How to Deal With Your Baby's Spit-Up

Many new parents wonder why their baby spits up so much. We asked the experts for the lowdown on this common concern, with tips for handling the mess.

Mom with baby spit-up on shoulder
Photo: Liam Norris/Getty Images

Is your baby spitting up a lot after feedings? There's usually no need to stress. "70% of infants under 3 months will spit up three times a day, and it's even perfectly normal for them to be spitting up as often as 10 or 12 times," says William Byrne, M.D., chief of pediatric gastroenterology at Doernbecher Children's Hospital, in Portland, Oregon. Keep reading to learn what causes babies to spit up and how to handle it.

Why Do Babies Spit Up?

If your baby keeps spitting up within two hours of feeding and yet seems perfectly happy, they probably have gastroesophageal reflux (GER). The condition peaks around 4 months old, when two-thirds of infants have symptoms, according to the National Institutes of Health. The ring of muscle separating the bottom of a baby's esophagus from the stomach is still developing, allowing stomach contents to slosh back up.

Babies need to consume a lot of calories to support their rapid growth—three to four times as many as an adult per pound of bodyweight. Plus, they have a tendency to swallow air while sucking. As a result, their stomach becomes very full, and they're prone to spit up what they eat (they can also spit up after crying or coughing forcefully).

Is My Baby Eating Enough?

Even if your baby spits up after every feeding, they're probably taking in enough. Your pediatrician will evaluate your infant's weight gain at their well-baby checkups. If everything's on track, they're getting the calories they need. It may seem like their whole meal is coming back up, but it's likely less than a tablespoon, says Dr. Byrne. So don't "top off" your baby with more milk if they spit up after eating. In fact, overfeeding can lead to even more reflux.

When Do Babies Stop Spitting Up?

Don't worry, the day will come when you won't need to do laundry after every feeding. GER symptoms tend to decrease around 6 months, once your baby's digestive system has matured and they start sitting upright and eating solid foods. The problem usually disappears by your baby's first birthday, when the muscles at the bottom of the esophagus become stronger (a few babies continue spitting up until 24 months though). Don't be surprised if GER gets worse before it gets better; some children's symptoms reappear when they learn to crawl and their stomach contents shift around, causing the baby to spit up more than usual.

4 Tips for Dealing With Your Baby's Spit-Up

Even though you can't really prevent GER, you can minimize the mess by investing in extra bibs and following these tips.

  1. Avoid overfeeding. An overly full belly is a major cause of reflux, so avoid overfeeding your baby, says Aeri Moon, M.D., a pediatric gastroenterologist in New York City.
  2. Burp your baby. Swallowing too much air while eating leads to gas bubbles in the stomach that can trap some food. When the air comes back up as a burp, so does the breast milk or formula. Ensuring that your baby is latched on correctly and burping them before, throughout, and after each feeding can help reduce this problem.
  3. Use products for formula-fed infants. If your baby is spitting up formula, consider using a bottle that reduces gas. If your baby is 4 months or older and your pediatrician approves, you can try thickening the formula to help it sit better in their stomach (mix in a tablespoon of rice cereal for every 4 ounces of formula).
  4. Keep your baby upright after feedings. Gravity is on your side when it comes to reflux, and it can make a big difference in helping food stay down. Position your little spitter at roughly a 30-degree angle while feeding. Then keep your baby upright for at least 20 minutes afterward, either in your arms or in a carrier, so that the food can travel out of the stomach and into the small intestine. You can also buy a wedge to place under the head of the mattress, which will decrease the chances of your baby spitting up in sleep (but don't put a pillow in the crib because this increases the risk of sudden infant death syndrome).

Does My Baby Have GERD?

GER isn't something to worry about—even the healthiest babies have it. But for about 2% of full-term babies and a higher percentage of preemies, reflux causes pain and medical problems. In these cases, a doctor may diagnose gastroesophageal reflux disease (GERD). Telltale signs include:

  • a lack of interest in eating
  • extreme fussiness during feeding
  • wheezing
  • coughing
  • hoarseness
  • failure to gain weight

GERD is reflux in the extreme: So much acid splashes back up from the stomach that it irritates the lining of your baby's esophagus. Your baby might try to relieve the discomfort by coughing, arching their back, or pulling their legs up to their tummy. If your baby has these symptoms, contact their pediatrician The doctor may recommend smaller, more frequent meals, additional burping, or in some cases, medication.

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