How to Tell When Baby Spit Up is a Medical Concern

Spit-up is completely normal until it becomes too forceful and too frequent, which is a sign parents need to seek out a pediatrician for help.

The number of burp cloths (or burpees) first-time parents receive at a baby shower can come as a surprise. What are these strange, smooth towels, they wonder? Why do we need so many? Then, within a few weeks of their kid’s birth, parents are introduced to the wonderful world of baby spit-up and understand the purpose of the burpee. And for some, spit-up may become enough of an issue that they run out of birth cloths. That’s when worry set in. Because while every kid spits up, the frequency and force might be indicative of a bigger issue.

“Some amount of spit up is normal,” explains Dr. Natalie Muth, spokesperson for the American Academy of Pediatrics and co-author of the Picky Eater Project: 6 Weeks to Happier, Healthier Family Mealtimes. And the reason it’s normal has everything to do with the fact that babies are still developing outside the womb. Not all of their parts are working as well as they will when they’re just a few months older.

“Spit up is due to infants having a floppy sphincter that separates the esophagus from the stomach,” Muth explains. “A little bit of crying, gravity, or a too-full stomach can cause the floppy sphincter to open up and the partially-digested breast milk or formula to come up from stomach to the esophagus and out the mouth, rather than the direction it is supposed to go.” Specifically, the other direction.

Interestingly, and contrary to popular belief. It doesn’t appear that formula necessarily increases the amount a baby will spit up, given the correct parental portion control. While it is true that breastmilk does digest faster than formula, allowing the kid to move it through their system more efficiently, babies will still likely spit up with breast or bottle both. In fact, more than two-thirds of babies spit up regularly, according to Muth.


How to Tell When Baby Spit Up is a Medical Concern

  • Consider frequency. Spit up after every feeding is abnormal.
  • Look at the force of the spit-up. Projectile vomiting isn’t the same as spit-up.
  • Understand that when spit-up is clustered with other symptoms, like colic or lack of weight gain, there could be a medical problem.
  • Reach out to a pediatrician if you are ever in doubt of whether spit-up is a concern.

And that’s why a distinction should be made between the fairly normal spit-up and straight ahead vomiting. “Spitting up is more like some of the food is regurgitated or ‘burped up’ whereas vomiting is usually more forceful,” Muth explains. “And when ‘spit up’ is actually projectile vomiting after most, if not all, feeds then it is very important that the baby is seen by a pediatrician.” That because the problem may be something more profound than a floppy sphincter and instead may be indicative of a larger problem.

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The warning signs of a larger problem are compounded when forceful, projectile-vomiting style spitting-up is clustered with other symptoms. When combined with low weight, refusal to feed, prolonged crying or colic, spitting-up may indicate an issue that requires some professional attention.

“Projectile vomiting can indicate something called pyloric stenosis which is when a muscle (the pylorus) is so large that food cannot pass from the stomach to the small intestines,” says Muth. “This typically affects babies around 3-6 weeks old and is an emergency.” But it is not the only concerning condition.

Frequent projectile vomiting or forceful spit-up at every feed could also indicate an infection and lead to dehydration. Those signs, along with a failure to gain weight, could also be linked to gastroesophageal reflux disease (GERD), which is not linked to normal spit up. Additionally, blood in the spit-up could indicate esophageal damage.

That said, most spit-up will be typical and can be controlled in part, with some good parental, after-feeding behavior. “Parents can help decrease spit up by feeding the baby smaller amounts of food more frequently, keeping the baby upright for 20-30 minutes after feeds, and being sure to burp the baby with every feed,” explains Muth, but adds this caution: “Parents should not position babies to sleep with a wedge or raised up as this increases risk for SIDS.”

Happily, for most babies, spit-up will subside as they get older and are introduced to complementary foods. This inevitably allows parents to turn all those burpees into perfect dust rags. Still, Muth stresses, before that happens, if parents are ever concerned about the frequency and amount of spit up, there is one thing for them to do: “Consult the babies pediatrician to assess further.”

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