Spit-up, also known as infant reflux or gastroesophageal reflux, happens when a baby’s stomach contents, such as milk or formula, come back up after a meal. Spit-up is very common, even in healthy babies. In fact, more than half of all babies spit up in the first three months of life.1
Common spit-up experiences include:
- Spitting up one or two mouthfuls of milk or formula
- Spitting up during or shortly after feedings
- Smaller spit-ups with burping
- Larger spit-ups after overfeeding
- Typically no crying or discomfort
Why is my baby spitting up a lot?
There are a number of reasons why your baby may be spitting up a lot, and how your baby is eating, growing, or positioned can impact how much they spit up.
Still-developing digestive function
In newborns, the lower esophageal sphincter—a muscular valve between the esophagus and the stomach that keeps the food down—may not open and close properly yet.2 So after feeding, a tablespoon or two of clear or milky drool may come back up through the esophagus and rush out the mouth and the nose. It could be a sudden “surprise,” or you may receive a forewarning burp. While your baby may be eating like a champ, their digestive function could need a little more time to catch up.
Overfeeding
Your baby's tiny tummy can only hold so much. What your little one's belly can't fit may come back up as spit-up.
Spending time on their backs
Since newborns can’t sit up yet, they spend a lot of time lying on their backs, which can aggravate reflux. However, even if your little one has reflux, back sleeping is still the recommended sleeping position for reducing the risk of sudden infant death syndrome. And if your baby does spit up while on their back, their gag reflex will allow them to swallow or cough up the spit-up.3 As your baby learns to sit up, typically around six months, the reflux usually starts to improve.
Gas
Built-up air bubbles in your baby’s belly can trigger spit-up. Some common gas-producing culprits include:
- Eating too fast
- Using an incorrect baby bottle nipple size
- Sucking on a pacifier
- Crying
Overstimulation during or after feeding
A baby who is overly excited before eating may gulp too much milk or formula, which could lead to gas and spit-up. An abrupt change of position or active play, such as bouncing immediately after feeding, could also irritate your baby’s sensitive digestive system.
When does a baby stop spitting up?
Many babies stop spitting up by 12 months,4 often due to:
- A more developed lower esophageal sphincter function
- Sitting up more and spending less time on their back5
- An introduction to solid foods
Is your baby vomiting or just spitting up?
Spitting up is characterized by the easy flow or dribble of a mouthful or two of contents through the mouth. Vomiting is a forceful, projectile throwing up of stomach contents caused by a strong contraction of the abdominal muscle and diaphragm. Vomiting could indicate a virus, cow’s milk protein allergy, blockage, or other health conditions and could lead to dehydration. If your baby is vomiting, call your pediatrician.
Explore more ways to differentiate between spitting up and vomiting.
When should I be concerned about baby spit-up?
If your baby is a "happy spitter" and isn't bothered by the reflux, there's often no need to worry. However, spit-up could occasionally indicate an issue needing medical attention. For example, some babies may spit up because of an allergy to the protein in cow's milk, even if they're getting it through breast milk.
Talk to your pediatrician if you have any concerns about your baby’s issues. Keep an eye out for these other indications that your baby’s spit-up issues could potentially be connected to a food allergy or sensitivity, gastroesophageal reflux disease (GERD), or another health condition:
- Little to no weight gain
- Crying, irritability, and fussiness
- Acting sick or uncomfortable, including arching their back while spitting up
- Refusing food
- Vomiting
- Spit-up that looks bloody, yellow, or green
- Diarrhea or other digestive issues
- Respiratory issues such as coughing or wheezing
- Rash
- Spitting up when over 12 months old
What are some ways to help ease baby spit-up?
If you notice your baby spitting up frequently, consult your pediatrician. Your little one may benefit from switching to a formula specially designed to help reduce spit-up.
You may also want to try the following:
- Position your baby's head higher than the rest of their body when feeding.
- Burp your baby after every 1-2 fluid ounces of formula, but wait for them to take a break—don't interrupt their feeding. For breastfed babies, burp after feeding on each side.
- Check that you have the proper nipple flow (a bottle held upside down allows one quick drop at a time, but not a steady stream), and burp your baby often.
- Avoid tight diapers as they put added pressure on the stomach.
- Don't play vigorously with your baby right after a feeding.
- Reduce pacifier time, as constant sucking can pump your baby's stomach up with swallowed air.
- Calm your baby down if they are frantic, stressed, or rushing through feeding.
- Hold your baby upright for 30 minutes after feeding.
- Give smaller, more frequent feedings to lessen the chances of spit-up.
Ask your doctor if switching to Enfamil A.R.™ could help relieve spit-up
Spit-up is a common experience for many babies, and while it’s a bit messy, it typically won’t cause discomfort or affect your baby’s growth and development.6 But if your little one is spitting up a lot or you have any questions or concerns, call your pediatrician and consider asking them if an infant formula designed to help ease spit-up issues could provide some relief. Enfamil A.R. formula is specially formulated with added rice starch for a thicker consistency to reduce reflux and spit-up by over 50%* in one week. It provides complete nutrition for your infant up to 12 months of age and meets reflux reduction guidelines as set by the American Academy of Pediatrics.7
While you’re waiting to talk with your doctor, be sure to join Enfamil Family Beginnings to earn rewards on Enfamil purchases and get discounts, free baby formula samples, and baby freebies! You’ll also get custom baby content and tips delivered to your email.
Spit-up is just one of the many feeding issues that your baby may encounter during their first year. If you think your baby may be struggling with another feeding issue, get tips to give them some relief.
References:
1 “Reflux in Infants.” MedlinePlus. https://medlineplus.gov/refluxininfants.html.↗ Accessed September 29, 2022.
2 “Spitting up - self-care.” MedlinePlus. https://medlineplus.gov/ency/patientinstructions/000754.htm.↗ Accessed September 29, 2022.
3 Porto, Anthony, MD, MPH, FAAP. “What is the safest sleep solution for my baby with reflux?“ HealthyChildren.org. https://www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/What-is-the-safest-sleep-solution-for-my-baby-with-reflux.aspx#:~:text=Take%20the%20spitting%20over%20the,even%20for%20babies%20with%20reflux.↗ Accessed September 29, 2022.
4 Porto, Anthony, MD, MPH, FAAP. “Gastroesophageal Reflux & Gastroesophageal Reflux Disease: Parent FAQs.” HealthyChildren.org https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/GERD-Reflux.aspx.↗ Accessed September 29, 2022.
5 Porto, Anthony, MD, MPH, FAAP. “What is the safest sleep solution for my baby with reflux?“ HealthyChildren.org. https://www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/What-is-the-safest-sleep-solution-for-my-baby-with-reflux.aspx#:~:text=Take%20the%20spitting%20over%20the,even%20for%20babies%20with%20reflux.↗ Accessed September 29, 2022.
6 Mayo Clinic Staff. “Spitting up in babies: What's normal, what's not.” Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/in-depth/healthy-baby/art-20044329#:~:text=Spitting%20up%20is%20common%20in,reflux%20or%20infant%20acid%20reflux.↗ Accessed September 29, 2022.
7 Lightdale JR, Gremse DA; Section on Gastroenterology,Hepatology, and Nutrition.Gastroesophageal reflux:management guidance for the pediatrician. Pediatrics. 2013 May;131(5):e1684-95.doi:10.1542/peds.2013-0421. Epub 2013 Apr 29. PMID: 23629618.
