How To Tell The Difference Between Baby Spit-Up And Vomit

Spitting up is completely normal for a baby, but vomit should be cause for concern.

Originally Published: 
A dad holding a baby who has just vomited.

With babies, the line between sick and well can sometimes be hard to discern. That’s especially true when it comes to baby vomit vs. spit-up. So how can you identify the difference between baby spit-up and vomit, and when do you need to call the pediatrician?

It turns out that a baby throwing up is quite different than a baby spitting up. Understanding the difference is a matter of observing body temperature and signs of distress.

What Is Spit-up?

Baby spit-up and baby vomit both relate to food that went in and is now coming out again. But although one is an occasionally disgusting but harmless surprise for parents, the other can be a sign of something more serious.

The most reliable distinction between an infant spitting up and throwing up is usually a fever, but there are other signs to watch for too.

“I hear it all the time in my practice,” says pediatrician Dennis Cooley, M.D. “There have been studies that one-fourth of the discussions at well-child care visit end up concerning things like spitting-up.”

In fact, Cooley notes, an estimated two-thirds of all infants spit up. And the reason is fairly easy to understand: Babies are unevenly pressurized. At the end of the esophagus, a.k.a. the “food tube,” there is a sphincter that opens to allow nourishment into the stomach. But that’s not the only time the sphincter opens, according to Cooley. Sometimes it opens just because.

“When spitting-up happens, it’s because a baby is not eating and not swallowing and the sphincter will open up,” Cooley explains. “Because of the changes in pressure between the chest and the abdomen, it forces stomach contents up into the esophagus.”

In babies, that’s a very short trip, so the momentum allows what was once in their bellies to escape. Vomiting, on the other hand, is generally forceful, sometimes projectile, and almost always plentiful. This can help parents tell the difference between the main genres of early childhood upchuck.

Baby Spit-up Vs. Vomit

Although babies rarely react to spitting up, they usually show signs of distress when vomiting, which can be associated with crying and painful squirming. Vomiting may also be accompanied by a fever or noticeable changes in appetite.

“Now, all babies will probably do a little bit of vomiting,” says Cooley. “But if you’re seeing persistent vomiting, it’s something you want to bring up with your pediatrician.”

How to Prevent Baby Spit-Up

Vomiting happens for specific medical reasons and likely signals a problem that needs attention. On the other hand, there’s no way to completely prevent spitting-up from occurring. There are, however, ways to keep it from happening less frequently. Breastfeeding helps because babies swallow less air into their stomachs when they eat this way. Burping a child a couple of times during feeding also helps equalize the pressure.

Bottle-feeders will want to make sure they have an appropriate nipple that allows breastmilk or formula to flow just right. They’ll also want to keep a kid relatively upright during feeding. Keeping them flat or having a nipple that allows a baby to draw in too much air as they suck can increase spit-up incidents.

Although it’s tough to accept that baby spit-up is unavoidable, it can be even harder for parents to understand when it is a problem. Cooley notes that doctors aren’t always great at leading parents to clarity, mostly because they use a bunch of interchangeable terms for the same thing. They might call it spitting, spitting-up, reflux, or vomiting, which can be confusing for parents. What matters is knowing when to be concerned: force, volume, fever, and distress are the best signs that vomiting may be cause for concern.

When your baby stains your shirt, that’s probably OK. When your baby ruins your shirt, it might be time to pick up a phone.

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