Baby Spit Up: How Much Is Too Much?

Everyone tells you you’ll be doing more laundry when baby arrives, but nobody tells you it’s because of baby spit up! You’ll wonder: Why is baby spitting up this frequently? Does baby have reflux? Is baby getting enough to eat?

New parents have enough to worry about, so let’s get to the bottom of these questions, and more. Read on to find out:

What Is Baby Spit Up?

First thing’s first: In most cases, spitting up is very common.

This is more of a laundry problem than a medical problem and seldom bothers baby. — Dr. Sears

Some experts estimate that nearly 40% of normal, healthy babies spit up after feedings. If baby spits up right away, it may look just like milk; if baby spits up once he/she has begun to digest it might look curdled and smell slightly sour. 

If you’re worried about the quantity of baby spit up, you’re not alone. Many parents see what looks like a lot of spit up and wonder if their baby is getting enough to eat. You might take comfort in knowing that baby spit up is made up mostly of saliva and gastric juices—there’s usually only a small amount of milk in spit up.

Although that puddle can still be off-putting, Dr. Sears estimates that most baby spit up is only about a teaspoon of liquid. To put your mind at ease, he suggests trying this simple experiment: Pour a tablespoon of milk on the countertop and compare the resulting puddle to the stain on your clothes from your baby’s spit up. You’ll likely notice that the puddle on the counter is much larger.

Baby spit up usually dribbles or spurts out of their mouth. Occasionally baby’s spit up looks forceful, like projectile vomiting. Without other signs of illness, more forceful baby spit up may be a sign of reflux, possibly as a result of food sensitivities (something mom is eating or from the type of formula) or an anatomical issue. (More on this below.)

Why Do Babies Spit Up?

Still, you’re probably wondering why this happens—and why some babies spit up as frequently as they do. The most common causes of baby spit up are:

1. Immature Digestive System

It’s also important to remember that part of the reason your baby spits up is because…well, they are a baby. Baby’s digestive systems just aren’t as mature as ours are.

“In infants, the ring of muscle between the esophagus and the stomach—the lower esophageal sphincter (LES)—is not fully mature, allowing stomach contents to flow backward,” explains Dr. Andrew E. Mulberg, a pediatric gastroenterologist.

2. Improper Latch

Beyond basic biology, the simplest and most common cause of baby spit up is one that is actually relatively easy to fix. Sometimes a baby isn’t latched on snugly enough to the breast or bottle, and takes in an excessive amount of air. To reduce baby spit up, breastfeeding mamas can remedy this by ensuring baby has a deep, close latch; bottle-fed babies should have a tight seal around the nipple teat.

3. Fast Letdown

Likewise, a fast letdown during breastfeeding can make it difficult for a young baby to keep up with the flow of milk. This can cause some of that milk to come back up. It can also cause baby to take in excess air, as they struggle to swallow all of the milk. If you’re having trouble with an overactive letdown, try different breastfeeding positions (laid-back nursing works with gravity to help keep the flow at a manageable pace) or get help from a lactation consultant. If you are bottle-feeding, make sure you have a slow flow nipple and practicing paced bottle feeding.

Baby Spit Up vs. Vomit

So we know that baby spit up is normal. But at some point you’ll probably wonder: Is my baby spitting up… or is he/she vomiting? Here’s how to tell the difference between baby spit up and vomiting: 

Quantity

Though it can look like much more, baby spit up is generally only about a teaspoon at a time. Vomit, on the other hand, is likely to be persistent, adding up to much more.

Force

If baby is sick, it is usually more forceful. In babies, vomiting is generally projectile. Spit up, on the other hand, is more likely to slide or dribble out of baby’s mouth.

Color

Vomit tends to be green or yellow (this indicates bile is present), whereas baby spit up is usually white, off-white, or light yellow in color.

Smell

You might argue that baby spit up doesn’t smell so great, but it’s usually just a bit sour. Vomit, on the other hand, has a more foul smell.

Mood

You will notice your baby cry or look sick (red, watery eyes and/or change in complexion) when they are about to vomit. She may also have a fever. If baby is generally happy and asymptomatic, it’s more likely that he/she is spitting up.

	Spit Up	Vomit
Quantity	Spit up is generally only about a teaspoon at a time	Vomit is more persistent, adding up to much more
Force	Spit up is more likely to slide or dribble out of baby’s mouth	Vomiting is more forceful and generally projectile
Color	Spit up is usually white, off-white, or light yellow	Vomit tends to be green or yellow
Smell	Spit up doesn’t smell so great, but it’s usually just a bit sour	Vomit has a more foul smell
Mood	Baby is generally happy and asymptomatic	Baby may cry or look sick (red, watery eyes and/or change in complexion) when they are about to vomit

What to Do if It Seems Like Baby Is Vomiting Due to Illness

If your baby is less than 12 weeks old and seems to be vomiting, call your pediatrician immediately. In rare cases this can be a sign of a serious condition called hypertrophic pyloric stenosis, which prevents food from reaching the intestines.

If your baby is a bit older, a viral infection is the most common cause of vomiting, and will usually pass on its own. Still, it’s always a good idea to give your doctor a call to discuss symptoms, concerns, and treatment, especially if it’s accompanied by a fever.

The most common complication in babies older than 12 weeks is dehydration. Here are the signs of dehydration in an infant:

• Fewer wet diapers
• Lethargy or weakness
• Lack of tears when crying
• Sunken eyes or soft soft
• Decreased saliva

My Baby Is Spitting Up More Than Usual

So your baby wasn’t spitting up, but now it seems like they can’t keep anything down? That’s normal, too. Sometimes babies will begin spitting up much more than usual, seemingly out of the blue. Here are some reasons your baby may be spitting up more often:

1. Change in diet

Some babies spit up more frequently after starting solids, especially if they are eating too much too soon. Cut back on solids to see if that helps. Others will react to a change in a breastfeeding mom’s diet. Revert back to old eating patterns to see if that clears things up.

2. Teething

Sometimes teething babies, who are producing more saliva than usual, will spit up excess saliva along with their milk.

3. Illness

Babies may also spit up more when they have a cold, as baby is trying to rid his/her body of the extra mucus.

How Can I Tell If My Baby Is Getting Enough Food?

Ask yourself these questions:

• Is your baby generally happy and healthy?
• Is your baby gaining weight?
• Is your baby wetting diapers?
• Is your baby growing well?

If you answered yes to these questions, you probably don’t need to worry—even if you’re dealing with a lot of baby spit up. But remember: You know your baby best. If something seems off, call your pediatrician.

Otherwise, if your baby is unusually fussy, seems to lack energy, or if the baby spit up has blood in it, or looks and smells like vomit, it is time to call the doctor.

Can Babies Choke on Their Own Spit Up?

It’s very unlikely for a baby to choke on their own spit up. Babies have a reflex that causes them to cough out or swallow any fluid they spit up or swallow, even while sleeping.

If you are worried or simply want to ease baby’s discomfort, you can prop up the end of the entire crib with blocks to elevate baby’s head. (Never use pillows or anything inside the crib to prop up baby!)

Baby Spit Up: How Much is Too Much? – Crib Propped Up

(image source)

When Do Babies Stop Spitting Up?

Most instances of spitting up end with the conclusion of the “fourth trimester,” at about 3-4 months. (Paloma stopped spitting up around 4 months old.) Other babies begin spitting up less starting at 6 months, once they start solids, which can often help them “hold down” their food and settle their stomachs. Other babies decrease the instances of spitting up by 9-12 months. And some are late bloomers, and don’t stop spitting up until closer to a year. But don’t fret: By that one year mark, most babies are done spitting up on a regular basis.

Resist the Urge to Feed Baby Infant Rice Cereal

Some may recommend mixing milk with rice cereal as early as 6 weeks (!) to thicken baby’s food and help it stay down, it’s not a good idea—for lots of reasons. Mainly, rice cereal it’s low in nutrients and hard on digestion. Baby’s digestive system really isn’t ready for solids, and particularly grains, until at least 6 months. Rice cereal is also full of yucky preservatives and toxins. Read more about baby cereal here.

When to Call the Doctor

Although baby spit up generally isn’t cause for concern, excessive baby spit up can occasionally be tired to anatomical dysfunction or metabolic disorders. Call your pediatrician if: 

• baby is losing or not gaining weight
• baby spit up increases significantly
• baby is coughing, gagging, or otherwise struggling to eat
• spit up is green or has blood in it
• normal baby spit up becomes projectile
• baby is unusually fussy or, conversely, baby is lethargic

Could My Baby Have Reflux?

Sometimes babies can develop a condition like GERD, or acid reflux. In these cases, the backflow that often happens as a result of an immature digestive system can cause babies pain or discomfort.

There are two forms of reflux in babies: acid reflux and silent acid reflux. Acid reflux usually causes projectile vomiting and intense crying; silent reflux, a more subtle condition, usually causes sour breath, hiccups, and physical stiffness or discomfort.

Signs of reflux include:

• Discomfort or crying after eating
• Coughing
• Refusing the breast/bottle
• Arching back after eating
• Resistance to laying on back
• Gagging or choking
• Excessive gas
• Foamy bowel movements
• Persistent crying or colic
• Sour breath
• Frequent burps and hiccups
• Failure to gain weight

Read more about baby reflux, including my experience with it, here. 

Natural Ways to Relieve Baby’s Reflux

The good news is that if spitting up is becoming a serious issue for your baby—or if your baby is showing signs of reflux—there are things you can do to make your baby feel better.

1. Try probiotics

Some mothers report seeing positive changes once they give their baby a probiotic—or if they are breastfeeding, if they take a probiotic themselves. A 2014 study published in JAMA Pediatrics supported this claim. The researchers found that babies who took probiotics for the first three months of life showed improvements in colic symptoms, acid reflux, and constipation. 

I don’t normally suggest giving babies supplements, but L. reuteri, a probiotic that has been clinically shown to reduce crying time by 50% in colicky breastfed infants, made a big difference for Paloma. Here are other great probiotics for babies.

2. Keep baby elevated

A baby with reflux needs a little extra TLC during and after feedings. Keep baby in a sitting position while feeding them (a boppy pillow can offer extra support) and hold baby upright for at least 30 minutes after meals (babywearing can make this an easier task for mama). 

3. Try cell salts

Some newborns don’t make enough Nat Phos, a natural cell salt that helps with digestion. A tablet of Nat Phos 6X, a homeopathetic remedy, can be split in half and dissolved in breastmilk and administered with a syringe or dissolved under baby’s tongue. (It’s important to check with your doctor before administering cell salts to your baby.) 

Other simple “hacks” for naturally helping your baby deal with reflux or excessive spitting up include:

• avoid putting excessive pressure on your baby’s belly
• limit car rides, rocking, or other motion after feedings
• burp your baby after feedings

Mostly, take note of what seems to bother your baby, and what soothes them. It is not a “one-size-fits-all” approach, and you know your baby best.

4. Try an elimination diet

When all else fails, a breastfeeding mama can try an elimination diet. The biggest culprit is usually dairy and cutting it out of your diet can make all the difference for your baby. (The proteins in dairy can irritate a baby’s underdeveloped digestive tract.)

That is usually all that is needed. However, some mothers may find that eliminating these foods and beverages also help:

• Dairy (as mentioned above)
• Soy
• Gas-producing vegetables like broccoli, cabbage, onions, and peppers
• Acidic food like coffee, tomatoes, and citrus
• Wheat
• Nuts
• Eggs
• Shellfish
• Gluten

See how to start an elimination diet.

5. Try another formula

If baby is formula-fed, saying goodbye to all that baby spit up might be as simple as switching formulas. Try a cow-milk free formula if you think that might be the culprit. See the best baby formula here.

How About You?

Did you have a baby who spit up? What helped your baby feel better? And what would you tell a new parent who is worried about baby spit up?