Baby Spit-Up: How Much Is Too Much?

Parents of young infants know, or soon learn, that feeding and burping little ones can be a messy process. While burping can help infants expel excess air they take in during feeding, it often results in more than just air coming up. In fact, almost all babies will, at least occasionally, spit up some milk during and after feeding, sometimes even if they are not being actively burped.

In the majority of cases, spitting up is perfectly normal and harmless in otherwise healthy infants. It is simply the result of an immature digestive system and will usually occur less frequently as a baby grows. Typically, by the time a child is 9-12 months of age, spitting up will be a rare occurrence.

In the meantime, as long as your baby is growing, thriving, and isn’t having red flag symptoms such as frequent coughing or colicky behavior, spitting up is usually nothing to worry about.

Simple Remedies to Try at Home

Some of the more common reasons for excessive spit-up are overfeeding and swallowing too much air during feeding. The following tips may help reduce spit-up and make your baby more comfortable:

• Feed your baby before they get very hungry. If they are starving before a feed, they are more likely to take in more air as they gulp.
• Take frequent burp breaks during feedings.
• Maintain your baby in an upright position for at least 20 minutes after feeding.
• Avoid overfeeding. Try offering smaller amounts more frequently.
• If breastfeeding, experiment with your own diet. Cow’s milk and soy-based products eaten by the mother are the most likely to cause excessive spit-up in a breastfed baby.
• Pacifier use after feeding can be helpful if your baby will accept one.

When to See Your Pediatrician

As a parent, you are the best judge of what’s normal for your baby and what isn’t. “Trust your gut,” says Lauren Beene, MD, pediatrician at UH Rainbow Suburban Pediatrics. “If you’re concerned about your baby’s spit-up, or aren’t sure what’s normal, ask your pediatrician.”

If you notice any of the following changes in your baby’s feeding and spit-up habits, it is important to have them evaluated by your pediatrician. Although unlikely, some of the symptoms listed below may be a sign of a medical condition that requires treatment or dietary change, especially if the child isn’t gaining adequate weight.

• Regularly spits up more than 1 or 2 tablespoons at a time
• Spitting up is forceful, similar to projectile vomiting
• Baby experiences choking, coughing or wheezing
• Baby refuses to eat or is irritable while eating
• Baby arches their body after or during feeds
• Baby is colicky

If your baby’s spit-up is green or yellow, is bloody or contains a substance that looks like coffee grounds, they should be evaluated immediately.

Medical Conditions That Can Cause Excessive Spit-Up

Even though occasional spitting up is a normal and temporary occurrence in infancy, sometimes it may signal a medical condition that requires intervention. Possible conditions include:

Gastroesophageal Reflux Disease (GERD)

GERD is the medical term for problematic acid reflux. It is very common in young babies and occurs when formula or breast milk in the stomach backs up into the esophagus and into the mouth.

“All babies have some degree of reflux,” says Dr. Beene. “This is because the sphincter that keeps milk in a baby’s stomach does not close as tightly as in adults. In otherwise healthy babies, this problem will usually resolve without treatment as the digestive system matures. However, if babies start having red flag symptoms such as refusal to eat, crying or arching of the body during or after feeding, they should be evaluated by their pediatrician.”

“Management of GERD in babies varies by their symptoms and exam findings,” says Dr. Beene, “Some babies may have improved symptoms if they change formulas or, if breastfed, their mom avoids dairy and sometimes soy. Some babies may need a more extensive work-up or be started on medication to decrease symptoms. Every situation is different, so please call your pediatrician if you’re concerned your baby has GERD.”

This condition usually peaks at around four to six months of age and goes away between 12 and 18 months of age.

Esophagitis or Gastritis

Sometimes, inflammation of the esophagus and stomach can contribute to excessive spitting up and should be evaluated and treated by a pediatrician.

Pyloric Stenosis

The pylorus is a muscular valve located at the lower part of the stomach. When food in the stomach is ready to move into the small intestines for the next stage in digestion, the pylorus opens to allow it to pass through. In infants with pyloric stenosis, the pylorus muscle is enlarged, narrowing the opening and eventually preventing food from moving into the intestines. This rare condition is more common in boys than girls and occurs in babies between birth and six months of age.

The most common symptom of pyloric stenosis is forceful, projectile vomiting of large amounts of milk that will often have a curdled appearance because of prolonged exposure to stomach acids. Other symptoms may include:

• Weight loss
• Good appetite in spite of vomiting
• Lethargy
• Constipation
• Mucous in the stool

Because severe vomiting is the primary symptom, babies with pyloric stenosis are at high risk for dehydration which can be life-threatening. If your infant has symptoms of pyloric stenosis, they should be seen immediately by your pediatrician or in the emergency room.

A confirmed diagnosis of pyloric stenosis can only be treated with surgery, which most babies tolerate well and go on to thrive.

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University Hospitals Rainbow Babies & Children’s has a wide network of highly skilled pediatricians at convenient locations across the region. Our specialists have the advanced training and experience to care for children of all ages and provide parents with the support and encouragement they need.