What Does It Mean When My Baby Spits Up?

It is 2 am and you have just fed your little baby and quietly put him back to sleep. That’s when it happens: spit up on fresh sheets, and it’s time to change them one more time. Every parent has been there. Spit ups happen, and there are a multitude of reasons for infants to spit up – some reasons are more significant than others.

Every baby will spit up because of something called physiologic reflux. These babies are what we call “happy spitters.” There is a flap at the end of the esophagus that covers the top of the stomach. This is to prevent food from coming back up after you swallow. This flap is not well formed until approximately one year of age. It also takes about 30 minutes for the stomach to empty after eating. So every time you lay your baby down to sleep or change a diaper too soon after eating, chances are some of that food is coming back up.

These babies normally do not seem phased by the fact that they have just spit up all over their clothes. In fact, the parents are usually the ones crying out in frustration. Sometimes these incidents are unavoidable, but there are a few things you can do to try to minimize the mess.

1. Keep your infant upright for 30 minutes after eating.
2. Burp frequently during feeds to prevent gas bubbles from taking up space in the stomach.
3. Avoid overfeeding. Every baby’s stomach is about the size of its fist. Babies in general will eat every 2-4 hours and when they drink breastmilk or formula, they usually can only take a few ounces at a time. A good rule of thumb is giving 0-1 oz. more than their age in months. For example, a 3 month old usually takes 3-4 oz each time.
4. Try to avoid too much movement immediately after eating. For 30 minutes after eating, even bouncing a baby, putting your little one in a swing, going on a car ride, or changing their diaper can be enough movement to provoke a spit up.

There are some indicators that spitting up can be more than just normal physiologic reflux. Gastro-esophageal reflux disease (GERD), milk protein allergy, or pyloric stenosis are some more serious problems that present with spitting up. These conditions will have other warning signs associated with them, like weight loss or less frequent urination. If your baby seems very fussy with eating or while he is spitting up, it could indicate a more serious problem. Also, be concerned if you see blood in your baby’s stool, or if you see your infant projectile vomiting (sometimes across the room) and still acting very hungry immediately after eating.

I know the constant routine of changing outfits, feeding frequently, not getting much sleep, and cleaning up messes on the floor can be tiring. It can also be frustrating and you just want your baby to not throw up for one day. Hopefully it is just normal “happy spitter” that he or she will outgrow and these tips will help. As always, be mindful of other warning signs that you may need to discuss with your doctor if it seems more than just a little spit up.

Jennifer Adair M.D.

Jennifer Adair, M.D., was born and raised in Mobile. She graduated from Davidson High School in 2002 and received her Bachelor of Science in Chemistry at The University of Alabama in 2006. She completed her medical training at the University of South Alabama College of Medicine, and pediatric residency at the University of Nevada College of Medicine – Las Vegas and the University of South Alabama. She joined Children’s Medical Group in July 2013 and currently practices at their Airport office. Jennifer and her husband, Cory, reside in Mobile with their dogs, Fitz and Barkley.