Baby Spit Up – What Is Normal & When To Be Concerned?

NewbornPediatric Gastroenterology

Reviewed By
Sharad Kunnath, M.D.

​​Spitting up is normal and completely harmless for most infants. When the spitting up or vomiting becomes too frequent, your child may have
Gastroesophageal Reflux (GER). This reflux is a result of an immature digestive system and the poor closure of the valve (ring of muscle) at the upper end of the stomach. Most reflux or spitting up occurs during or after a meal, when the stomach, or tube that connects the stomach, is full. GER can begin during the first few weeks of life, peaking around 4 months and ending by 12 months of age. As long as your baby is not experiencing any discomfort and is making the appropriate weight gain, he/she is a healthy and normal infant.

Boys Town Pediatric Gastroenterology offers parents tips to help reduce GER:

• Do not over feed your baby. More frequent, smaller feedings may reduce vomiting.
• Add rice cereal to bottle feedings. (1 Tablespoon of rice cereal per 1 ounce of formula or breast milk)
• Keep your baby in an upright position for 30 minutes after feeding.
• Burp your baby during and after feedings.
• Do not smoke around your baby.
• Elevate your baby’s head during sleep. (According to the American Academy of Pediatrics, the best sleep position for a baby is on his/her back).
• Avoid tight diapers or elastic waistbands that put pressure on baby’s abdomen.

Contact your physician right away if your child’s condition is severe, worsens or you notice the following symptoms:

• Blood or a yellow or green fluid when vomiting
• Poor weight gain or growth
• Difficulty eating
• Inconsolable or severe irritability
• Difficulty breathing, wheezing, turning blue, chronic cough or breathing stops

Always contact your physician if you have questions or concerns about your baby’s health. If GER symptoms continue, you may choose to see a Pediatric Gastroenterologist—a medical doctor who specializes in the digestive health care of infants, children and adolescents.

​

Newborn




Pediatric Gastroenterology

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Why Do Babies Spit Up and When Do They Stop?

If you’re a new parent, you may have lots of questions about baby spit-up. First, know that newborn or baby spit-up is normal. In some rare cases spitting up may indicate something else, but we’ll help you decipher the signs so you can better tell the difference, especially if you’re concerned that your baby is spitting up a lot, spitting up more than usual, or keeps spitting up. Read on for more on this subject and for additional insights about your baby’s health and well-being.

Why Do Babies Spit Up?

Spitting up is typical behavior for newborns and older babies, too, especially after they’ve been fed, whether by breastfeeding or formula-feeding. Your baby may spit up after every feeding or just some feedings.

Spitting up tends to happen in young infants because the “gatekeeper” muscle—the lower esophageal sphincter, which acts as a valve between the esophagus and the stomach—isn’t fully developed. When, say, your baby’s stomach is too full, or your little one changes positions suddenly after a feeding, their stomach contents may flow back into the esophagus, and then out of your little one’s mouth. Voilà, you have spit-up, more formally known as gastroesophageal reflux or just reflux.

What Causes Babies to Spit Up?

The immediate causes or triggers of spitting up may include your baby

• overfeeding or feeding too fast

• swallowing too much air

• being active too soon after a feeding.

Some formula-fed babies may spit up more frequently because of a sensitivity to soy-based formulas. And when a baby is breastfed, spitting up may occasionally be connected to an allergy or sensitivity to something in the mother’s diet.

How Much Spit-Up Is Normal?

Most babies will eject between one and two mouthfuls of spit-up at a time. It’s worth noting that the amount your baby spits up will often look like it’s more than it actually is, especially if you’re judging by the size and number of spit-up stains that are left behind!

When Do Babies Stop Spitting Up?

Most babies outgrow spitting up at around 12 months of age, but since every baby is different, your baby may outgrow this a little before or after that time.

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Can Spitting Up Affect Your Baby’s Development?

No, spitting up shouldn’t interfere with your baby’s health or development. If your baby seems happy and comfortable, is eating well, and is gaining weight, there’s generally nothing to worry about.

Rest assured that your baby’s healthcare provider will be tracking your baby’s height, weight, and overall development during each checkup. Consult with the provider if you ever feel concerned about your baby spitting up.

How to Reduce Spit-Up

There are some simple steps you can take to manage spit-up, most of them connected with the way you feed your baby and what you do directly after a feeding.

Here’s how to help reduce the chances of your baby spitting up:

• Feed your baby in an upright position with their head higher than their stomach to help avoid spit-up—a laid-back position is OK, but not a laid-down position

• Keep your baby in an upright position for at least 30 minutes after a feeding

• Avoid active play after a feeding

• Avoid placing your baby in a swing or bouncer after a feeding

• Avoid overfeeding—opt for smaller feedings more frequently throughout the day

• Burp your baby during and after each feeding to lessen air in their stomach

• Keep track of which formula you use with your baby (if you’re formula-feeding) or what foods you’re eating (if you’re breastfeeding) as your baby may be reacting to something in their or your diet. Consult your baby’s healthcare provider for guidance if you suspect a food allergy or intolerance.

Always place your baby on their back to sleep, even if you’re worried about spit-up. This is the safest sleeping position for little ones, as it reduces the risk of sudden infant death syndrome (SIDS).

Spitting Up Vs. Vomiting

Many parents confuse spitting up with vomiting. Here the difference between spit-up and vomit.

• Spitting up is the easyupward flow of stomach contents through your baby’s mouth. It most often happens when your baby burps after a feeding.

• Vomiting (sometimes erroneously referred to as projectile spit-up) is a forceful ejection of stomach contents through your baby’s mouth that occurs when your baby’s abdominal muscles and diaphragm contract vigorously.

When to Contact Your Baby’s Healthcare Provider

Contact your baby’s healthcare provider if the spit-up looks green or yellow, contains blood, or looks like coffee grounds, or if your baby is vomiting.

The Bottom Line

Spitting up is a normal occurrence for newborns and even older babies. Little ones may spit up when overfeeding or feeding too quickly; or when swallowing too much air during a feeding, which can lead to baby gas; or when they are active too soon after a feeding.

Occasionally, spitting up is linked to a food allergy or intolerance. There are a number of ways to alleviate your baby’s spit-up, such as feeding them more frequently but in smaller amounts, burping them during and after a feeding, and avoiding activity after a feeding.

If your baby is growing and gaining weight regularly, there’s no need to worry about lost nutrients due to spitting up. And if you’re still unsure, consult your baby’s healthcare provider, who will be monitoring your baby’s height, weight, and general development at every checkup.

Sooner than you know, you’ll be back to worrying less about your baby’s spit-up and more about having enough diapers and wipes on hand. That’s where the Pampers Club app can come in handy—it helps earn you cash back for all your purchases!

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Whether it’s your first or third baby, you’re bound to have questions about feeding. Reflux (spitting up) is a common topic among frequently discussed feeding topics, so you are not alone in finding the answer to the question “Why does my baby spit up so often?”.

So why do babies spit up? And is spitting up normal for babies? You have probably thought about this many times. After reading this article, you will receive important information that will explain the causes of infant spitting up, and you will learn how to act to help the child.

If you have any questions or your child has other symptoms, be sure to contact your doctor.

Why do babies spit up and when is it normal?

Let’s look at why babies spit up and answer the frequently asked question “Why does my baby spit up so much?”. Many newborns spit up after feedings or when burping because their digestive tract is not yet fully developed. However, in some situations, the likelihood of regurgitation in infants increases.

So what causes reflux in babies? The following are some of the main causes of regurgitation in infants: ¹

• The child has moved.
• The child was eating too fast.
• You help your baby spit up air, and with the air, the baby spit up part of the food.
• The child has too much air in the stomach.
• The child has excessive salivation.

So is spitting up normal in infants? In simple words: spitting up after some feeds, or even after each, is absolutely normal for a growing baby. However, there are points that need to be noted in order to distinguish ordinary regurgitation from vomiting. The two processes are very different, so you should check with your doctor if your baby is vomiting heavily after every or most feeds.

Also seek medical attention if the child has the following symptoms that a doctor can help identify: ²

• The child spit up frequently, does not gain enough height or weight e.
• Judging by external signs, he is in pain, cries a lot or arches his back.
• Coughing or difficulty breathing, which may be a symptom of gastroesophageal reflux disease.
• Regurgitates even if he hasn’t eaten anything.
• There is severe vomiting.
• Fever or diarrhea, which may be a sign of an intestinal infection and lead to dehydration.

If your baby spit up a small amount of milk after a feed and continues to grow and stay healthy, rest assured that this is normal and nothing to worry about. If you have any questions about reflux in infants, check out this article to learn about the symptoms of reflux and how to deal with it!

What to do

Now that you’ve learned that spitting up is normal and what causes it, you’re probably wondering what you can do to help your baby. After you have consulted with your pediatrician and he has determined that spitting up is not a cause for concern, there are a few things you can do to help you when you are not sure: ¹

1. Regular belching of air.

In addition to burping after feedings, try helping your baby burp when changing breasts. And when feeding from a bottle, try to have the child spit up air every 30-60 ml of the mixture. Consider using an anti-colic bottle with an AirFree valve. The AirFree valve prevents air from entering the nipple even when the bottle is in a horizontal position and the nipple remains completely filled with milk. The use of such a bottle will allow your baby to drink in an upright position, which will reduce the frequency of reflux, improve the digestion process and make the feeding process more comfortable for both you and the baby. Find out more about Philips Avent anti-colic bottles with AirFree valve here.

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2.

Keep your baby upright after feeding.

As mentioned above, air belching is one of the causes of regurgitation in infants. When the baby is sitting in a highchair, he may spit up even more because this position puts pressure on the tummy. So, instead of sitting up, try to keep your baby upright in your arms after feedings and while burping.

3. Avoid vigorous movement after feeding.

To avoid spitting up after a feed, it is best to refrain from any bouncing, rocking or active play until the milk has been digested better.

4. Keep your baby’s head up while feeding.

When you’re trying to find the right feeding position that’s comfortable for both your baby and you, try to avoid a position where your baby’s head is down. In other words, it is necessary to ensure that in the process of feeding the head of the child is above the level of his legs.

5. Raise the mattress at the head of the bed

It is a good idea to roll up some towels or blankets and put them under the mattress (but not on top of the mattress) in the crib. Make sure that only the headboard is raised and that there are no creases in the middle of the mattress. There should be a very slight slope from which the baby will not slip.

It’s a natural process

If you ever ask yourself the question “Why is my baby spitting up?” just remember that spitting up is a completely natural, sometimes troublesome process that is part of parenthood. There are various reasons for spitting up in babies, but if your baby looks calm after a feed and is actively developing, you have nothing to worry about. In truth, spitting up is more of a problem for the parents than for the child himself, who may not even notice it.

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Designed to reduce colic, gas and spit up ¹

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If you see any other symptoms or feel that the baby is not getting enough milk, do not postpone the visit to the doctor. If the doctor confirms that the baby’s spitting up is normal, all you have to do is keep a clean bib ready!

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¹ ​kidshealth.org – Breastfeeding FAQs: Some Common Concerns leave the Philips Healthcare (“Philips”) official website. Any links to third party websites that may be included on this site are provided solely as a convenience to you. Philips makes no warranties regarding any third party websites or the information they contain.

3 I understand

You are about to visit a Philips global content page air or excess food. But what if the baby spit up after every formula feed, even if he is getting the ideal amount of food? Valeria Maksimovna Shchelkunova, a mother and neonatologist from Spain, shares her observations and advice.

– Valeria Maksimovna, when a baby spit up a lot – is this a norm or a pathology?

— Regurgitation does not always indicate the presence of pathology, even heavy regurgitation due to overfeeding can be considered the norm. According to the table for assessing the frequency and volume of regurgitation, the process is considered functional if it does not cause significant disturbances in the child’s condition, does not impair the quality of his life.

Assessment of the intensity of regurgitation

0 points	Absence of regurgitation
1 point	Less than 5 regurgitations per day, not more than 3 ml
2 points	More than 5 regurgitations per day, not more than 3 ml
3 points	More than 5 regurgitations per day, up to 1/2 the amount of formula administered per feeding, not more than half of the feedings
4 points	Small volume regurgitation within 30 min. or more after each feeding
5 points	Regurgitation from 1/2 to the full volume of formula administered during feeding in less than half of the feedings

Regurgitation is considered physiological if:

900 41 children gain weight well and keep up in growth;
• no blood impurities in the vomit, aspiration, respiratory arrest;
• the child has no difficulty in sucking and swallowing;
• feeding does not occur in abnormal positions.

— How to distinguish vomiting from regurgitation?

– Vomiting is profuse vomit from freshly eaten breast milk or formula. In the classical sense, regurgitation is the reverse outflow of food from the stomach in a volume not exceeding 5 ml. Anything more can be called vomiting.

— Why does the child spit up a lot? Does formula feeding affect regurgitation?

– If a child spits up like a fountain after drinking formula, the reasons can be diametrically opposed – from the inadequacy of the proposed nutrition to serious health problems: malformations, neurological diseases. Functional regurgitation must always be distinguished from regurgitation as a result of pathology – and based on the reason to make any decisions.

Causes of profuse regurgitation in infants

Inadequate volume of formula	place his stomach: the excess will come back through vomiting. If the entire daily volume of food is distributed during the day when the night feeding is refused, the stomach is overloaded – and profuse vomiting occurs.
Incorrect posture during feeding	If the mother is feeding a child who is lying on his back, and his head is straight, not raised. Incorrect feeding may cause the baby to swallow too much air, which can lead to vomiting.
Digestive problems	Lactase deficiency. Allergies. Motility disorder. Hereditary metabolic diseases. Congenital malformations of the gastrointestinal tract.
Neurological diseases	Birth trauma of the cervical spine.
Intoxication syndrome	Intoxication of the body during illness, at high temperature (the center of thermoregulation is located in the brain next to the vomiting center).

— When a baby spit up after formula feeding, could this be a symptom of a food allergy?

– With cow’s milk protein allergy, as with any food allergy, an aseptic inflammatory reaction occurs in the intestinal wall, and protein absorption is affected. In addition, carbohydrate metabolism is disturbed, because due to inflammation of the intestinal wall, secondary lactase deficiency occurs (a decrease in the production of the lactase enzyme). As a result, lactose (milk sugar) is not broken down adequately, leading to increased gas production and vomiting. The baby may experience discomfort at the beginning of feeding and react with increased nervous excitability when there is an increase in peristalsis. This can also cause vomiting.

— What symptoms should a child see a pediatrician for?

— There are a great many symptoms, so if the parents have any doubts, they need to see a doctor, even if they have been told a hundred times that this is normal.

A medical examination is required if:

• the child has spit up all the formula he has eaten;
• the child burps after each feed and the regurgitation is profuse;
• on the background of vomiting there is a high temperature, bodily rashes;
• there is a lag in anthropometric data;
• the child is restless or, conversely, too lethargic;
• after vomiting, in a normal state, the child’s voice changes, wheezing is heard in his breathing.

— Valeria Maksimovna, if infantile regurgitation is regarded as a disease, how will they be treated?

– Therapy will be directed to the reason why the child is spitting up profusely.

Lactase deficiency – you need special enzymes that break down carbohydrates. Food Allergy to Cow’s Milk Protein Dairy-free diet for breastfeeding mothers, hydrolyzate therapeutic formula or prophylactic hypoallergenic formula for artificial baby. Fever, identified infectious agent – exposure to the source of infection.

Neurological disorders – a comprehensive approach and treatment under the supervision of a neurologist: gymnastics, massage, drug therapy. Metabolic diseases – special treatment and nutrition, replacement therapy. Congenital anomalies of the gastrointestinal tract – specialized surgical procedures.

Prevention of aspiration and swallowing of large amounts of air:

• an adequate mixture and its calculated volume;
• anti-reflux or anti-colic nipple;
• feeding the baby in an elevated position at an angle of 30-45 degrees, slightly turned on its side;
• long enough posture (at least 20-30 minutes) and rest after feeding with delayed massages, active exercises and games.

There are no special medicines and folk remedies for the treatment of regurgitation and vomiting. If it is not possible to determine the cause of this condition, the doctor prescribes the child an anti-reflux formula or the introduction of a thickener into the mixture (in breast milk) as treatment.

— How do anti-reflux mixtures help prevent spitting up?

— Anti-reflux mixtures practically do not differ in composition from conventional mixtures: their basic components fully cover all the necessary expenses of the baby. The difference is that thickeners are added to antireflux mixtures – special substances that swell when they enter the stomach and thereby retain its contents. Their effect subsides as the contents move through the gastrointestinal tract.

— What kind of feeding regimen can be considered optimal for a child under one year old?

yat by the hour

If you breastfeed every time the baby cries, you can overfeed and lead to profuse spitting up.

If formula is fed on demand, it will not be possible to take into account the amount eaten, because one way or another, the daily amount of food is calculated, which cannot be exceeded.

To determine the amount of supplementary feeding with formula, control weighings are carried out before and after breastfeeding – that is, you cannot dilute a full bottle of formula and decide that how much the child will eat, how much he will eat.

Not every child’s anxiety means that he needs to eat. If less than an hour has passed since the last feeding, you need to think a hundred times whether the child is really hungry. Sometimes it is enough to change the diaper, to vilify the baby in the arms, to talk to him affectionately – to pay attention to the baby.

– What is the best mixture to use to prevent spitting up?

– As a rule, the first mixture is assigned randomly: the choice is more related to the preferences and experience of the pediatrician, the behavior of children on a particular mixture. If the selected mixture is not suitable, a formula with other components is selected, work is underway to identify what the child might not like in the first mixture. The formula is selected based on age. For each age group, a certain composition of the mixture is required, covering all the necessary costs of proteins, fats, carbohydrates, minerals and other useful substances. Choosing a formula line is the choice of a pediatrician that parents trust.

— What determines the volume of the mixture?

– The volume of the mixture is selected individually. According to the calculation formulas, the daily volume is first determined, which is divided by the number of feedings per day – this is how the dose per feeding is determined. All calculations are carried out by the doctor so that there are no overfeeding and underfeeding.

— When should the mixture be changed?

– The mixture is changed when the baby spits up in a fountain after each feeding or the mother and the doctor cannot find the reason for this, other than the use of the mixture. This is also done when confirming an allergy to cow’s milk proteins, lactase deficiency and, if necessary, introducing a specialized therapeutic mixture in case of a proven metabolic disorder. And the mixture needs to be changed according to age – an incorrectly selected mixture does not cover the costs of the baby, it is not absorbed.

Signs that may alert when artificial feeding:

• lag in height and weight gain;
• intolerance to the components of the mixture, which may be accompanied by regurgitation, allergic rashes, urticaria, rash on the cheeks;
• feeding anxiety, formula spitting out;
• problems with the tummy: increased gas formation, colic, bloating up to the abdomen with a “drum”;
• stool changes: constipation and hard stools, diarrhoea, offensive character, mucus, blood, undigested lumps.

— How can a child’s digestion change after switching to a new formula? And is there any reason to see a doctor?

– When switching to a new mixture, everything can change dramatically, even if the new food is in the same line as the previous one. The transition should always be gradual, because finding the problem is not easy.

Anxiety symptoms

• Any skin manifestations and digestive problems that have never happened before.
• The child began to behave restlessly, cry a lot, worry, or, on the contrary, looks too lethargic, wakes up both at night and during the day.
• The child farts a lot, but sometimes he does not poop, even if he pushes hard.
• Baby’s stools are too loose and frequent.

Urgently need to run to the doctor in case of allergic manifestations. Dyspeptic disorders associated with regurgitation or vomiting, impaired intestinal motility, constipation, may resolve themselves, as you get used to the new mixture. There must always be an adjustment period. A child needs at least two weeks to get used to a new mixture: this is especially true for therapeutic mixtures with a specific unusual taste. There is no need to panic here, the problem is not nutrition.

— By what age should regurgitation normally stop completely?

– Spitting up completely stops when the baby stops receiving formula or breast milk. But the frequency of such conditions decreases significantly by the age of 6 months, when the child begins to eat sitting or at an angle of more than 45 degrees.

The causes of regurgitation are many and varied, ranging from as simple as overfeeding to as complex as neurological problems. You must always be on your guard: look at the symptoms of regurgitation and evaluate their features, that is, try to find the cause. More often, regurgitation is physiological, easily corrected by diet therapy, the correct position of the baby during feeding, compliance with the regimen and amounts of food.