparison with children after the year ² .
• Weakness of the lower esophageal sphincter that separates the esophagus from the stomach
• Normally, the lower esophageal sphincter should tightly “close” the esophagus, allowing food to pass into the stomach and not allowing it to enter back into the upper digestive tract. However, in young children (up to a year), the muscles of the esophageal sphincter are poorly developed, and it does not do its job very well ² .
• Slow movement of food through the gastrointestinal tract
• The neuromuscular system of newborns is immature. It does not ensure the proper movement of food through the esophagus, causing regurgitation.

One of the important risk factors contributing to regurgitation in newborns is aerophagia. This is the swallowing of large amounts of air during feedings. This happens when the baby is not properly attached to the breast, the mother has a lack of breast milk, or the bottle is in the wrong position in the child who receives the mixture. The size of the opening in the nipple also matters – if it is too large, the newborn swallows a lot of air ³ .

With aerophagia, the baby becomes capricious, restless immediately after feeding. Noticeable bloating. If the baby spits up immediately after a feed, the milk (or formula) remains practically fresh, uncurdled ³ .

Promotes regurgitation after feeding and a predominantly horizontal position of the baby during the day, combined with relatively high intra-abdominal pressure ⁴ . Therefore, the correct position of the baby after feeding is so important. To avoid regurgitation of an excessive amount of stomach contents, after feeding, it is necessary to hold the baby in an upright “column” position for some time (10-20 minutes), lightly patting on the back and allowing excess air to “exit”.

Regurgitation in many newborns can be provoked by other situations in which pressure in the abdominal cavity increases and stomach contents are thrown into the esophagus, in particular ³ :

• tight swaddling;
• stool disorders, in particular constipation;
• long, forced cry and some others.

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How can you tell the difference between normal spitting up and vomiting?

Sometimes regurgitation is considered a manifestation of disorders in the digestive tract of children. Due to the constant reflux of acidic stomach contents into the upper sections, inflammation and other complications may develop, including growth retardation, a decrease in hemoglobin levels, and others. Therefore, it is important for parents to understand where the line is between physiological and pathological regurgitation ¹ .

If the mother is worried that her baby is spitting up, keep track of when this happens and count the total number of spit ups per day. Normally, regurgitation usually occurs after eating (the child burps after each feeding), lasts no more than 20 seconds and repeats no more than 20-30 times a day. With pathology, the problem manifests itself at any time of the day, regardless of when the baby was fed. Their number can reach 50 per day, and sometimes more ¹ .

The amount of discharge during regurgitation also matters. With normal, physiological regurgitation, it is approximately 5 – 30 ml. If this volume fluctuates between 50 and 100 ml, it is already defined as profuse vomiting. With a jet of vomit up to 50 cm, doctors talk about “vomiting a fountain.” A variant of atonic vomiting is possible, when the contents of the stomach flow “sluggishly”. It occurs with atony of the stomach (decrease in muscle tone of the stomach wall) and disruption of the esophagus ¹ .

Vomiting in babies is a warning sign. Doctors are especially alarmed by repeated vomiting, a fountain, with an admixture of bile, in combination with constipation. Vomiting can lead to the development of dehydration, acid-base imbalance and other consequences, therefore, if it occurs, you should urgently contact a pediatrician to find out the cause and begin treatment. A doctor’s consultation is necessary if the child is spitting up a lot (more than 15-30 ml at a time), with a frequency of more than 50 episodes per day ^1.3 .

Physiological regurgitation: symptoms

Regurgitation in newborns, which is considered a normal variant and does not cause concern to pediatricians ³ :

• usually continues for a certain period of time;
• is characterized by slow, “passive” leakage; if the baby spits up a fountain, it is better to consult a doctor;
• has a sour smell of curdled milk;
• occurs without the participation of muscles – the baby does not strain during regurgitation;
• does not affect the general well-being of the baby.

How to help a newborn who spit up often?

If the baby is healthy, no medication is prescribed for spitting up. To help the child allow simple measures based on lifestyle changes and feeding.

• Frequent feeding of the baby
  It is known that the baby is more prone to spit up if his stomach is full. To improve the situation, it is recommended to feed the baby more often, avoiding oversaturation, best of all – on demand ⁵ .

• Correct feeding technique
  Every feeding, the mother must ensure that the baby does not swallow too much air during suckling. When sucking, there should be no loud, smacking, clicking sounds. You also need to control that the baby captures the nipple along with the areola.

• Choosing the right bottle and nipple
  If the newborn is bottle-fed and receiving formula, it is important to choose the right bottle and nipple. The hole in it should be such that the milk flows out in drops, and not in a stream. The nipple must not be filled with air ⁴ .

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• Baby standing upright after eating

To allow air that has entered the digestive tract during meals to escape, it is important to keep the newborn upright for 10-20 minutes after feeding ⁴ .

• Ensure the correct position of the baby during sleep

To reduce the negative impact of the acidic contents of the stomach on the esophagus, it is necessary to put the baby to sleep in the supine position. The side or prone position, which many pediatricians used to recommend, is no longer recommended. It was found to be associated with an increased risk of sudden infant death syndrome ⁵ .

If parents notice alarming symptoms, such as spitting up too often or large volume, etc., it is important to consult a pediatrician without delay. This will allow you to identify the real problem in time and help the baby grow up healthy and happy.

References

¹ Zakharova I. N., Andryukhina E. N. Regurgitation and vomiting syndrome in young children // Pediatric pharmacology, 2010. V. 7. No. 4.

² Nagornaya NV, Limarenko MP, Logvinenko NG Experience in the use of domperidone in suspension in infants with regurgitation syndrome // Health of the child, 2013. No. 5 (48).

³ Zakharova IN Regurgitation and vomiting in children: what to do? //Pediatrics. Supplement to Consilium Medicum, 2009. No. 3. S. 58-67.

⁴ Zakharova I. N., Sugyan N. G., Pykov M. I. Regurgitation syndrome in young children: diagnosis and correction // Effective pharmacotherapy, 2014. No. 3. P. 18-28.

⁵ Vandenplas Y. et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) //Journal of pediatric gastroenterology and nutrition. 2009; 49(4): 498-547.

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Preventive measures against regurgitation in children

08.03.2017

Regurgitation is the spontaneous reflux of gastric contents into the esophagus and mouth. This condition is not uncommon in infants and is often a cause for concern for parents. The frequency of regurgitation syndrome in children of the first year of life is 18-50%: up to 4 months – 67%, up to 6 months 24%, up to 1 year 5%. In most cases, regurgitation is “benign” and disappears on its own after 12-18 months. At the same time, “benign” or physiological regurgitation characterizes:

• the age of the child is up to 12 months;

• spitting up 2 or more times a day for 3 or more weeks;

• sufficient weight gain;

The child has no signs of metabolic disorders, diseases of the gastrointestinal tract or the central nervous system. The child does not experience difficulty in swallowing or feeding, there is no forced position of the body.

Do not confuse regurgitation with vomiting. When a child burps, the abdominal muscles do not tense up. With vomiting, on the contrary, muscle tension occurs and food is ejected by pressure not only through the mouth, but also through the nose. In some cases, there may be general anxiety, pallor, cold extremities. Often with vomiting, the temperature rises, loose stools appear, which is a sign of an infectious disease. Vomit may contain unchanged milk, mucus, blood or bile.

What causes physiological regurgitation

What is the tendency of babies to spit up? This phenomenon is explained by the peculiarity of the structure of the gastrointestinal tract of young children. At the age of one year, the esophagus is shorter and wider, physiological narrowing is weakly expressed. The stomach is located horizontally, its capacity is small, and the muscles that close the entrance to the stomach and prevent the contents from being thrown back into the esophagus are poorly developed. As the child begins to walk, the axis of the stomach becomes more vertical. The capacity of the stomach increases by the year from 30-35 ml to 250-300 ml. The secretory apparatus matures, the work of the closing muscles (sphincters) improves, which leads to a gradual decrease in the frequency and disappearance of regurgitation. These features explain the predisposition of young children to regurgitation and even the inevitability of this condition. However, there are measures to help reduce the frequency of regurgitation.

Factors contributing to physiological regurgitation include:

1. Overfeeding. As a rule, actively sucking babies begin to suffer from overfeeding, with abundant milk secretion, as well as when switching to artificial or mixed feeding with an incorrect calculation of the required amount of milk formula. Regurgitation appears immediately or some time after feeding in the amount of 5-10 ml. Milk can flow out unchanged or curdled.

2. Swallowing air during feeding (aerophagia). A similar situation arises if the child suckles greedily at the breast, and the mother’s milk is not very plentiful; due to the retracted, flat nipple of the mother’s breast, since the child fails to fully capture the nipple and areola; with artificial feeding, if the hole at the nipple of the bottle is large enough or the nipple is not completely filled with milk. Babies with aerophagia often experience anxiety after feeding, bulging of the abdominal wall (belly inflates). After 10-15 minutes, the swallowed milk flows out unchanged, which is accompanied by a loud sound of air eructation.

3. Intestinal colic or constipation. These conditions lead to an increase in pressure in the abdominal cavity and a violation of the movement of food through the gastrointestinal tract, causing regurgitation.

Until the child is four months old, spitting up up to two teaspoons of milk after feeding, or one spitting up of more than three spoons during the day, is considered the norm. You can check the amount of spitting up in the following way: take a diaper, pour one teaspoon of water on its surface, and then compare this spot with the spot formed after the next spitting up.

Abnormal regurgitation may be due to:

• surgical diseases and malformations of the digestive system;

• diaphragmatic hernia;

• pathology of the central nervous system, trauma of the cervical spine during childbirth;

• food intolerance, lactase deficiency;

• increased intracranial pressure.

Such regurgitation is characterized by intensity, systematicity, the child spits up a large amount of milk. At the same time, there is a violation of the general condition of the baby – the child is whiny, loses or does not gain weight, cannot eat the amount of food necessary for his age. In such a situation, a pediatrician, gastroenterologist, surgeon, allergist, neurologist should be examined. It also requires examination and exclusion of anomalies in the structure of the upper gastrointestinal tract, the preservation of regurgitation for more than 1 year.

Scale for assessing the intensity of regurgitation:

1. Less than 5 regurgitations per day with a volume of not more than 3 ml – 1 point.

2. More than 5 regurgitations per day with a volume of more than 3 ml – 2 points.

3. More than 5 regurgitations per day up to half the amount of formula or breast milk, not more often than in half of the feedings – 3 points.

4. Spitting up a small amount of milk for 30 minutes or more after each feeding – 4 points.

5. Regurgitation from half to full volume of formula or breast milk in at least half of the feedings – 5 points.

Regurgitation with an intensity of 3 or more points requires a visit to a doctor.

Preventive measures against regurgitation in children

If regurgitation is physiological in nature, then it is not worth treating or correcting in this case. It is necessary to deal with the elimination of the cause, if possible, and carry out prevention.

Prevention of regurgitation in children includes the following measures:

1. Postural therapy: when feeding, it is necessary to hold the baby at an angle of 45 °, make sure that he completely grasps the nipple with the areola; after feeding, hold the baby in an upright position (“column”) for 20 minutes – to drain the swallowed air. Due to this, the air that has entered the stomach will be able to go out. If nothing happened, then put the baby down and after a minute or two, lift him upright again.

2. Make sure that the opening in the bottle is not too large and that the nipple is filled with milk. Experiment with nipples – perhaps the other will be better. Milk should come out in drops, not a trickle.

3. Before you start feeding your baby, lay him belly down on a solid base.

4. After feeding, try to minimize the baby’s physical activity, do not disturb him unnecessarily, and change clothes only if there is an emergency.