How to Tell the Difference Between Spit-Up and Vomit

Spitting up is completely normal for a baby and is related to pressure changes in their body, but vomit should be addressed with concern.

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Spit-up. The white tide. It’s always a surprise for a parent. From the smiling, unconcerned mouth of a sweet babe, the thick, pale emesis comes burbling forth. It never fails to find its way onto fresh work clothes or nice upholstery. What’s more, the eruption often happens when burp cloths are nowhere in sight, leaving the sour-smelling regurgitation to pool wetly where it lands. For just a moment there is a silent pause before disgust sets in. How could this be normal? And can anything stop it?

“This is really a common concern that parents bring to primary care pediatricians,” explains American Academy of Pediatrics Fellow Dr. Dennis Cooley. “I mean. I hear it all the time in my practice. There have been studies that one-fourth of the discussions at well-child care visit end up concerning things like spitting-up.”

Cooley notes that yes, spitting up is totally normal. In fact, he says that 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.ka. 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 just opens.

“When spitting-up happens, 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 tum tums to escape into heady atmosphere of the family room. This explains why spit-up generally doesn’t arrive with the violence of vomit and allows parents to potentially tell the difference between the main genres of early childhood upchuck.

Vomiting is forceful, sometimes projectile, and vomit is usually plentiful. A baby will also show signs of concern when it occurs. Often babies spit-up without a care in the world, but vomiting is regularly associated with crying and writhing. 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.”

Vomiting happens for specific medical reasons and signals a problem that likely needs to be solved (time often being the most effective solution). 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 a baby is unlikely to take in as much air into their stomachs when they eat. Burping a child a couple of times during feeding also helps to 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.

While it’s tough to accept that spit-up is unavoidable, it can be even harder for parents to understand when it is a problem. Cooley notes that doctors aren’t great at helping that situation. Mostly because they use a bunch of interchangeable terms for the same thing. They might call it spitting, spitting-up, reflux, or vomiting. This confuses the already complicated issue at hand or, more like, on parents’ sleeves. That issue is understanding when to be concerned and the most basic thing to remember is that force and volume are the key indicators.

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

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