It’s normal for babies to spit up both breast milk and formula. Infants spit up after feedings (sometimes every feeding) and often bring up some milk when they burp.
Doctors may use the phrase “happy spitter” to describe a baby who spits up but is generally comfortable, has no breathing problems, and thrives and grows well.
Despite this just being one of those things babies do, you can do things to help prevent it and keep your baby comfortable.
There are also signs to look out for that might indicate that spitting up requires a doctor’s evaluation. Check out My Baby Nursery for all your baby product needs.
My Baby Spits up – Is This a Problem?
Spitting up, sometimes called physiological or uncomplicated reflux, is common in babies and is usually (but not always) normal.
Most young babies spit up sometimes since their digestive systems are immature, making it easier for the stomach contents to flow back up into the esophagus (the tube connecting the mouth to the stomach).
Babies often spit up when they get too much milk too fast.
This may happen when the baby feeds very quickly or aggressively or when the mom’s breasts are overfull.
The amount of spit up typically appears to be much more than it is. If the baby is very distractible (pulling off the breast to look around) or fussy at the breast, he may swallow air and spit up more often.
Some babies spit up more when they are teething, starting to crawl, or starting solid foods.
What Causes Spitting Up?
Spitting up is common in healthy babies.
During their first three months, about half of all babies experience their stomach contents coming back up into the esophagus, a condition known as gastroesophageal reflux, infant reflux or infant acid reflux.
Usually, a muscle between the esophagus and the stomach (lower esophageal sphincter) keeps stomach contents where they belong.
Until this muscle has time to mature, spitting up might be an issue — especially if your baby is relatively complete.
In newborns, the digestive system is still developing, so there is more spitting up in the first few months than later on.
As babies feed, milk goes down the throat to the esophagus and then the stomach.
The esophagus is connected to the stomach by a ring of muscles called the lower esophageal sphincter.
This sphincter opens to let the milk go into the stomach, and then it immediately closes back up, but this “trap door” isn’t as reliable as it should be until about six months of age when it is more mature. This can cause a backflow of milk that results in spit-up.
Aside from this, there are three distinct reasons that babies spit up:
- Overeating: Eating too much or too fast can be the culprit because babies have small stomachs. A baby who is taking too much milk at each feeding might fill up—and the extra milk that his belly can’t hold has only one way to go.
- Sensitivity or allergies to certain foods or drinks in your diet: Allergens can be transferred into breast milk and cause your baby to spit up.
- Swallowing air during feedings: A baby who is drinking very quickly is also gulping air along with the milk. This is especially true if you have a strong let-down reflex or an overabundant milk supply.
What Is the Difference Between Spitting up and Vomiting?
Spitting up is the easy flow of a baby’s stomach contents through his or her mouth, possibly with a burp.
Vomiting occurs when the flow is forceful — shooting out inches rather than dribbling from the mouth.
It seems like my baby is spitting up a lot. Can spitting up affect my baby’s growth?
Normal spitting up doesn’t interfere with a baby’s well-being.
As long as your baby seems comfortable and eats well, and gaining weight, there’s little cause for concern. If your baby is gaining weight, then he or she isn’t being harmed by the calories lost through spitting up.
Keep in mind that it’s easy to overestimate the amount your baby has spit up based on the size of a spit-up stain.
Some Causes of Excessive Spitting Up
Breastmilk oversupply or forceful let-down (milk ejection reflex) can cause reflux-like symptoms and usually can be remedied with simple measures.
Food sensitivities can cause excessive spitting.
The most likely offender is cow’s milk products (in baby’s or mom’s diet). Other things to ask yourself: is the baby getting anything other than breastmilk – formula, solids (including cereal), vitamins (fluoride, iron, etc.), medications, herbal preparations? Is mom taking any medications, herbs, vitamins, iron, etc.?
Babies With Gastroesophageal Reflux Disease (GERD) Usually Spit up a Lot.
Although seldom seen in breastfed babies, regular projectile vomiting in a newborn can be a sign of pyloric stenosis, a stomach problem requiring surgery. It occurs four times more often in boys than in girls, and symptoms usually appear between 3 and 5 weeks of age.
Newborns who projectile vomit at least once a day should be checked out by their doctor.
GERD (A.K.A. Reflux)
For the babies that are not “happy spitters,” spit-up may be caused by gastroesophageal reflux disease (GERD). If the lower esophageal sphincter doesn’t tighten up immediately after it opens, the term “reflux” is used since the spit-up coming back up may be accompanied by stomach juices and acids.
Reflux can cause considerable discomfort in some babies. Symptoms of GERD include:
- Gagging, choking, coughing, wheezing, or other breathing problems
- Pain and discomfort
- Poor growth due to vomiting (rarer)
Warning signs of severe reflux:
- Inconsolable or severe fussiness or crying associated with feedings.
- Poor weight gain, weight loss, or failure to thrive. Difficulty eating. Breast/food refusal.
- Difficulty swallowing, sore throat, hoarseness, chronic nasal/sinus congestion, chronic sinus/ear infections.
- She was spitting up blood or green/yellow fluid.
- Sandifer’s syndrome: Baby may ‘posture’ and arch the neck & back to relieve reflux pain–this lengthens the esophagus and reduces discomfort.
- Breathing problems: bronchitis, wheezing, chronic cough, pneumonia, asthma, aspiration, apnea, cyanosis.
Discuss your baby’s spit-up patterns with your pediatrician to figure out if GERD could be the culprit. If so, medication and other measures may be necessary.
GERD may cause babies to either undereat (if they associate feeding with the after-feeding pain, or if it hurts to swallow) or overeat (because sucking keeps the stomach contents down in the stomach and because mother’s milk is a natural antacid).
Current information on reflux indicates that testing or treatment for reflux in babies younger than 12 months should be considered only if spitting up is accompanied by week weight gain or weight loss, severe choking, lung disease or other complications.
The infant with significant reflux who seems to be growing well and has no other significant health problems benefits most from little or no therapy.
When GERD is suspected, many doctors first try a trial of various reflux medications (without running tests) to see if the medicines improve the baby’s symptoms.
If testing is done, a 24-hour pH probe study (PDF) is the current “gold standard” for reflux testing in babies; this is a procedure where a tube is placed down the baby’s throat to measure the acid level bottom of the esophagus.
A barium swallow (upper G.I.) is not so invasive (baby swallows a barium mixture, then an x-ray is taken) but is not practical for diagnosing reflux in babies since most babies will reflux given barium. An upper G.I. will not identify whether the baby’s stomach contents are higher in acid or if there has been any esophagus damage due to reflux.
Still, it will show any blockages or narrowing of the stomach valves that may be causing or aggravating the reflux. Additional tests may be recommended in certain circumstances (see the links below for further information). In rare cases, when the baby has very severe reflux that is not relieved by medication, surgery may be recommended.
Ways to Reduce Spit-Ups
There are several things you can do to decrease the likelihood or frequency of your baby spitting up.
Burp Your Baby
Try to burp your baby during and after each feeding to remove air from her belly. Some breastfed babies do not need to burp after every feeding, as they tend to swallow less air than bottle-fed babies.
However, if you have an abundant milk supply or a swift flow of milk, that may not be the case.
Sometimes babies spit up because they are burped. Still, this is a worthwhile measure.
When you burp your baby, you are helping release the air swallowed during the feeding.
After a burp, your baby will be more comfortable. Removing air may also make more room in your baby’s stomach to continue the feeding. Online baby product directory at My Baby Nursery.
Keep Feedings Calm and Quiet
Try to limit distractions, noise, and bright lights while you are breastfeeding.
Calmer feedings may lead to fewer spit-ups. Don’t bounce or engage in very active play immediately following a feeding either.
Feed Your Baby More Often
If you wait too long between feedings and your baby is very hungry, she may feed too quickly and take in excess air.
Stick with the same recommended quantity of milk over a day; consider adjusting your feeding schedule.
Manage a Strong Let-Down
If you have a forceful let-down reflex, your milk may be flowing too fast for your baby.
Try to nurse in a reclined position so that your baby is taking in the milk against gravity. You can also pump or express some milk from your breasts before beginning a feeding to help slow down the flow.
Relieve Engorgement Before Feeding
If you have too much milk or your milk supply has not yet adjusted to your baby’s needs, your breasts might be engorged.
This can make your breasts complete and hard, making it difficult for your baby to latch correctly and get a good seal around your nipple.
As a result, your baby will take in air as he tries to nurse.
Use a pump or express some milk before feeding your baby to soften the breast. This will help your baby to latch on properly.
Experiment With Positions
Try different breastfeeding positions to see if some are more comfortable than others for your baby. And after feeding, try to keep your baby’s head upright and elevated for at least 30 minutes.
What Can You Do to Reduce Spitting Up?
Consider these tips:
- Keep your baby upright. Feed your baby in a more upright position. Follow each feeding for 30 minutes in a good position. Avoid immediate active play or the use of an infant swing.
- Avoid overfeeding. Feeding your baby in smaller amounts, more frequently, might help.
- Take time to burp your baby. Frequent burps during and after each feeding can keep air from building up in your baby’s stomach.
- Put the baby to sleep on his or her back. To reduce the risk of sudden infant death syndrome (SIDS), it’s essential to place your baby to sleep on his or her back. Putting a baby to sleep on his or her tummy to prevent spitting up isn’t recommended.
- Experiment with your diet. If you’re breastfeeding, your baby’s doctor might suggest that you eliminate dairy products or certain other foods from your diet.
Our breasts let down milk at varying rates.
Regulating the flow can be difficult. A full belly is more likely to cause episodes of spitting up. Look back on the breastfeeding classes you so eagerly took during your pregnancy. Frequent, smaller feedings are easier to digest.
Less food equals less spit-up.
It also regulates flow.
Breasts that have their milk expressed more often are less likely to have a forceful let-down during feedings. The results are less air in your baby’s belly. These feedings will fill her belly with a reasonable amount of milk, satisfying her hunger.
In light of this, she’s less likely to regurgitate part of that feeding.
Compared to the breast, bottles offer the baby a more regulated stream of milk. The result is a slower feeding that doesn’t fill the belly too quickly. Done right, a bottle feeding is also less likely to introduce excessive amounts of air. The result is what I noticed with our daughter: less gas and less spit-up.
- Aim for frequent breastfeeding whenever baby cues to feed. These smaller, more frequent feedings can be easier to digest.
- Try positioning the baby in a semi-upright or sitting position when breastfeeding, or recline back so that baby is above and tummy-to-tummy with mom. See this information on upright nursing positions.
- For fussy, reluctant feeders, try lots of skin to skin contact, breastfeeding in motion (rocking, walking), in the bath or when the baby is sleepy.
- Ensure good latch to minimize air swallowing.
- Allow the baby to finish one breast (by waiting until the baby pulls off or goes to sleep) before you offer the other. Don’t interrupt active suckling to switch sides. Switching sides too soon or too often can cause excessive spitting (see Too Much Milk?). For babies who want to breastfeed very frequently, try switching sides every few hours instead of at every feed.
- Encourage non-nutritive/comfort sucking at the breast since non-nutritive sucking reduces irritation and speeds gastric emptying.
- Avoid rough or fast movement or unnecessary jostling or handling of your baby right after feeding. The baby may be more comfortable when helping upright much of the time. It is often helpful to burp often.
- As always, watch your baby and follow his cues to determine what works best to ease the reflux symptoms.
Why Spitting up Happens
Spitting up is natural.
For babies under three months of age, there is little need for concern. Almost half of all babies experience some spitting up during this period. It’s because, during this time, the lower esophageal sphincter is not mature.
Until that muscle gets strong enough to hold down the stomach contents, spitting up is expected. Naturally, you’ll probably notice it more when her belly is full after a feeding.
This reaction is normal.
Chances are, your baby is just like ours—happy, content, and eating without issue. As long as your baby is hitting these markers, there is no need to worry. If you have a “happy spitter,” all is well.
In the end, it was a matter of our making sure that we kept her upright after each feeding. And don’t forget to burp! Getting that excess air out of the belly will help prevent the food from working its way back up the esophagus.
Our babies get reflux too. And it’s uncomfortable for them as well. If your baby is painful, isn’t gaining weight, or fusses over overeating, it could be reflux. There are plenty of medications and (like us adults) lifestyle changes that can make feedings more pleasant and relieve her symptoms. My Baby Nursery is your one-stop baby product store.
For the most part, finding a solution to spitting up is simple trial and error. It’s not your milk, and it’s not the formula. It’s all about you and the baby-making feeding time your time.