As a new parent, it can be alarming to see your baby regurgitate what looks like their entire milk feed. You may be thinking, “Why is my baby spitting up a lot?!” Both of my girls spit up regularly as newborns, and I was constantly worrying about whether they were healthy. Fortunately, I learned that baby spit-up is often considered normal. I also learned factors that could be causing their spit-up, when they would likely outgrow it, and what I could do to minimize it in the meantime.
Almost all babies spit up, and it can happen for many different reasons, from their anatomy to their feeding routines.1 Here are some common causes of baby spit-up:
There’s a flap and a muscle called a sphincter that divides the esophagus from the stomach. The muscle’s role is to keep stomach contents down. In newborn babies, the sphincter is relaxed and weak. The stomach often has higher pressure than the esophagus, and the sphincter isn’t strong enough yet to counteract the greater pressure.2,3 When the pressure in the stomach is high, food will come up the esophagus, and a baby will spit up.
The flap at the top of the stomach that’s supposed to hold food down is immature. So, any change in position that alters the pressure within the stomach can cause spit-up. This can happen from bouncing your baby or sitting them upright while bending at the hips. Any feeding or resting position that places baby’s stomach above their head, even slightly, further increases the stomach pressure and the chances of spit-up.1,4
Babies often swallow some air along with their breast milk or formula. Their tiny stomachs simply cannot hold a large volume of milk and air. When they burp out the air to make room for more milk, they may also regurgitate some of their milk with it.1
Again, babies’ stomachs are very small and can fill up quickly and easily with milk and air. While babies are innately pretty good at regulating their milk intake and stopping eating when they’re full, you may be overfeeding your newborn. If they take in too much milk at a time, baby will likely spit up the contents that their stomach cannot contain.1
Occasionally, your baby may spit up excessively due to a cow’s milk protein allergy.2 However, milk allergy is likely to cause other, more severe symptoms in addition, such as bloody stools, extreme irritability, or rash. Milk allergy may also cause true vomiting, as opposed to just spit-up.6
Spit-up and vomit can seem similar, as they both involve the ejection of stomach contents back up through the mouth. But they’re differentiated based on their forcefulness, the amount, and whether there’s pain associated. Let’s explore the differences between spit-up vs. vomit:
Vomiting in babies can be forceful or projectile, meaning it can shoot across the room. You may be able to see or feel your baby’s stomach muscles contract with vomiting. Vomiting can be uncomfortable or painful for a baby, so they may cry out because of it.1
Spit-up is a gentler flow of regurgitation; it isn’t as forceful. Spit-up also involves smaller amounts of partially digested breast milk or formula, and it often occurs with a burp. A baby who’s spitting up remains unbothered and happy throughout, and there are no forceful muscle contractions.1
There’s a wide range of normal volumes of spit-up. Most babies spit up at least some, and some spit up a lot. Spit-up often appears to be more than it actually is, especially on absorbent clothing, burp cloths, and blankets.3 If you’re concerned, try pouring one whole ounce of water on the floor or some cloth. Chances are, your baby isn’t spitting up that large of a volume!
Instead of focusing on a normal or abnormal amount of spit-up, try to examine the bigger picture. If your child is gaining weight appropriately, they aren’t losing too many calories through spit-up. If they appear happy and healthy, this is another good sign that they’re spitting up a normal amount.3
If your child is projectile vomiting several feet away after every feed, has blood in their spit-up, or is struggling to gain weight due to the amount of spit-up, this may be an abnormal amount of spit-up.1 You should also seek prompt medical care if baby seems dehydrated, which you would know because they have fewer wet diapers than usual or at least one wet diaper every six hours.5 If you have concerns about whether the amount your baby is spitting up is normal, you should always contact your pediatrician.
Spitting up is nearly universal in newborns and continues (or may even increase) until around 4 months of age. So, if your baby is spitting up more than usual, it could simply be a product of their age! At 4 months old, spitting up peaks, then it may begin to taper off. By 7 months of age, baby will likely be spitting up far less often.7 Spitting up usually resolves completely on its own by your baby’s first birthday.5
Remember, spitting up is normal most of the time. However, there are steps you can take to decrease the amount and frequency that your baby is spitting up:
Burping up air can cause spit-up along with it. So, try to minimize the amount of air your baby is swallowing while eating. Whether you’re breast- or bottle-feeding, ensure a solid, deep latch and pace your feedings. Especially when bottle-feeding, make sure you’re using the correct nipple size, point the nipple toward the roof of the mouth, and keep air out of the very tip of the bottle nipple. You can do this by holding the bottle just tilted up from flat and letting air bubbles rise to the top of the milk after shaking the formula or thawed breast milk.1,9
Try keeping baby’s head slightly elevated above their stomach for 20 minutes after a feed. This may help prevent increased stomach pressure that sometimes leads to sphincter failure and spit-up. Holding baby upright on your chest or even in a slightly elevated cradle hold after a feed can allow gravity to aid digestion in starting. Just make sure not to place them in a seated position where they’re bent at the hips. This can add additional pressure on the stomach.4
Feed your baby when they’re hungry, and stop when they seem full. You might be wondering, “If my baby spits up, should I feed them again?” Instead, look for hunger cues such as baby bringing their hands to their mouth, turning their head toward your breast or a bottle, smacking or licking their lips, and tensing their fists. Crying is a late sign of hunger.10
To prevent overfeeding and future spit-up, look for fullness cues, and stop feeding your baby once you see them. Fullness cues include closing their mouth, turning their head away from the breast or bottle, and opening their palms in a relaxed position. Avoid overfeeding by refraining from force-feeding a bottle.10 If you’re breastfeeding, you can try offering only one breast at a time and alternating which breast you offer at each feeding, especially if you have an oversupply or an overactive letdown.4
Because air in the tummy can cause spitting up, burping your baby during and after feeds can control gas buildup in the stomach and decrease the amount and frequency that your baby spits up. Try burping them at least halfway through a bottle, or after 2-3 ounces, and at the end of the feeding. If you’re breastfeeding, burp them between switching sides, but you don’t necessarily need to unlatch baby preemptively to burp them. If your baby hates being burped, you can skip it because when they’re crying and angry, they may take in more air.4,9
If none of these interventions make a dent in your baby’s spit-up, talk to your pediatrician. There are other interventions you can try, such as thickening their feeds or changing their formula (or changing your own diet if breastfeeding). However, you should only do these at the recommendation and under the supervision of a medical provider.1
Most of the time, spit-up is benign and will pass on its own. It isn’t usually a sign of an underlying issue. Rarely, baby spit-up or vomiting can indicate a deeper health issue, such as:
Sometimes, spit-up can be one of many signs that your baby has an allergy or intolerance to dairy in their formula or your breast milk. If you suspect milk allergy or your baby has other signs such as rash, bloody diarrhea, or extreme irritability, talk to your pediatrician about trialing a hydrolyzed formula or a dairy-free diet to see if their symptoms improve.1
If your baby has regular spit-up or vomiting, and it seems to be painful or it’s enough that your baby is refusing to feed or having trouble gaining weight, they may have gastroesophageal reflux disease (GERD). If you’re concerned that your baby may have GERD and not just regular spit-up, please talk to your pediatrician.8
This condition is when the valve at the bottom of the stomach that empties into the intestines thickens and narrows, preventing the stomach from emptying. This causes forceful, projectile vomiting. Pyloric stenosis can be a cause of baby vomiting, which worsens over time and is usually identified around 4 weeks of age.1
While baby spit-up is easy to read into and can sometimes be a sign of a more serious issue, it’s usually just a passing fact of newborn life. Babies reflux for all different reasons. Spit-up can look like more than it is, so try to worry more about their overall health and demeanor than the amount. There are interventions you can try to reduce spitting up, and if you’re still worried, never hesitate to reach out to your pediatrician.