If you are feeding a newborn, you probably know to have a burp cloth nearby.
Small amounts of spit-up after feeding are to be expected with young babies. Many parents will feel concerned about how much their baby is spitting up or have questions about what is normal. The good news is that in most cases, spitting up is completely normal in newborns and young babies.
My role as a Registered Nurse and International Board Certified Lactation Consultant (IBCLC) is to help parents understand normal newborn feeding behaviours and provide guidance on how to navigate when additional assessment or investigation may be needed.
🧐 Did you know . . .
Half of all babies will experience physiological reflux by 3 months of age
(physiological means it is part of normal development)
More than 60% of all babies spit up at least once per day in the early months of their life
Most babies outgrow spitting up by their 1st birthday
Why do babies spit up?
Spitting up is usually caused by milk flowing back up from the stomach into the esophagus (where food travels from our mouth to our stomach), and sometimes into the mouth. Babies may spit this milk up from their mouth or swallow it back into their stomach. This can be common for babies because:
Their digestive system is still developing
The muscle that keeps milk in the stomach (esophageal sphincter) is not fully mature
Babies spend a lot of time lying down
Their diet is 100% fluid/liquid for the first 6 months of their life
Their bellies are small and fill quickly
What is “normal”?
You likely do not need to be concerned about the occasional spit-up if your baby is:
Feeding well and comfortably
Generally content during and after feedings
Gaining weight and growing well
Sleeping well based on their age *check out my newborn sleep guide! 👈🏻
Meeting developmental milestones
Spitting up shortly after a feeding ends
Having spit-up that looks like milk, or slightly curdled milk (this happens when milk solids come into contact with stomach acids)
Having spit-ups that dribble or gently flow out of their mouth
Amount of spit-up can vary, and it can be hard to “measure”. Even though it may look like a lot at once, most babies will only spit up one or two mouthfuls of milk at a time. Spit-up may be confused for vomiting.
Vomiting is the forceful throwing up of stomach contents when the belly muscles contract around the relaxed stomach, forcing stomach contents up the esophagus and through the mouth. Vomiting is not normal for babies, especially before the introduction of solid foods.
🩺 Report any concerns you have to your baby’s pediatrician or primary care provider, especially if you notice the following:
Baby is extremely fussy after feeding, arches their back, or seems in pain after most feedings
You are having to work very hard to get your baby to nurse/feed
You are feeling concerned about the frequency or amount your baby is spitting up
There is mucus and/or blood in their poop
🏥 As a parent, you know your baby best. Have your baby assessed right away by urgent/emergent care if you notice:
Forceful (often described as “shooting” or “projectile”) vomiting after feedings
Signs of dehydration: less than the minimum number of expected wet diapers for their age, has a dry mouth or no tears while crying, or a sunken soft spot
Their vomit is a different colour: green (bile), red (blood), or their vomit looks like coffee grounds
Baby is extremely sleepy/lethargic or difficult to wake up
Difficulty breathing
A fever of 38°C or higher (a fever in a baby under 3 months of age should always be assessed right away)
How can I help my baby manage spitting up?
Working with an infant feeding specialist like a Lactation Consultant can be incredibly supportive. As infant feeding and lactation experts, IBCLC’s look at the “whole picture”, whether you are exclusively breastfeeding, combination feeding, or exclusively bottle feeding.
If you have questions about how a Lactation Consultant could help you and your baby, you can book a FREE discovery call or fill out the form below to ask additional questions.
The following strategies can also be helpful to reduce spit-ups:
Baby wearing after feedings and throughout the day
Keeping baby upright after feeding (some babies need up to 30 minutes)
Try burping throughout the feeding and at the end of a feeding
Avoid tummy time and active play immediately after feeding
Offer smaller, more frequent feedings to reduce belly fullness
References:
La Leche League International - Breastfeeding Info: Reflux
Canadian Pediatric Society - Position: Reflux In Healthy Infants
American Academy of Pediatrics Healthy Children - Health Issues: Infant Vomiting
