All babies spit up at times. It is almost always normal and does not usually cause fussiness in babies. The spit up itself is not a problem.
Spitting up is one of the most common questions we are asked. That’s because all babies spit up; the real question is why the baby is spitting up and is it normal or not? In most cases, it is normal.
What are the symptoms?
- Stomach contents coming up the esophagus from the stomach; may come up into the throat. May come out mouth and/or nose.
- May come up effortlessly, or may be more of a vomiting motion.
- Many burps will have some stomach contents come up with the air; this is completely normal.
- Fresh milk will appear fresh. Milk that has been in the stomach acid for any time will be curdled and may smell sour. That is normal; it means your child is a mammal that can digest milk.
What causes a spitting up?
Babies are on a full-liquid diet. They lie down a lot. They swallow a lot of air and have burps to make. They can’t sit up straight and when upright still slump in a way that pushes on their bellies. The muscle valve at the top of the stomach is not very tight until about a year old. (This is by design so babies can expel air and extra liquid easier).
What should I expect?
It usually starts about 1 month old and lasts until around 12 months old. It usually goes away completely by 18 months.
Is it reflux?
By definition, yes. But it is normal reflux. This is normal behavior for infants. Research has now shown that it does not cause fussiness or colic in healthy children. Children who are abnormally fussy usually have another cause. It’s not lactose intolerance either. Babies are almost never lactose intolerant. That happens later in life.
How is it treated?
- Since it is normal, it does not need treatment. It does not usually cause fussiness. Fussiness is caused by other things.
- It is no longer treated with acid reducing medications. These are no longer recommended.
- Fussiness and/or reflux that is greater than normal should consider treatment for milk protein sensitivity.
How can I prevent my child from spitting up?
- Give appropriate amounts in each feeding. Or give smaller amounts and increase the frequency of feeds.
- Avoid tight fitting pants and diapers. Avoid car seats right after feeding.
- Burp more often. If bottle feeding, may try a different nipple that causes less air swallowing.
- If breastfeeding, may try different positions to slow down milk flow and prevent gulping.
- Avoid tobacco smoke.
- Don’t make babies finish bottles. Don’t re-feed because your baby spit up.
When spitting up is not normal or may indicate a more serious problem
- Blood in spit up
- Green spit-up
- Progressively worsening projectile vomiting
- Failing to gain weight well
- Pain and/or arching the back at the beginning of a feed
- Choking and turning blue
