Baby Spitting Up? Learn What’s Normal – and What’s Not

You might have heard that spitting up is more of a laundry problem for parents than a health issue for babies, but there are certain signs that can indicate trouble. Do you know what to look for? We asked our Facebook community what questions they had, and then turned to experienced moms and a pediatrician (and mom of four!) for their insight and even burping tips to make baby – and you – more comfortable.

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Q: What are some good ways to help a baby who spits up often after feedings?

Sarah says:
My son Aiden often spit up after eating. I always kept a good supply of receiving blankets handy in every room to help catch the spit up. He spit up so much that burp cloths were a joke and we found receiving blankets provided better coverage! It would help when we kept Aiden elevated after feedings. Put baby in a semi-upright position (holding them or in a baby chair). We also found that warning friends and family to avoid holding him in a position that pressed on his belly was wise. If anyone put pressure on his belly (with an arm across it for example), he would definitely spit up.

Dr. Meg says:
The reality is, most babies spit up a lot or a little. So if your baby spits up, join the club! Spitting up is caused by several things, the most common of which are over feeding and a bit of reflux of milk from the stomach back to the mouth. Spitting up is not necessarily a sign of poor health and usually does not warrant worry or concern.

The most important thing to do when feeding a baby who spits up frequently is to keep him as upright as possible while feeding. Propping a pillow beneath your arm can raise his head while he is nursing or bottle feeding. It also helps to stop frequently and burp baby so that if he spits, a little comes up with a burp, not a lot.

Once you have finished feeding, be sure to keep baby in a car seat or bouncer for at least 30 minutes so that gravity can help keep food in his tummy. I recommend avoiding placing baby in a swing right after feeding since this can aggravate spitting up.

Remember: Spitting up bothers parents a whole lot more than it does babies!

Q: What is the best position to burp baby, and have less spit up?

Sarah says:
When I worked as a nurse in OB we always burped the babies by sitting them on our lap and propping one hand under their chin with a burp cloth over that hand, and the other hand patting their back. This position helped to put a little pressure on the tummy while keeping them upright to get the gas bubble out. Since they weren't looking over our shoulder when we burped them (which seems to be a popular position), we were better able to catch any spit up and keep it from going all over us.

Dr. Meg says:
I agree with Sarah when it comes to burping positioning. Holding baby on one leg facing the other while supporting his chin with one hand and patting his back with the other accomplishes several things. First, if baby does spit up, you stay clean and second, it can help aid baby’s burping. The most important thing is to be sure that baby is in as upright a position as possible while burping him to maximize air expulsion and minimize milk from coming up.

Q: My baby is spitting up A LOT after every feeding. I am worried she is not getting enough to eat, what should I do?

Sarah says:
More than likely she’s getting enough to eat. The spit up we see may seem like a lot, but it’s likely less than what she has actually eaten. I’d be warier of “topping her off” after she’d just spat up, as that can make her feel even more uncomfortable or spit up even more. I’d check with your pediatrician about her weight gain, and if she’s gaining weight just fine, she’s likely getting enough to eat.”

Dr. Meg says:
There are two types of spitting up that babies do and it is important to distinguish one from another because they are caused by different things. First, babies can just burp milk through their mouths and it spills onto their shirts. Then, there is projectile vomiting where babies experience milk shooting out of their mouths more forcefully. They can spit up onto a person right in front of them while babies who dribble milk from their mouths can’t.

The first form of spitting, where the milk dribbles from the mouth, is caused by overfeeding or from reflux of milk from the stomach, up through the esophagus and out the mouth. The majority of babies with this rarely have significant problems gaining weight. If your baby does this, don’t try to feed her after a spit up. I know this is hard because having a baby regurgitate milk, no matter the cause, is very stressful for parents - particularly mothers! Feeding our babies is emotional and sometimes we feel like failures if our baby doesn’t take in the amount of calories we feel she should. But as I said, many babies who spit up significant amounts do not have trouble gaining weight.

If baby is projectile vomiting, talk to your pediatrician right away, because it is important to determine whether it is due to an obstruction like pyloric stenosis or the more common problem, gastroesophageal reflux. Pyloric stenosis is a condition where the valve at the bottom of the stomach is too tight and milk can’t pass through. If this is the case, baby will spit up after every feeding and may not gain weight. The treatment is simple surgery where the pyloric valve is opened.

If, on the other hand, baby has common reflux, my recommendation to parents is to try to change formula first. I personally recommend trying an alternative formula like Enfamil A.R.

Some pediatricians quickly prescribe medication to decrease acid production in the stomach but this doesn’t always help. And, some babies don’t do well on medications. Additionally, many parents try thickening baby’s milk with rice or oat cereal. While this is commonly tried, there can be problems associated with thickening feeds. First, calorie for calorie, baby gets better nutrition from breastmilk or formula than either mixed with cereal. In other words, sacrificing milk for cereal doesn’t serve baby well nutritionally. Also, if you give thickened feeds through a bottle, you will likely need to cross cut the nipple for the milk to flow well. If you accidently use this nipple for regular milk feeds, baby can choke because the flow is too fast.

Aside from trying a formula created specifically to reduce spitting up, try feeding the baby smaller amounts more frequently. Taking in a smaller volume during feeding can really help reduce baby’s spitting up. And of course, be sure to feed baby in as close of an upright position as possible and make sure that for 30 minutes after she eats, she remains upright.

*These answers are not intended to be used in place of speaking with your personal physician. Please consult your physician for any medical issues and/or emergencies.

ABOUT OUR EXPERTS

Meg Meeker

Pediatrician, mother of four, and best-selling author of six books, Dr. Meg Meeker is the country's leading authority on parenting, teens and children's health. Dr. Meg writes with the know-how of a pediatrician and the big heart of a mother because she has spent the last 30 years practicing pediatric and adolescent medicine. She is a Fellow of the American Academy of Pediatrics, certified by The American Board of Pediatrics and serves on the Advisory Board of The Medical Institute.

Sarah

Sarah is a Registered Nurse and mom to four children. She blogs at Must Have Mom, where she shares must have recipes, DIY projects, parenting tips and more in an effort to simplify everyday life for busy families.

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