Why Babies Spit Up and How To Help
- Paul Patterson, MD, FAAP
- Jan 30, 2023
- 10 min read
Updated: Mar 1, 2024
Spit ups are one of the most common things new parents deal with, but they can be frustrating and even a little scary. You don't know why your little one is throwing up, or how to make it stop.
Have no fear! Although spit up might seem like a big—and messy!—problem at first, knowing what's causing it can help you manage the issue. In this article, we'll discuss why babies spit up, when to be concerned, and how you can minimize the mess.
In this article:
What is spitting up?
“Spitting up” refers to a baby expelling small amounts of semi-digested milk or formula from their mouth or nose, usually soon after eating.
Babies tend to swallow air along with breast milk or formula and that air gets trapped in their stomach with the liquid. When the air comes up, some of the milk or formula comes up too, through either your baby's mouth or their nose.
It's common for infants to spit up and is usually not a cause for concern.
In fact, almost half of young babies spit up regularly. In most cases, spitting up will slow down and eventually stop on its own as your baby's digestive system matures.
Typical appearance of spit ups
Baby spit up usually looks like the milk or formula that your baby recently drank.
If your baby has started eating solid foods, their spit up may be slightly curdled or discolored, based on what they ate.
Consistency-wise, spit up can be thin and watery or much thicker, depending on what your baby ate and when.
The amount that a baby spits up can vary a great deal. Sometimes a baby spits up only a few drops, but other times they might spit up a larger amount that soaks their (or your!) clothes and requires an outfit change.
Spitting up vs. vomiting
Spitting up is different from vomiting, although both involve the contents of your baby's stomach being expelled from their mouth.
The main differences between spitting up and vomiting involve:
Force: When a baby spits up, the liquid generally just dribbles out of their mouth. Vomiting is much more forceful. In particular, projectile vomiting is when vomit shoots out of a babies mouth and should never be confused with spitting up.
Effort: Babies usually spit up passively and might not even realize that it's happening. Vomiting requires more effort and can even cause pain or discomfort.
Quantity: Spitting up is typically a small amount of liquid, while vomiting is usually a larger amount of liquid or food.
Likelihood of spitting up by age
Spitting up is most common in young babies and typically begins around 2 to 3 weeks.
It typically peaks around 4 to 5 months of age and begins to decrease in frequency after 6 to 8 months.
Most babies will have stopped spitting up by their first birthday.
However, some babies may continue to spit up occasionally even after they turn one.
Source: Curien-Chotard M, Jantchou P. Natural history of gastroesophageal reflux in infancy: new data from a prospective cohort. Used with permission via Creative Commons license.
How frequently does your baby spit up?
More than six times per day
Four to six times per day
One to three times per day
Rarely or never
Potential causes for baby spit ups
There are numerous reasons why even healthy infants may spit up regularly:
Immature digestive system/gastrointestinal tract
Too much activity right after a feeding
Swallowing too much air while feeding
Eating too quickly
Food intolerance or sensitivity
Digestive condition
1. Immature digestive system/gastrointestinal tract
Newborn babies' digestive systems are not yet fully mature (the reason why they can't eat solid foods until around 6 months).
This can contribute to discomfort and spitting up in several ways.
Most importantly, their esophageal sphincter, the muscle at the end of the esophagus that closes to keep out stomach contents, is underdeveloped. This makes it much easier for swallowed milk or formula to come back up–their stomach is like a bottle with no cap!
Second, a newborn's stomach and intestines can't yet digest complex sugars and proteins, which can cause difficulty in digesting certain foods and contribute to spit ups.
A baby's digestive system is generally considered to be fully mature by their first birthday.
2. Too much activity right after a feeding
Just like yours, your baby's tummy needs a little time to settle after eating. It's best to wait 30 minutes or so before doing tummy time, bouncing, or anything else energetic!
3. Swallowing too much air while feeding
Swallowing too much air while feeding can cause gas and discomfort. To avoid this, make sure that you are holding your baby upright for feedings.
If you are bottle-feeding, hold the bottle at a 45-degree angle or less to ensure that the nipple is always filled with milk/formula.
Consider using a baby bottle that is designed to reduce air intake, such as a vented bottle or an angled bottle.
4. Eating too quickly
If a baby eats too quickly, they are more likely to swallow air, as well as overeat.
If you are bottle-feeding, make sure to use a bottle nipple with the correct flow rate for your baby's age and development. An overly fast flow can make your baby gasp or choke and swallow air.
5. Food intolerance or sensitivity
Breastfed babies
The foods that breastfeeding mothers eat can contribute to their baby's digestive discomfort and spitting up.
Just like grown-ups, some babies may be more sensitive to the effects of certain foods in breast milk than others. Unlike allergies, this type of reaction tends to be minor and temporary, so your baby will likely become less sensitive over time.
If you think that your baby could have an intolerance or sensitivity to something that you eat or drink, you can try eliminating certain items from your diet for a time to see if it helps. Just check with your own physician and your baby’s pediatrician before eliminating any foods.
Formula-fed babies
Most babies can easily digest cow's milk formula with no adverse reactions. However, 1-2% of infants are allergic to the proteins in cow’s milk and require special formula. Of these babies, up to 50% are also sensitive to soy protein and require an even more specialized formula.
Always consult with your healthcare provider before eliminating foods from your diet or switching formulas. They can provide guidance and rule out other possible causes for your baby's discomfort.
6. Digestive condition
Almost all healthy babies have some degree of infant acid reflux, also known as gastroesophageal reflux (GER), which manifests as fussiness, gas, and spitting up.
If these symptoms occur frequently or your baby seems to be in pain, consult with your doctor. Your baby may have a more serious form of acid reflux called gastroesophageal reflux disease (GERD), discussed in more detail below.
When to be concerned about spitting up
As annoying as it can be to put yet another spit up-stained onesie in the laundry, keep in mind that some degree of spitting up is normal in healthy babies.
It is not usually a cause for concern unless the spitting up is excessive or accompanied by other symptoms that could indicate a more serious problem.
Symptoms to watch for:
Poor weight gain or weight loss
Coughing or breathing difficulties
Spit up that is green or yellow, contains blood, or looks like coffee grounds
Frequent crying (more than usual fussiness)
Refusing to eat for multiple feedings
Fewer wet diapers—this could be a sign of dehydration
If your baby is experiencing any of these symptoms, you should seek immediate medical attention.
Gastroesophageal Reflux Disease
Gastroesophageal reflux disease (GERD) is a condition in which stomach acid and other stomach contents flow back into the esophagus, causing discomfort and irritation. It is a chronic and much less common form of the type of infant reflux that many babies experience.
The following graph compares the prevalence of gastroesophageal reflux disease (GERD) vs. regular infant reflux (GER).
Source: Curien-Chotard M, Jantchou P. Natural history of gastroesophageal reflux in infancy: new data from a prospective cohort. Used with permission via Creative Commons license.
Just like GER, GERD in babies is usually caused by a weak or immature lower esophageal sphincter, the muscle at the end of the esophagus that is supposed to close during regular digestion. This is more likely to occur in babies born prematurely.
Symptoms of GERD in babies can include:
Frequent spitting up
Difficulty swallowing
Crying or fussiness during and after feedings
Repeated feeding refusal
Poor weight gain
Arching of the back or neck during or after feedings
Coughing or wheezing
GERD can be very uncomfortable for babies, but it is rarely considered dangerous.
However, it can occasionally cause complications such as failure to thrive or breathing problems, so don't disregard the symptoms.
If your baby is experiencing symptoms of GERD, it's important to consult a pediatrician to develop an appropriate treatment plan.
How to reduce spitting up
There are several ways that you can reduce the frequency and quantity of your baby's spit up.
1. Hold your baby upright after feeding
After feeding, hold your baby in an upright position for 20 to 30 minutes. This will help the milk or formula settle in their stomach.
2. Burp your baby
Make sure to burp your baby during and after feedings to release any trapped air. Depending on your baby's age and feeding style, you may need to burp them even more frequently.
3. Avoid overfeeding
Avoid overfeeding your baby. Too much milk in their stomach can cause your baby to spit up more.
As discussed above, make sure that you are using a bottle nipple with the correct flow rate. If the milk flows too quickly, your baby could overeat before registering that they are full.
4. Smaller, more frequent feedings
Similarly, try giving your baby smaller, more frequent feedings to prevent an overly full stomach.
5. Avoid tight clothing
Dress your baby in loose, comfortable clothes that don't squeeze around the belly. Tight waistbands can put pressure on your baby's stomach, making it more likely they will spit up.
6. Consult your pediatrician
If your baby is spitting up frequently or in large amounts or frequently seems fussy or uncomfortable, consult your pediatrician to rule out any underlying medical conditions.
Spitting up FAQs
Q: My baby is spitting up a lot—should I be concerned?
Spitting up is common even for healthy babies and does not automatically mean that something is wrong.
However, if your baby is spitting up excessively, or if the spit up is accompanied by other symptoms such as weight loss, coughing, or difficulty breathing, it may be a sign of a more serious condition such as GERD.
In this instance, it's important to consult with your pediatrician. They will evaluate your baby's overall health and might recommend changes you can make reduce spitting up.
In some cases, your pediatrician might prescribe medication to treat reflux. However, most babies do not require medication.
Q: Is it normal for spit up to come out of my baby's nose?
It is relatively common for milk to run out of a newborn's nose.
This occurrence is called nasal regurgitation and it occurs because the nose and mouth are connected at the throat, making it easy for milk to come out of your baby's nose when they spit up.
Nasal regurgitation is not usually a cause for concern unless:
It happens at every feeding;
Your baby struggles to eat or swallow correctly;
Your baby inhales the spit up (this is rare); OR
Your baby experiences other symptoms discussed above (coughing, fussiness, discomfort, etc.).
If your baby regularly spits up through their nose, you should consult with their pediatrician for advice and to determine if there are any underlying health concerns.
Q: Why is my baby spitting up clear liquid?
There are several reasons why a baby might spit up clear fluid, including:
Excess saliva: Babies tend to produce—and swallow—more saliva than adults. If your baby spits up this excess saliva, it may come out as a clear liquid. This is particularly true if your baby is teething, when it's common to produce excess drool.
GERD: Clear spit up is a common symptom of GERD.
In rare cases, conditions such as a gastrointestinal infection or pyloric stenosis
Spitting up clear liquid is not always a cause for concern. As with other spitting up, consult with your pediatrician if your baby's clear spit up is excessive or accompanied by other concerning symptoms.
Q: Why is my baby spitting up curdled milk?
When stomach acid comes into contact with the milk or formula in your baby's tummy, it can cause it to curdle and even resemble cottage cheese.
The main factor is time since the last feeding. If your baby spits up during or right after a feeding, the spit up will likely look like the milk that they just swallowed. If your baby spits up a little while later, the milk has had time to mix with your baby's stomach acid and become curdled.
The following visual is designed to help you understand some of the symptoms associated with spitting up. It is not an exhaustive list of concerning or benign symptoms. You should always feel free to contact your healthcare provider with any questions.
Q: Should I worry that my baby isn't getting enough to eat if they spit up?
Spitting up is a common and normal occurrence for babies, and it doesn't necessarily mean that they aren't getting enough to eat.
Keep in mind that spit up contains a lot of saliva, so your baby might not be losing as much milk as it appears.
Make sure you are bringing your baby to all of their well child check ups so their healthcare provider can monitor their growth and weight gain.
Q: Can spitting up cause Sudden Infant Death Syndrome (SIDS)?
There is no known relationship between spitting up and SIDS.
The Takeaway
It's normal for babies to spit up occasionally, since many babies experience infant acid reflux to some degree. Although it can be messy at times, there are a few steps you can take to reduce it.
For the most part, regular spitting up is no cause for alarm. However, as with any changes in your baby's behavior, be sure to talk to your pediatrician if your baby is spitting up excessively or if you see any other symptoms.
In general, being mindful of your baby's eating habits will help reduce the amount of spit-up.
Sources:
Curien-Chotard M, Jantchou P. Natural history of gastroesophageal reflux in infancy: new data from a prospective cohort. BMC Pediatr. 2020 Apr 7;20(1):152. DOI: 10.1186/s12887-020-02047-3.
Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2018 Mar; 66(3): 516–554. doi: 10.1097/MPG.0000000000001889
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