How much baby spit up is too much?

A baby with a full tummy is usually a happy baby, which probably explains why infants doze off after most feedings. And when their tummy is full of breast milk or formula, it’s perfectly normal for a baby to spit up a little bit of it.

Is your baby spitting up too much?

Contact your pediatrician.

Why it happens

“Babies are made to spit up,” said Melinda Feely, MD, a family medicine physician at OSF HealthCare. “The muscle between their stomach and esophagus isn’t fully developed at birth, so whenever there’s a little air bubble in their stomach after feeding, it will sometimes move through that opening and bring some of that liquid with it – usually just a mouthful.

“We like to call them ‘happy spitters.’ The baby is just sitting there, happy and cooing, when all of a sudden – blip! A little spit up happens. However, some babies hold on to every drop and don’t spit up at all, so there’s a wide range of what’s considered normal.”

Normal spit up can have a number of different appearances, including curdled, non-curdled, white, yellow, clear or even mucus-like.

It’s different than vomiting

“As opposed to the easy flow, low-force event of spitting up, vomiting is a more forceful or shooting event, and it’s usually accompanied by other symptoms, such as fever or diarrhea,” Dr. Feely said. “Vomiting also presents more of a risk for dehydration than spitting up.”

A good way to determine if a baby is becoming dehydrated is a decrease in the number of wet diapers they have per day. Immediately after birth, that number should be equal to the number of days old the baby is, and it will increase over that first week to at least four wet diapers per day.

Tips for reducing spit up

If your baby seems to be spitting up too much, there are some things you can do that may help.

Hold the baby upright while feeding: “There are numerous positions for breastfeeding and bottle feeding that keep the baby more upright and use gravity to help keep liquid in their tummy, such as seated positions,” Dr. Feely said. “This is especially important with bottle feeding since liquid flows much more quickly from a bottle than when breastfeeding. If you hold a bottle upside down, liquid will easily drip from it, but a baby has to work to get milk from a breast.”

Don’t overfeed: “In the first month or so, babies will generally stop eating when they’re full, but they also suck to soothe themselves,” Dr. Feely said. “If you have a fussy baby, it’s sometimes hard to figure out if they’re hungry or if they just want to suck to soothe. Some parents automatically give them another bottle, which leads to overfeeding and can increase the likelihood of spitting up.”

Consider different bottles or nipples: Bottle feeding can sometimes lead to swallowing too much air, which leads to more spit ups. To avoid this, use slow-flow nipples or bottles that are made to be air-free.

Burp the baby during and after meals: This can keep air from building up in a baby’s tummy.

Avoid play time for 30 minutes after meals: This includes things like bouncing, swinging, tummy time, etc.

Keep the baby upright after feeding: This will help keep food in the baby’s stomach.

Try a different formula or adjust the mother’s diet: “Some babies have intolerances, and changing their formula or the mother’s diet can solve the problem,” Dr. Feely said. “Regarding the mother’s diet, dairy is one of the main issues that comes up, but caffeine can also be a problem. It’s also important to remember that it takes about two weeks for the proteins from dairy or formula to completely work their way out of the baby and mother’s bodies, so parents need to give diet changes time to work even though it’s hard because the baby is unhappy.”

Always place the baby on their back to sleep: “Parents should be doing this anyway to help prevent SIDS – sudden infant death syndrome,” Dr. Feely said. “It’s also important when putting a baby to bed after feeding because it will avoid putting pressure on their tummy, which can cause them to spit up. While it may seem like it’d be easier for a baby to choke on food they’ve spit up while laying on their backs, our bodies have a flap just above the larynx called the epiglottis that prevents stomach contents from going down the airway, and this cap is larger in newborns to protect them.”

When to see a doctor

There are a number of signs in a baby’s spit up that should lead to a visit to their pediatrician.

“You don’t want to see spit up that’s dark green, neon green, neon yellow, red or something that looks like coffee grounds,” Dr. Feely said. “These can be signs of something wrong in the liver, stomach or elsewhere.

“If they change from being a happy spitter to forceful spitting or spitting a larger volume than before, that could be a sign of a bigger problem. Also, if the baby is crying a lot more than usual, that irritability can be a sign of a belly ache or acid reflux that’s burning their esophagus.”

Other signs include:

  • Not gaining weight
  • Not wanting to feed
  • Fewer wet diapers than usual
  • Frequent vomiting after feeding
  • Stool changes, such as blood in their stool
  • Starting to spit up more at 6 months old or later, which is when the baby should be sitting up and holding food down better
  • Difficulty breathing: This can happen if a baby breathes in something they’ve spit up. While the epiglottis usually keeps this from occurring, it occasionally can happen.

About Author: Luke Legner

Luke Legner is a writing coordinator at OSF HealthCare. He joined the Ministry in April 2021 after several years working in corporate communications in the heavy equipment industry. A Pontiac native, he graduated from Illinois State University in 2002 where he earned a bachelor’s degree in mass communication.

Luke and his wife, Ashley, reside in Bloomington and have one son and two daughters. When he’s not tackling a home improvement project, you can usually find Luke watching his beloved Chicago Cubs or The Andy Griffith Show.

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Categories: Kids & Family