Baby Reflux & Spitting Up: Normal vs GERD
Does your baby spit up after feeding? It's completely normal to worry, but most cases are harmless. Let's explore the difference between normal spit-up and concerning signs that need medical attention.
Spit-Up vs Vomiting: What's the Difference?
Spit-Up (Reflux)
- Milk flows out gently from the mouth
- Happens effortlessly and naturally
- Small amount (1-2 tablespoons)
- Baby seems comfortable and content
- Usually occurs right after feeding or during burping
Vomiting
- Contents are forcefully expelled
- Involves abdominal muscle contractions
- Larger volume
- Baby may seem distressed or cry
- Projectile vomiting: shoots several inches away
Why Do Babies Spit Up?
In newborns, the lower esophageal sphincter (the muscle between the stomach and esophagus) is still immature, making it easy for stomach contents to flow back up.
- More than 50% of all babies experience reflux
- Typically peaks around 4-5 months
- Usually resolves by 12-18 months
- Improves as baby sits up and gravity helps
How to Reduce Spit-Up
During Feeding
- Keep baby upright: Feed at a 45-degree angle or higher
- Smaller, more frequent feeds: Prevent overfeeding
- Burp regularly: Every 2-3 minutes during feeding
- Breastfeeding: Check latch to minimize air intake
- Bottle feeding: Ensure proper nipple flow rate
After Feeding
- Hold upright for 20-30 minutes
- Burp thoroughly before laying down
- Avoid laying baby flat immediately
- Don't overtighten diapers
- Skip tummy time right after feeding
For Formula-Fed Babies
- Mix formula according to instructions
- Consider AR (anti-reflux) formula (consult pediatrician)
- Try different formula brands if recommended by doctor
- Use anti-colic bottles to reduce air intake
Signs of GERD (Gastroesophageal Reflux Disease)
While most reflux is normal, GERD is a more serious condition. Watch for these warning signs:
- Intense fussiness during or after every feeding
- Arching back like a bow during feeds
- Refusing to eat or feed
- Poor weight gain
- Frequent coughing or wheezing
- Difficulty sleeping or staying asleep
If you notice these symptoms, consult your pediatrician for evaluation.
Common Causes of Vomiting
Usually Temporary
- Overfeeding: Too much milk at once
- Pyloric spasm: Temporary stomach muscle contraction
- Cold or illness: Mucus causing gagging
- Stomach bug: Viral or bacterial infection
- Motion sickness: During car rides
Requires Medical Attention
- Pyloric stenosis: Narrowing of stomach outlet (projectile vomiting, weight loss)
- Intussusception: Intestinal blockage (bloody stool, severe pain)
- Increased intracranial pressure: After head injury
When to Seek Emergency Care
Go to the ER Immediately
- Green or yellow (bile) vomit
- Blood in vomit
- Persistent projectile vomiting
- Signs of dehydration (no wet diapers for 6+ hours, lethargy)
- Severely distended abdomen
- Vomiting with fever
- Vomiting after head trauma
See Your Doctor Same Day
- Not gaining weight
- Refusing to feed
- Vomiting throughout the day
- Diarrhea along with vomiting
- Unusually fussy or irritable
What to Do When Baby Vomits
- Turn baby on their side: Prevents choking on vomit
- Offer small amounts of fluids: Frequently to prevent dehydration
- Wait 1-2 hours before feeding again
- Reduce feeding volume, increase frequency
- Offer pediatric electrolyte solution if recommended
What to Avoid
- Elevating head with pillows (SIDS risk)
- Laying baby flat right after feeding
- Tight clothing around the tummy
- Tummy time immediately after feeding
- Giving reflux medication without doctor's guidance
The Bottom Line
Baby spit-up is typically a normal part of development. Most babies outgrow it by their first birthday, so try not to worry too much.
However, if your baby isn't gaining weight, has green vomit, or experiences persistent projectile vomiting, see your pediatrician right away.