Ask the Pediatrician: Why do babies spit up?

Q: My baby spits up fairly often. What causes this, and should I be concerned?

A: All babies spit up. Some babies spit up more than others, or at certain times.

Typically, babies spit up after they gulp down some air with breast milk or formula. A baby’s stomach is small and can’t hold a lot, after all. Milk and air can fill it up quickly.

With a full stomach, any change in position such as bouncing or sitting up can force the flap between the esophagus (food pipe) and stomach to open. And when that flap (the esophageal sphincter) opens, that’s when some of what your baby just ate can make a return appearance.

So, what can you do—if anything—to reduce the amount of your baby’s spit up? How do you know if your baby’s symptoms are part of a larger problem?

Here are some common concerns parents have about spit up:

My baby spits up a little after most feedings.

Possible cause: gastroesophageal reflux (normal, if mild)
Action to take: None. The spitting up will grow less frequent and stop as your baby’s muscles mature, especially that flap we talked about earlier. It often just takes time.
My baby gulps their feedings and seems to have a lot of gas.

Possible cause: aerophagia (swallowing more air than usual)
Action to take: Make sure your baby is positioned properly during feeds. Also be sure to burp the baby during and after feeds. Consider trying a different bottle to decrease your baby’s ability to suck in air.
My baby spits up when I bounce them or play with them after meals.

Possible cause: overstimulation
Action to take: Keep mealtimes calm. Limit active play for about 20 to 30 minutes afterward.
My baby’s spitting up has changed to vomiting with muscle contractions that occur after every feeding. The vomit shoots out with force.

Possible cause: pyloric stenosis or another health problem that requires diagnosis and treatment
Action to take: Call your pediatrician right away so they can examine your baby.
I found blood in my baby’s spit up or vomit.

Possible cause: swelling of the esophagus or stomach (esophagitis or gastritis), or another health problem that requires diagnosis and treatment
Action to take: Call your pediatrician right away so they can examine your baby.
Regardless of whether or not your baby’s spit up warrants watchful waiting or medical intervention, some simple feeding suggestions can help you deal with the situation at hand.

Here are six tips to help reduce your baby’s spit up:

Avoid overfeeding. Like a gas tank, fill baby’s stomach it too full (or too fast) and it’s going to spurt right back out at you. To help reduce the likelihood of overfeeding, feed your baby smaller amounts more frequently.
Burp your baby more frequently. Extra gas in your baby’s stomach has a way of stirring up trouble. As gas bubbles escape, they have an annoying tendency to bring the rest of the stomach’s contents up with them. To minimize the chances of this happening, burp not only after, but also during meals.
Limit active play after meals and hold your baby upright. Pressing on a baby’s belly right after eating can up the odds that anything in their stomach will be forced into action. While tummy time is important for babies, postponing it for a while after meals can serve as an easy and effective avoidance technique.
Consider the formula. If your baby is formula feeding, there’s a possibility that their formula could be contributing to their spitting up. While some babies simply seem to fare better with one formula over another without having a true allergy or intolerance, an estimated 5% of babies are genuinely unable to handle the proteins found in milk or soy formula, a condition called cow’s milk protein intolerance/allergy (CMPI and CMPA). In either case, spitting up may serve as one of several cues your baby may give you that it’s time to discuss alternative formulas with your pediatrician. If your baby does have a true intolerance, a one- or two-week trial of hypoallergenic (hydrolyzed) formula designed to be better tolerated might be recommended by your baby’s provider.
If breastfeeding, consider your diet. Cow’s milk and soy in your diet can worsen spit up in infants with CMPI and CMPA. Removing these proteins can help to reduce or eliminate spit up.
Try a little oatmeal. Giving babies cereal before 6 months is generally not recommended—with one possible exception. Babies and children with dysphagia or reflux, for example, may need their food to be thicker in order to swallow safely or reduce reflux. In response to concerns over arsenic in rice, the American Academy of Pediatrics now recommends that parents of children with these conditions use oatmeal instead of rice cereal.