Why Do Babies Spit Up?

You just finished feeding your baby and they appear happy and content. A slight smile even seems to spread across their adorable little face. All is right with the world.

Then, they burp and … out it comes: BLECH.

Spitting up after a meal is common among babies, especially in their first few months. But is there a point where what’s typical becomes a worry? Let’s find out from pediatric gastroenterologist Sujithra Velayuthan, MD.

What causes spit-up?

Food and drink that reaches the stomach aren’t supposed to reverse course. A tight muscle valve (lower esophageal sphincter) between your stomach and esophagus (food pipe) is designed to prevent meals from coming back up.

But in babies, this valve is immature and randomly relaxes from time to time. This may let stomach contents escape into the esophagus to begin an upward journey back to the mouth. The result? Spit up.

Overall, spit-up is typical in about 1 out of 4 infants younger than 1, says Dr. Velayuthan.

Studies show that spit-up is even more common during their first few months of life. (Keep that burp cloth handy!)

Now, the good news: Most babies outgrow this common type of spit-up known as gastroesophageal reflux, or GER, by the age of 6 months.

When is spit-up a concern?

Most babies generally seem unaffected by GER and are even called “happy spitters.” But in some situations, spit-up can cause distress and indicate a condition known as gastroesophageal reflux disease, or GERD.

Signs your baby is dealing with the more serious GERD (as opposed to GER) include:

• Difficulty feeding or a refusal to nurse or take a bottle
• Arching their back with regurgitation
• Recurrent coughing or wheezing
• Apnea (meaning they stop breathing for a few seconds) with a change in muscle tone and the color of their lips
• Poor weight gain and growth
• Excessive irritability (from acid coming up in the esophagus)
• Sleep disturbances

Talk to your child’s pediatrician if you notice those symptoms of GERD to discuss treatment options and ways to manage the condition. You may also be referred to a pediatric gastroenterologist.

What’s the difference between spit-up and vomit?

The difference between spitting and vomiting can basically be summed up with one word: intensity.

When a baby spits up, that regurgitated gunk from their stomach seems to just flow effortlessly and easily out of their mouth. That dribble is usually just a small amount, too. The kiddo may even smile through the event.

Vomit, on the other hand, usually has some oomph behind it. You’ll see your baby’s midsection contract to help push out the ick. Odds are they won’t be happy.

While vomiting can occur with GER, it’s more frequently a sign of GERD or other issues.

Tips to limit spit-up

Knowing that spitting up is typical should offer worried parents some relief, but let’s be honest: The hope is your baby doesn’t let out any sort of regurgitated ick.

Dr. Velayuthan suggests these tips to help them keep their food down.

Change your feeding routine

Feeding your baby smaller but more frequent meals may help reduce spit-up after eating. (Basically, a fuller stomach is more likely to trigger regurgitation.) But talk with your pediatrician to ensure your child is still getting enough nutrients.

Adjust your positioning

Changing your baby’s positioning while they eat may lower the risk that they spit up breast milk or formula when they’re done. Aim for a more upright position, which can limit the amount of air swallowed during feeding to reduce spit-up with large burps.

If you’re breastfeeding (chestfeeding), make sure your baby’s mouth forms a tight seal on the breast to limit air taken in, too. If bottle feeding, keep the nipple filled with milk to limit air being sucked in. A tight seal between your baby’s mouth and the bottle nipple is also important.

Research has shown that laying a baby on their left side after eating may reduce reflux. A reminder, though: Given concerns about sudden infant death syndrome (SIDS), the proper position for an unsupervised baby is on their back.

Burp your baby after feedings

A few gentle pats on the back with your baby held upright may help them burp out any excess air gulped down while eating. That air in their belly may start the spit-up process.

Delay ‘down’ time

Gravity is your friend, so keeping your baby sitting up for a half-hour after feeding may help them keep breastmilk or formula down. Save the tummy time session for later. (It might be a good idea to hold off on using the infant swing, too.)

Dietary adjustments

Changes to what your baby eats also may help limit GERD symptoms. Your pediatrician can help you develop a plan to find potential causes and solutions. Options may include:

• If you’re breastfeeding your baby, what you eat may be playing a role in their GERD symptoms. Your pediatrician may suggest cutting dairy (or other foods) from your diet to see if that makes a difference. If the symptoms disappear, it may be a sign of a food allergy or sensitivity.
• If your child is drinking formula, switching to a different type sometimes may help reduce spit-up.
• Thickeners added to breast milk or formula may help reduce spit-up. (Rice cereal or other cereals can be used with formula. Cereal CANNOT be used with breast milk, which requires commercial products such as a carob bean gum thickener.)

Can medicine help manage GERD?

Medications (especially ones that suppress stomach acid) may be recommended for babies who are excessively irritable or refuse to feed. These are sometimes prescribed when other changes fail to improve symptoms.

Surgical options may be considered in certain situations if complications from GERD become life-threatening or if babies are born with conditions that make them more prone to lifelong reflux.

When to seek medical attention for spit-up

Spitting up is very common in infants, especially during the early months of life. But it’s best to talk with your pediatrician if your child shows the more alarming symptoms of GERD (including limited weight gain and growth).

They can work with you to create a plan to reduce spit-ups or possibly refer you to a gastroenterologist to see if something more serious is going on.