A Blog from Your Kaiser Permanente Pediatricians in Northern California

father and baby

Why Babies Spit Up or Have Reflux

Babies are messy. Poop and pee are bad enough – but then there’s the spit up. Once my daughter spit up right into her uncle’s mouth as he played airplane with her! These are normal body functions, but parents often worry about spit up. Does their baby need some kind of treatment?

All babies have reflux. When they swallow milk, it goes from the mouth down the esophagus and into the stomach (or “gastrium”). There’s a muscular area called the lower esophageal sphincter that joins the esophagus and stomach. It tightens to keep food and drink in the stomach. In babies, this muscle isn’t strong enough yet to prevent liquid from bubbling back up the esophagus and out of the mouth.

We call this gastroesophageal reflux (GER). It’s a normal, expected, and yes – messy – part of being a baby! At 4 to 6 months about 2/3rds of all babies spit up every day. This slows down after 6 months, and usually stops by age 1. Most babies aren’t bothered by GER at all. My daughter was the embodiment of what we pediatricians call “The Happy Spitter!” She was a very happy baby who urped up all day long. I changed her clothes and mine about 5 times a day, every day.

What’s the difference between spit up and vomiting?

I remember one father in my office who took offense at the term “spit up”:

“It sounds like you don’t understand how much is coming up – It’s not a small little spitty amount!”

Vomiting is a forceful process accompanied by stomach contractions. Spit up or GER can involve what seems like large amounts of liquid, but it comes out of the mouth in a relaxed or flowing way. It usually happens with a burp or with a change of position after a feeding.

When is GER really GERD?

Some babies have symptoms that are caused by the reflux. In that case we say the baby has gastroesophageal reflux disease (GERD). These symptoms can include:

  • Crying more than usual
  • Arching back with feeding
  • Refusing to eat
  • Failing to gain a healthy amount of weight

What helps?

There are several things that can help decrease spitting up until your baby outgrows it. You can:

  • Feed your baby smaller amounts. Think of spitting up as an overflow valve for the stomach. Babies tend to urp more when they’re too full. You may need to feed your baby smaller amounts more often – watch their cues to see.
  • Feed your baby before they get too hungry so they’ll gulp less air and be less tempted to overfeed.
  • Burp well in the middle and end of each feeding,
  • Hold your baby upright for about 20 minutes after each feeding. However, don’t place them in a crib or bassinet that has the head raised – this can cause them to slide down to the bottom in an unsafe position.
  • Keep feeding times calm and avoid too much movement after feeds.
  • Consider feeding them a cereal like oatmeal, if your baby is over 4 months and seems ready for solids. Solid foods stay in the stomach better than milk. Don’t just add cereal to bottles – feed it on a spoon.
  • Don’t stop breastfeeding. Reflux is never a reason to stop.
  • Talk with your pediatrician about a 2-week trial of a dairy elimination diet (for you) if your breastfed baby is often fussy and spitting up.
  • Try a thickened formula (one labelled AR) if your baby is fed formula. Ask your pediatrician about trying a hydrolyzed formula for a 2-week trial if this formula change doesn’t work.
  • Avoid tight diapers or elastic waistbands.

Does GER or GERD need treatment?

Not usually. Spitting up rarely needs medical treatment. It’s a normal process that babies outgrow. Sometimes parents ask for, or doctors offer, medication to reduce the acid of stomach contents in hopes of decreasing symptoms. These medications have potential risks that should be considered before using them.

  • Decreased bone mineralization
  • Increased childhood fractures
  • Iron deficiency
  • Alteration of the gut microbiome

There’s no current evidence that probiotics, herbal, or homeopathic treatments help infant GERD.

Call your pediatrician right away if your baby has any of these symptoms:

  • Repeated vomiting
  • Blood in spit up or stool
  • Difficulty swallowing or breathing
  • Hoarse voice, cough
  • Fever
  • Loss of appetite or failure to gain weight as expected
  • Fussiness

Call 911 or go to the nearest hospital if your child has difficulty breathing or is turning blue.

Babies do outgrow spitting up. This happens as a few things take place. The esophageal sphincter gets stronger as they get older. Solid foods stay down better, so as they eat more of those, you’ll see less reflux. And as they spend more of their time pulling upright to stand and walk, gravity helps keep the food down in their stomach. Until all this happens may your baby be a “Happy Spitter” and you survive the laundry!

Resources for Parents:

The American Academy of Pediatrics
Gastroesophageal Reflux & Gastroesophageal Reflux Disease: Parent FAQs

My Doctor Online
Gastroesophageal Reflux Disease (GERD) in Infants and Toddlers

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