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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 cause for concern.

With babies, the line between sick and well can sometimes be hard for parents to discern. That’s especially true when it comes to spit-up vs. vomit — how can you differentiate them, and when do you need to call the pediatrician? Baby spit-up and baby vomit both relate to food that went in and is now coming out again. Both smell terrible and have the potential to stain. But while 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.

“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,” explains American Academy of Pediatrics Fellow Dr. Dennis Cooley. He reassures parents that, yes, spitting up is totally normal. In fact, he says, 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 just opens.

Difference Between Spit-up and Vomit

“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, creating a heady atmosphere in the family room. This explains why spit-up generally doesn’t arrive with the violence of vomit, which can help parents to potentially tell the difference between the main genres of early childhood upchuck.

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Vomiting is generally forceful, sometimes projectile, and vomit is plentiful. While babies rarely react to spitting up, babies 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.”

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. 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 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.