Is All This Baby Spit-Up Normal?

It’s normal for babies to spit up breast milk or formula occasionally. For most babies spit-up is a quick, smooth flow of liquids up and out during or shortly after a feeding.

Spit-up normally does not lead to distress or weight loss. Although spit-up can seem like a large amount of liquid (especially after the third time wiping it up in one day!), in most cases it’s actually only a small amount.

Although spit-up is common, complications called gastroesophageal reflux disease (GERD) can develop for some infants.

Some signs that what your infant is experiencing is not normal spit-up but GERD are:

• choking on the spit-up as it comes out
• an unhappy, uncomfortable baby due to apparent heartburn or painful reflux all day long
• poor weight gain

If you see signs of GERD (or signs of any other illness including vomiting), it’s time for a trip to the doctor!

So why does everything your baby eats seem to come right back up? It has to do with a developmental milestone that isn’t as easy to spot as smiling or sitting up.

In older children and adults, a muscle located between the esophagus and stomach keeps liquids and food where they belong. Until this muscle has time to mature (particularly in the first year of life), spitting up can be an issue — especially if the stomach is extra full or its contents are sloshing around.

Spitting up in the first year is considered developmentally normal.

Other causes of spit-up include:

• aerophagia, which is consumption of air in greater quantities than usual
• overstimulation caused by bouncing, tummy time, etc.

Another cause could be pyloric stenosis. Occurring within the first months of a child’s life, this condition causes involves intense muscle contractions that occur after feedings, resulting in projectile vomiting. Babies with pyloric stenosis typically are hungry again right after vomiting. Surgery is used to correct this problem.

If your baby is showing signs of pyloric stenosis, it’s important to visit your baby’s doctor as medicines or medical treatment may be necessary.

While it’s important to be able to determine whether the liquid coming up is spit-up or vomit, it can be hard sometimes to make this call. There are several distinguishing factors that can usually help you settle on an answer between the two.

Spit-up typically comes up quickly and is mostly quiet as it strikes. Infants who spit up are generally happy before, during, and after.

Spit-up is most common in the earliest months of a child’s life and typically occurs less often as a child nears 1 year and beyond. (Spitting up usually begins before a child turns 6 months old if it is going to appear.)

Vomiting is almost always just one symptom of a bigger illness and not an illness in and of itself. Therefore, vomiting is typically seen in conjunction with other symptoms, like a fever or diarrhea.

Bouts of vomiting often come on quickly and end quickly, since they’re linked to the underlying illness. Additionally, vomiting frequently involves a retching noise and has a greenish tinge from liver bile.

When your child is spitting up, it’s only normal for you to wonder if they’re OK. Luckily, there are signs that what’s happening is more than normal spit-up and that you should reach out to your child’s doctor.

If your child has the following symptoms it’s time to contact your child’s doctor:

• losing weight
• seems fussy throughout the day due to discomfort
• liquids coming up and out are taking on a variety of colors (pinkish-red, deep yellow, or bile green) and textures

Your child’s doctor will be able to consider symptoms and conduct tests to determine if your child has developed GERD, pyloric stenosis, or another potential illness. If so, they’ll likely use medications and/or medical treatments to intervene.

Particularly in the first months of life, vomiting can be serious. During times of illness, infants may be particularly sensitive to dehydration. Whether your child is spitting up or vomiting, it’s important to keep watch to make sure your baby is keeping down sufficient liquids if they’re ill.

In considering whether or not to contact your doctor and how quickly your child needs help, keep in mind that not all spit-ups are equal!

• Normal spit-up can usually be handled at home and does not require contacting your child’s pediatrician.
• If your child is spitting up past 12 months of age, spitting up is increasing, or they seem to be losing weight, put a call in to your doctor (usually an appointment during office hours will suffice — no need to rush in).
• If your child spits up or vomits up blood or bile, chokes on milk to the point they turn blue or go limp, or is under 12 weeks of age and spit-up becomes projectile vomiting, an immediate trip to your healthcare provider is warranted.

If spit-up is getting you and your baby down, there are some things you can do to try to minimize the amount of spit-up you’ll both experience.

• Try smaller feeds. If breastfeeding, consider feeding off of only one breast per feed and pumping milk out of your other breast. If bottle feeding, consider reducing the amount of formula or breast milk offered at any one time.
• Calmly keep your baby upright for 20 to 30 minutes after feeding. Avoid bouncing or quick and rough movements.
• Pace feedings and take frequent breaks to burp.
• Avoid tight and binding clothing and diapers that can put pressure on your baby’s stomach.
• If breastfeeding, consider experimenting with your own diet. Removing certain foods like dairy products may help your baby’s stomach to better digest breast milk.
• Avoid putting your baby to sleep on their stomach. Not only is back sleeping recommended to prevent SIDS, stomach sleeping may only add to the amount they spit up!
• Don’t add solids to a bottle, unless directed by your doctor.
• If your baby spits up, but is happy and gaining weight, there is no need to rush to feed again them right away.

Although it can definitely be frustrating to hear “the noise” starting up again, spitting up is a normal activity for many babies. If your baby is happy and gaining weight, chances are everything is going to be fine, if a bit messy.

Rest assured that most of the time a deep breath and some paper towels are all you’ll need to get things back on track. The fact that spitting up should last no longer than the first year of life can also be a comforting mantra to focus on as you (continually) grab the appropriate cleaning supplies from the closet!

There are times though when spit-up can cross the line of normal or actually be vomit. If you are worried about your child, you should always contact their doctor to discuss their symptoms.