4 Reasons Why Babies Spit Up (and what you can do about it)

I have seen a lot of newborns and infants in my years of practice. Many of those spit up. In fact, most of them spit up at some point.

It is normal for babies to spit up.

But, some babies spit up A LOT!

You know those babies that get changed several times a day because they spit up all over their clothes.

You know the moms that always have spit up on their shoulders.

Maybe YOU are that mom. And you are always having to warn your friends and relatives that your baby will probably spit up on them. 

So, why do babies spit up? How do you know if spitting is a problem? And do you just have to live with it or is there anything you can do about it?

In this blog post I am going to give you 4 Reasons Why Your Baby Could Be Spitting Up (along with some tips for What You Can Do About It.

(Make sure you look for the 2 guides I made for you to download in the blog post below)

If you would like to watch the YouTube video version you can watch it here.

(make sure you subscribe to my channel The Dream Baby Broadcast so you get notified of new video education when I post it )

*Remember that any information that I provide here is for general information and educational purposes only. Please never try to diagnose your own child. If you find some information that you feel might help your child, discuss that with your child’s own personal healthcare provider FIRST before trying any treatment on your own.

Reason #1 Overfeeding

Babies eat very frequently. And babies cry a lot. Babies cry when they are hungry and sleepy and wet and poopy. As new parents, it is hard to know the difference in a baby’s cries. So, often they get fed when they aren’t really hungry.

I see a lot of overtired babies. They are fussy and cry a lot. They spit up. Their weight is skyrocketing. All because they are being fed every time they cry.

Crying is the way that babies communicate.

Babies don’t know what is bothering them. They just know something doesn’t feel right.

When babies get sleepy they show sleep cues - they rub their eyes, rub their face on your shoulder, get a far off look in their eyes, stare off into space and if they don’t get put to sleep right away -  they get cranky and start to cry. (FYI - crying is a late sign of sleepiness)

Many times parents think that baby is hungry and will feed the baby. But babies have very short sleep cycles and need to sleep more often than they need to eat.

So some babies are being fed twice as often as they actually need to eat.

You might think “well the baby wont eat if he isn’t hungry”. But many babies have developed the habit of feeding to sleep. They also have a neurologic sucking need. So, if you put the breast or bottle in the mouth, the baby will suck.

And you can train your body to want or need milk. And if babies are always fed to sleep, they need that association to go to sleep. (Get my article on sleep associations here)

But their tummy is very small. And it can only hold so much and what is excess will just come right back up at you.

Here is what you can do:

• Learn to recognize hunger cues from sleep cues.

Download this Cheat Sheet on Hunger vs Sleep Cues to help you decide if your baby is hungry or sleepy.

• Watch your baby’s sleep cues and try to put your baby down to sleep at the beginning of a sleep cycle without feeding to sleep
• Feed your baby when he wakes up from his naps.
• Formula feed every 3-4 hours at the amount specified by your healthcare provider - increase amounts slowly - by ½ oz at a time 
• Pace bottle feed so your baby doesn't feed too fast  (check out this video on paced bottle feeding from the Milk Mob) 
• Breastfeed on demand but typically every 2-3 hours 
• If pumping and feeding breastfed babies from the bottle, use paced bottle feeding to slow the flow down so baby doesn’t feed too fast

Reason #2 Oversupply and Forceful Milk Letdown

Some breastfeeding moms produce an excess supply of milk and have a forceful letdown or milk ejection reflex.

I see this a lot in moms who are pumping a lot in the first few days and weeks of life because they are trying to get their milk to come in early or they are trying to establish a "milk stash" for going back to work. This also happens randomly in some moms. 

You will notice this after the baby has been latched and sucking for a few minutes.  The baby will begin to gulp milk, sputter, choke, cough, pull off the breast often, or even bite down on the breast or nipple. The baby may spit up often and be gassy and may have frothy green poop.

These babies often do not like to comfort nurse and may even fight at the breast because the let down is so forceful and the milk flow is so difficult for them to handle.

You may or may not notice your milk lets down very fast. Your breasts may leak often and feel full all the time. You might feel that your breasts are never softer after a feeding.

The side that the baby is not feeding on may leak or gush milk while the baby is feeding.

Typically by 12 weeks supply will regulate when the maternal hormones are regulated.

Here Is What you Can Do:

Help baby deal with the milk flow:

Adjust the baby’s position

• Place the baby higher on the breast
• Cradle hold but with mom lying back so baby is higher on the breast and against the flow of gravity
• Football hold but baby sitting more upright and above the breast
• Baby sitting upright facing mom with legs straddling mom and baby facing breast

Nurse more frequently so that breasts are not so full

Hand express to get milk to let down first before baby latches so that baby does not get rush of milk

Break the suction and take baby off the breast when milk lets down and baby starts to struggle.

• Catch the spray of milk in a towel or a bottle until eased off.
• Then allow baby to relatch onto the breast.

Adjust Mom’s Milk Supply

Give the body time to work out how much milk baby needs

• In the first 4-6 weeks it is normal for body to be trying to determine how much milk baby needs. So, let body figure it out.

Avoid pumping, (If pumping to try to build up a “stash” for work etc stop until milk supply is regulated for baby)

If baby is gaining excess weight, feed on one side at a feeding just until supply regulated (this is the only time I recommend this).

• Hand express or pump just enough to relieve fullness or discomfort on the opposite breast.

If baby is underweight or adequate weight, continue feeding both sides per feeding.

If baby is very symptomatic and breasts are very full, consult a lactation consultant about other methods to safely decrease supply without risking losing supply. You want to be very careful because you can decrease your supply too much and then lose your supply.

Reason # 3 Milk Protein Allergy

Some babies who are spitting up have an allergy to the protein in their milk. This is most often to a cow’s milk based formula. A significant number of babies who are allergic to cow’s milk based formulas are also allergic to soy based formulas as well.

Occasionally, babies who are breastfed have a small amount of milk from mom’s diet cross over into the breast milk and can have an allergy as well.  They are not allergic to their mother’s milk! They are allergic to the cow’s milk protein (CMP) in their mom's diet. By eliminating the offending allergen from her diet, baby can continue to breastfeed without problems.

Cow's Milk Protein (CMP) allergy is not very common. Babies who have a parent or sibling  with eczema, seasonal allergies or asthma have a higher risk of CMP allergy.  Only about 2-3 % of all babies have CMP allergy and only about 0.5% of breastfed babies have it.

There isn’t really a test for this allergy in newborns and infants. Your healthcare provider can test for blood in your baby’s stool but if that is negative, that doesn't mean your baby doesn't have it. The best diagnosis is by taking a good history of symptoms and by process of elimination.

The signs/symptoms you see are most often blood in the bowel movement, frequent spitting up, gassiness, colic symptoms, irritability, excessive crying, eczema, diarrhea and poor growth.

Here is What You Can Do:

Talk to your healthcare provider about switching  to an extensively hydrolyzed formula (Alimentum, Nutramigen) for 2 - 4 weeks. These formulas are made up of proteins that are already broken down and can be digested without an immune reaction. 90% of babies with cow milk protein allergy will show great improvement.

Some babies need an amino acid based formula (Elecare) if these formula changes do not work (only 10% of the time).

Breastfeeding moms do not need to stop feeding. If breastfeeding, eliminate all milk, dairy, soy and egg from mom’s diet for 2-4 weeks. Read the labels. Avoid casein and whey too. You will need to take a calcium substitute or an appropriate milk substitute.

You should see improvement in the baby within 2 weeks. If baby improves, breastfeeding moms can add back egg into her diet after 2 weeks and see if baby worsens or regresses. If not, you can keep eggs in your diet. 

Goat’s milk, sheep milk, or soy milk are not appropriate substitutes or cow's milk formulas or milk in mom's diet as they have a high likelihood of allergy as well.

Most babies will be challenged again after one year of age. Cow’s milk protein allergy resolves in most children in early childhood.

Eliminating milk from your diet can be very challenging. You will need to be very diligent in reading all labels for a few weeks in order to be successful with a milk elimination diet if you are breastfeeding. But this will be worth it because babies with CMP allergy can be very miserable. Eliminating CMP from a baby's  diet can make a big change in their overall well being and contentment if they are allergic.

However, It is rarely necessary for a breastfeeding mother to stop breastfeeding due to cow's milk protein allergy.

Reason # 4 GE Reflux

Reflux happens when stomach contents are spit up or vomited back up into the esophagus (the tube that connects the mouth to the stomach). Most babies spit up. In fact, 50% of 4 month olds spit up at least once a day. This is considered a normal part of infancy. As the sphincter - the muscle that connects the esophagus to the stomach matures, the amount of spitting should lessen.

Spitting up - or reflux -  is not a problem - except for the inconvenience it causes - unless it is associated with complications. Then it is called GE Reflux Disease.

Babies who spit up without it causing any problems or complications to them are called “Happy Spitters”.

This means that they can feed well, are gaining weight appropriately, are not unusually fussy or irritable, are not sick and are generally happy - but they may spit up frequently, may soil a lot of clothes and may spit up on everyone who holds them.

Sometimes it is hard to tell reflux from other causes of spitting up. Or if it is worrisome or not because all spitting up in babies worries you. 

Download this Guide on REFLUX IN BABIES to give you more information.

Reflux and CMP allergy can look very similar. In fact, in the recent guidelines about GE Reflux from the NASPGHAN,  they recommend doing a trial of a cow’s milk elimination diet for all babies suspected of having GER because it can be so hard to tell the difference. And certainly, babies can have more than one diagnosis at a time.

So, if you suspect that your child has GER, it won’t hurt to try eliminating milk protein from their diet first to see if they improve.

If an elimination diet does not relieve their symptoms, it has not hurt them and you can go back to their previous diet (or yours if you are breastfeeding) easily.

Symptoms/Signs that may be related to GE Reflux

• Poor weight gain
• Weight loss
• Arching back
• Grimacing
• Gagging
• Irritability
• Excessive crying
• Wheezing
• Recurrent pneumonia
• Apnea

Here Is What You Can Do:

Lifestyle changes

Positioning

• Elevate approximately 45 degrees after feedings ONLY
• Do Not elevate during sleep
• Do not elevate in a car seat (babies spit more in a seated position)
• Stomach and side positions have an increased risk of SIDS and are NOT recommended
• *Do Not use positioners that keep your child in an upright or side lying position

Although it is a good idea to keep your child elevated for about 30 minutes after a feeding your child MUST be observed at all times when in this position

Thickened formula (or commercial AR baby formula) (typically one tablespoon per 2 oz of formula)

• Discuss with health care provider - concerns exist regarding increased calories in formula and increased energy requirements required to feed with this excess thickness of formula,
• Only use thickened formula in full term babies ONLY  - (serious surgical risks occur in using thickened formulas in preterm babies)

Avoid all  cigarette exposure

Medications are only recommended for babies with complications.

• Medications have many side effects and the risks must outweigh the benefits.
• Medications do not stop  the baby from spitting up
• Medications are used for the side effects or complications of reflux.

The medications are used to buffer the acids in the stomach which cause symptoms of heart burn, erosion to the esophagus which cause pain and irritability, and leads to weight loss , and respiratory problems like pneumonia and asthma.

So if your baby is experiencing these problems then medications may be worth discussing. But, medications are not a good option for babies who spit frequently but are still growing and gaining weight and are happy spitters.

There are many reasons why babies spit up. These are just 4 common reasons. Of course, babies can have more than one reason. And your baby can have reasons that are not listed here.

Most babies spit up for normal reasons that they outgrow without any need for medical interventions.

If your baby should ever suddenly develop spitting up or vomiting that he has not previously had or his spitting up suddenly gets worse, call your health care provider right away. Here are other reasons to call.

Call Your Healthcare Provider if you see:

Spitting up or vomiting worsens

Signs of dehydration

• sunken soft spot
• decreased wet diapers
• increased sleeping

Extreme fussiness

Crying for more than 3 hours

Sudden onset of vomiting

Projectile vomiting

Green vomit

Fever

Diarrhea

My nephew spit up all over everyone for the first several months of his life. Then he just got better. That is how it is for so many babies I see in my office. I try to help their parents sort out the situation.

They ask me for “that medicine that helped my friend’s baby” and we discuss it.

I know that you want to make this go away. And often we can figure out a solution for you. The medication is not usually the answer. I hope this article helps you figure out why your baby might be spitting and or what you might can try to make it better.

Download the cheat sheets and see if those will help you.

(If anything you might get some better sleep!)

And come on over to the Dream Baby Cafe Community and let me know which part of this helps you the most.  And if you know a mom who is carrying around burp cloths ready at a moment's notice - share it with her too.

(Special Thanks to our Dream Baby Mila for modeling for this blog post )