Spitting Up: Understanding why & what you can do about

Baby being bottle fed

It can certainly be concerning to see your baby expel what appears to be a large amount of liquid from his tiny body; however, spitting up, sometimes called uncomplicated reflux, can be totally common in healthy babies. In fact, about half of babies under three months experience this at least once per day and, more often, several times a day. Normally a muscle, (called the lower esophageal sphincter) between the esophagus and the stomach, keeps the contents of the stomach where they belong. In babies, this muscle isn’t fully developed yet, allowing the food to quickly make its way back up the esophagus and out of the mouth (and all over your clothes!) Since your baby’s stomach is so small, swallowing too much air during a feeding or getting too much milk too fast, such as when mom’s breasts are overfull, can also contribute to some milk being brought back up.

Although it appears that your baby may have spit up his entire feeding, the amount that actually comes back up is usually only a tablespoon or two, as opposed to the several ounces he just consumed. If your baby is happy, not in any obvious discomfort or distress, eating and gaining weight well, having enough wet and dirty diapers daily, then the spitting up is a “laundry” issue (sorry, mom!) and not a medical concern. Spitting up usually peaks around 4 months of age but can continue up to the first birthday. Most babies outgrow or show a significant decrease in the amount they spit up by 7-8 months, once they learn to sit up on their own and have started eating more solid foods.

If your baby is experiencing any of these symptoms in conjunction with spitting up, be sure to contact your pediatrician: refusing feedings, appears to be in pain or discomfort during or after a feeding, isn’t gaining weight, weight loss, spits up very forcefully, spitting up blood or green/yellow fluid, breathing issues like wheezing and arching of the back/neck with apparent pain or distress.

See the What To Do section for tips on how to help manage spitting up in infants.

What to Do

  • Create a calm feeding environment- Reduce stimulation, like bright lights and loud sounds, during feedings to avoid distracted eating which can increase the amount of air being swallowed if baby is popping on and off of the breast or bottle.
  • Pace Feeds- If you are nursing, feed on demand and allow baby to eat at his own pace. If bottle feeding, avoid tipping the bottle and allowing baby to “chug.” Pace the feeding by holding the bottle more horizontally, allowing the baby to eat more slowly, take breaks and draw the nipple back in when he is ready.
  • Burp frequently-Burping your baby more frequently (as opposed to waiting until the end of the feeding) will help eliminate excess air in the stomach. Burp your baby between switching breasts or after every 2 ounces if bottle-feeding.
  • Feed upright- Keeping your baby as upright as possible during feedings will help prevent the food from traveling back up into the esophagus.
  • Hold upright after feeds- Keep your baby in an upright position for at least 15 minutes after a feeding to help keep the stomach contents where they belong.
  • Don’t jostle baby after feedings- Try not to move your baby around too vigorously after a feeding. A full, tiny belly combined with an underdeveloped digestive system will make it easier for the milk to flow back up the esophagus.
  • Wait to put baby on his tummy- Placing your baby directly on his tummy after he eats increases pressure, which can increase spitting up. Try waiting about 20-30 minutes after he eats before doing some tummy time.
  • Avoid overfeeding- Smaller, more frequent feedings may help reduce spitting up by not allowing the tummy to become overfilled
  • Don’t wait until your baby is starving-If your baby is frantically hungry and crying, he will take in more air, making it more likely that he will spit up. Instead, look for early hunger cues like rooting and sucking on fingers and hands. 
  • Keep burp cloths and bibs handy- Spitting up can be messy for the both of you. Keep the burp cloths and the bibs handy to keep you and your clothes protected!