Babies and spit up: is this normal?

I cannot tell you how often I hear this question. Almost all babies spit up at one time or another and parents worry how much is too much and whether or not we need to do something about it.

So, here’s the lowdown on babies and spit up.

The first thing to know is we pediatricians refer to baby spit up as reflux. When parents first hear that term (reflux) they automatically think acid reflux and are confused because isn’t that an adult condition?

Let’s talk about reflux in babies

Reflux in babies is physiologic and presents as spit up. It is extremely common in newborns, particularly in premature infants. About half of all newborns up to the age of 4 months will have reflux and the numbers are higher in premature babies. This is simply a “mechanical” issue in babies where the lower muscle of the esophagus is “relaxed” and allows a backflow of breastmilk and/or formula. Most babies will grow and thrive throughout it all and will outgrow this “spitting up” phase by the time they reach 1 year (it’s much sooner for most babies).

We refer to babies who grow, thrive, and are otherwise unruffled by this spitting up as “happy spitters”.

Taking some “reflux precautions” such as keeping baby upright for 20-30 minutes after feeding, offering baby smaller and more frequent feeds, and burping often will ease this reflux. Ultimately, time is the best treatment for these happy spitters as the muscles of the lower esophagus strengthen and mature.

When it’s more than just spit up

Some babies will have more severe reflux. They may cry and grimace with the spit up and/or they may not be gaining weight. In these babies, an evaluation of the degree of reflux and/or a trial of anti-reflux medication may be in order. If your baby is formula feeding, her pediatrician may even recommend thickened formula to reduce the amount of spit-up.

Another red flag is if your baby’s spit-up is projectile or forceful. If this forceful spit-up (vomiting) occurs frequently after feeding, your baby’s pediatrician will want to rule out a condition known as pyloric stenosis.

Although rare, pyloric stenosis will not go away on its own. If your baby’s pediatrician suspects this, an abdominal ultrasound will be ordered. If present, surgery is needed to correct this thickened muscle at the junction of the stomach and small intestine.

A word on colic and reflux

Oftentimes an infant who presents with symptoms of colic may also have significant reflux exacerbating those crying jags. Be sure to mention any spit-up to your child’s doctor if you’re in the throes of colic. Treating and relieving moderate to severe reflux may improve the symptoms of colic greatly.

Bottom line: Most babies will have some degree of reflux. The good news is, most of them are happy and thrive throughout it all. For these babies, time is the best treatment.

Did or does your baby spit up frequently? What questions do you have about babies and reflux?

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7 Responses to Babies and spit up: is this normal?
  1. Nichole
    April 5, 2012 | 9:24 am

    Great post, Melissa!

    Matthew was my little puker. He spit up–violently–after every feeding. We’d lay him down to sleep and within a half an hour, he’d be screaming.

    We asked our pediatrician about it a couple of times, but since Matthew was such a happy little guy and was gaining weight, he urged us to be patient.

    But something told me that his reflux was truly a problem, so I pushed for an appointment with a specialist who found that he did, indeed, have a real problem. He began taking Prilosec and he turned into a new baby! No more spit up, no more crying, and WAY better sleep.

    Our pediatrician is so great, but since he wasn’t here with us during the terrible moments, I had to trust my gut. I’m so happy now that I did. :)

    • Melissa
      April 5, 2012 | 9:54 am

      Nichole, you bring up some very important points. His reflux made him scream/cry and it happened after every feeding. It’s so true how hard that is to convey in the office when all we see is a happy and growing baby. So, mom’s concern and reporting of events is SO important. Also? Mom instinct is powerful. Good job Mama!

  2. Betsy
    April 5, 2012 | 9:39 am

    My youngest brother had pyloric stenosis. I can still remember him projectile vomiting across the room as an infant. I was completely unphased by my own kid’s spit up after having witnessed that as a child!

  3. Sherri
    April 5, 2012 | 9:19 pm

    Oh, the spit up…memories……xoxo

  4. Kimberly
    April 11, 2012 | 3:03 pm

    Appreciate that you’ve covered this topic with the differences between just spit up and when to be concerned that it’s reflux. We hear from so many parents of babies who struggle with reflux and colic as an additional issue to deal with when trying to help their babies get the sleep they need.

  5. Mary
    April 12, 2012 | 8:36 pm

    My son Matthew was born 3-4 weeks early. He is almost 3 months old. He eats every 3-4 hours and 4 oz. each feeding unless he doesn’t want it all. But he has frequent spit ups.. Sometimes it is soon after eating, or hours after eating out of the blue. We keep him upright during and after feedings and watch how much he is moved around, but he still will do it.. We are going through burp cloths a lot and sometimes it will be all over his clothes if it is a lot that comes up. Is this normal? We have switched formulas per the doctor advice but he still seems to spit up a lot after it gets in his system 2 days. Some days he can be better than others but I wasn’t sure if this could be normal or if he should be on meds for it. We have added the cereal in is bottle. I add 2-3 tsp for a 4 oz bottle. I didn’t want to put too much to cause too much gas for his tummy. Just enough to hopefully stick with him.. Spitting up is normal but I wasn’t sure if this was something that needed more attention or not. He is not in pain that I can tell when this happens but concerned its alot at times.. Thank You!!!!

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