There are some things about newborn care that no amount of parenting classes can prepare you for: cleaning your first diaper blowout, sucking snot from plugged-up infant nostrils and the sheer amount of baby spit-up you’ll encounter.
About half of all babies spit up at some point during their early lives. While it might feel concerning to see your little one spitting up — you're probably wondering whether she's actually keeping enough breast milk or formula in her stomach — know that spit-up is normal and expected.
Keep reading for the full lowdown on baby spit-up, plus when to talk to your doctor if you're concerned about how much your little one is spitting up.
Why do babies spit up?
Baby spit-up, or the dribble of stomach contents that can come out after feeding, is messy, frustrating … and perfectly normal.
An infant's digestive system is still developing, and her lower esophageal sphincter — a ring of muscle that keeps food in the stomach — isn’t fully functional for several months. This makes it very easy for food that she’s just eaten to come back up. If your baby's stomach is very full after a feeding or you’ve changed her position suddenly after eating, for example, that can force food out of her stomach and up her esophagus in the form of spit-up.
Babies also might spit up when they burp, drool, cough or cry. The fact that your infant is on an all-liquid diet (you know, breast milk or formula) also makes it easy for the contents of her stomach to come right back up.
In very rare cases, your baby’s formula might be contributing to excessive spit-up. According to the American Academy of Pediatrics (AAP), an estimated 5 percent of babies have milk-soy protein intolerance, meaning that they cannot properly digest the proteins present in milk- or soy-based formulas. (Spit-up is one of several signs that could indicate this condition.) If your baby is diagnosed with this condition, her doctor might recommend a hydrolyzed formula.
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Possible causes for baby spit-up
Although spit-up is normal, there are a few reasons why your little one might be emptying the contents of her stomach.
Spit-up
Normal spit-up looks a lot like whatever baby is eating, which is either breast milk or formula before she starts solids (usually sometime around 6 months). Both breastfed and formula-fed babies spit up, and the act of spitting up usually looks effortless. It often comes out through the mouth and/or nose, but doesn’t cause pain and isn’t forcefully done. In fact, most babies typically don’t mind or notice spit-up.
Reflux (infant GERD)
Technically, spit-up is reflux. But sometimes, if it's accompanied by other symptoms or poor weight gain, spit-up might indicate that your baby has a condition called gastroesophageal reflux disease in babies, also known as infant GERD.
With infant GERD, the lining of the esophagus becomes irritated and damaged by all the spit-up. It can cause pain and fussiness during and after feeding, and make it harder for baby to feed and gain weight. Other signs of GERD include excessive drooling, uncontrollable crying, poor sleep and erratic feeding patterns. Talk to your child's pediatrician if you notice these symptoms.
Baby spit-up vs. vomit: How can you tell the difference?
Spitting up and vomiting might seem similar. They’re both messy, and both involve your baby’s stomach contents ending up on your clothing.
But unlike spit-up, vomit is forceful (and in more serious cases, even projectile). It is also caused by a virus, bacteria, food poisoning or some other kind of specific health issue. Sometimes, vomit can be green (which hints that there might be an infection) or red (which indicates there’s some kind of blockage or gastrointestinal bleeding). Other causes of baby vomit might be motion sickness, certain prescription medications, or disturbing sights or sounds.
In rare cases, true vomiting might indicate that your baby has something called pyloric stenosis, which is when a muscle in the stomach thickens, preventing food from moving to the small intestine. This can cause projectile vomiting and dehydration, and needs to be treated immediately. Symptoms typically start when baby is between 2 weeks and 2 months old.
How much baby spit-up is normal?
Yes, spit-up means laundry day happens a lot more often during baby's first few months of life. But it’s usually perfectly normal. And while you might feel like your baby is spitting up all her breast milk or formula, that is usually not the reality.
Some babies rarely ever spit up; others spit up after nearly every meal. And volumes of spit-up can vary. Most often, spit-up is a mix of food and stomach acid, and it’s hard to quantify how much is actually coming back up — which is why doctors rarely use volume on its own to tell whether spit-up is normal or a sign of something more serious.
Instead, doctors typically consider the following when assessing a baby’s spit-up:
- Is the spit-up forceful?
- Is it colored red or green?
- Does baby appear to be uncomfortable or in pain?
- Is baby still feeding normally?
- Is baby still gaining weight normally?
Those kinds of questions help practitioners figure out whether a baby is spitting up normally or if something else might be contributing. But as long as your baby is still otherwise healthy and gaining weight, spit-up is likely normal.
Some parents also wonder if it's typical for babies to spit up hours after eating. While spitting up typically happens during or shortly after a feeding, if your baby is otherwise healthy, happy, gaining weight and doesn't have any of the red flags above, this is also probably normal, but ask your child's pediatrician if you have any concerns.
When do babies stop spitting up?
Spit-up happens in most infants, so know that it’s normal — and it gets better as they get older!
Babies typically spit up until they’re around 12 months old. You can expect spit-up to get more frequent until about 3 months of age, and then it should gradually start to get better as baby gets stronger and can sit up on her own.
However, if your baby starts spitting up for the first time after 6 months of age or her spit-up turns to vomiting, that could be a sign that something more serious is going on.
Tips to minimize spitting up in babies
To prevent spitting up from happening as often, there are a few steps experts typically recommend.
- Don’t overfeed. Babies’ stomachs are small, and it’s easy to overload them. (This tends to be more of an issue with bottle-fed babies, since it’s easier for babies to get milk from a bottle nipple than from the breast.) Try feeding more often at smaller volumes if you notice that your baby often spits up during feedings.
- Hold baby upright for 30 minutes after feeding. Sitting chest-to-chest on you for at least a half hour after each feed might minimize the amount of spitting up your baby does.
- Burp frequently. Burping gently during and after feeds — for bottle-fed babies, at least once halfway through a feeding or after every 2 or 3 ounces, and when you switch from one breast to the other for breastfed babies — can help reduce spit-up.
- Limit post-feeding activity. Going straight from a feeding to playtime might cause milk to come back up, for example.
- Use a slow-flow nipple. If you bottle-feed, try using a slow-flow nipple. These are designed to slow down feeding and reduce the amount of air baby takes in while eating — which may help reduce spit-up risk.
When to call the doctor about baby spit-up
Spit-up is usually normal and healthy. But in rare cases, your baby’s spitting up habits might indicate a more serious health problem. Be sure to talk to your doctor if you notice any of the following:
- Not gaining weight well or losing weight
- Crying or arching her back while feeding
- Refusing to feed
- Spit-up that starts after 6 months or continues past 18 months
- Yellow, green or red spit-up
- Frequent forceful or projectile vomiting
- Spit-up accompanied by other symptoms such as bloody stools, wheezing or coughing, fewer wet or dirty diapers, lethargy and/or fever
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