Why babies spit up and when to be concerned

If your baby frequently spits up either during feedings or when moved from one position to another, they may have gastroesophageal reflux (GER), a common condition that affects at least half of all babies.

Reflux is the natural result of a baby’s immature stomach valve being unable to keep food in. Usually, reflux is painless and it can look like your baby is spitting up a lot more fluid than they really are. Sometimes, it’s referred to as ‘happy spitting.’

How long does reflux last?

Reflux typically peaks around 4 months and goes away without treatment by 18 months.

Is it ‘happy spitting’ or GERD?

Some babies experience symptoms that are more troublesome than the normal acid reflux of infancy. This is known as gastroesophageal reflux disease (GERD).

Spitting up is just one symptom of GERD and isn’t cause for concern on its own. If you see any of these other signs, discuss them with your baby’s pediatrician:  

1. Extreme fussiness or irritability
2. Weight loss or poor weight gain
3. Frequent arching of the back
4. Gagging or choking during feeding
5. Coughing or hoarseness during or after feeding
6. Recurring feeding refusal
7. Blood, green, or yellow fluid, or a substance that looks like coffee grounds in your baby’s spit up or vomit 
8. Head-turning during or after feeding (may resemble a tic or seizure)
9. Frequent ear infections or respiratory infections

7 ways to minimize spit ups

Try smaller, more frequent feedings. Reflux is more likely to occur when your baby is very full. The increased pressure in their stomach physically pushes liquids up against their not-yet-fully-developed valve. This valve is intended to block food from coming back up through the esophagus.

To reduce reflux, your baby may benefit from feeding more frequently on demand—not on a set schedule. 

If bottle feeding, slow it down. A Paced Bottle Feeding technique is helpful for some babies who spit up frequently. It more closely resembles the mechanics and speed of breastfeeding. Key elements include: 

• Holding your baby upright as much as possible
• Offering the bottle horizontally, then tilting it to fill the nipple halfway in response to your baby’s sucking
• Allowing your baby to naturally take pauses from sucking or pacing a fast feeder by lowering the bottle to horizontal to empty the nipple. 
• Swallowing air during feedings increases the pressure in your baby’s stomach. Slow-flow nipples have fewer or smaller holes to help your baby keep up with the pace of bottle feeding without gulping air. Specialty anti-gas or anti-colic bottles are vented specifically to reduce air intake. 

Burp your baby frequently. Burp bottle-fed babies every 1 or 2 ounces. Breastfed babies can be burped any time they come off of the nipple or when switching breasts.

Try tummy time, left side-lying, or upright position after feedings. Tummy time and lying on the left side are both positions that have been shown to reduce reflux. If not on their tummy or side, aim to keep your baby in an upright position for about 30 minutes after feeding them.

Consider wearing your baby in a soft-structured carrier. Gravity helps prevent the contents of your baby’s stomach from rising into their esophagus. It also helps their stomach empty into their intestines more efficiently. 

Avoid baby gear after feedings. The inclined and rounded position of a car seat, swing, or bouncy seat is more likely to cause stomach acids to enter the esophagus, even if you don’t see them come all the way up as spit up. 

Feed your baby when they wake up. Try to wait at least 30 minutes after a feeding to put your baby down to sleep. Giving them some time to digest can make sleeping more comfortable.