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What is normal spit-up, or normal reflux?
Spitting up (normal reflux) is typically 1-2 mouthfuls of breast milk or formula, but it can be more.
More than half of all infants have occasional spitting up that does not bother them ("happy spitters").
Some babies spit up with every feeding but remain happy and unbothered when they spit up.
It usually starts within the first week of life and may last up to one year of age.
It usually does get better with age, as infants reach six to seven months.
What are the symptoms of normal reflux?
Smaller amounts often occur with burping ("wet burps").
Larger amounts may be normal or due to overfeeding.
Usually happens during or after a feeding.
Spitting up (normal reflux) does not cause any crying.
Spitting up does not interfere with normal weight gain.
What causes spitting up or normal reflux?
A part of your baby’s stomach is not strong enough yet to keep everything in the belly from coming back up.
Over-feeding can cause reflux and spitting up.
How do I tell if my baby is spitting up or vomiting?
The following suggests normal spitting up:
No pain or crying when it happens.
No effort with spitting up. No diarrhea.
Your baby acts hungry, looks well, and acts happy.
Your baby is wetting their normal number of diapers.
The following suggests vomiting:
New symptoms started in the past one to two days.
Your baby is uncomfortable when they vomit, cry, or arch their back.
The vomiting is forceful, projectile, or looks dark green.
Your baby has diarrhea as well.
Your baby looks or acts sick.
Your baby is wetting fewer diapers than is normal for them.
What can I do to help my baby?
Avoid pressure on your baby’s tummy
Do not put the diaper on too tightly. It puts added pressure on the stomach.
Wait about 20 to 30 minutes after feeding before doing tummy time or play time, especially bouncing.
Place your baby in an upright position:
After meals, try to hold your baby in the upright (vertical) position.
Perform frequent burping:
You can burp your baby 2 or 3 times during each feeding. Do it when they pause and look around. Do not interrupt their feeding rhythm to burp them.
Try burping your baby for about a minute, if no burp comes out, go ahead, and stop. Some babies do not need to burp.
Adjust feedings:
Your baby may benefit from a change in formula. Check with your baby’s healthcare provider before switching formulas.
Avoid over-feeding your baby. Watch for their hunger cues.
If breastfeeding, keep a food diary (if you have time) to see if there are any foods or drinks, such as caffeine, that cause your baby to spit up more.
Breastfed babies (from The American Academy of Pediatrics Parenting Website)
Breastfed newborns usually nurse every 2 hours from the start of the feeding to the next feeding, so 10-12 sessions in 24 hours is the norm. Over time the feedings space out but this is a slow process.
Most breastfed infants take 1 oz in the first few weeks, an amount that slowly increases over time. It tops out at rougly 4.5 oz at a year of age.
At times, breastfed infants can take in more if a nursing parent has an oversupply of milk. These infants may spit up, show signs of fussiness and increased stools.
Bottle-fed babies (from The American Academy of Pediatrics Parenting Website)
If bottle-fed, most newborns eat every 2 to 3 hours; 8 times is generally recommended as the minimum every 24 hours. Babies might only take in half ounce per feeding for the first day or two of life, but after that will usually drink 1 to 2 ounces at each feeding.
By the end of the first month, most babies consume at least 3 or 4 ounces per feeding, about every 3 to 4 hours. By 6 months old, they may take in 6 to 8 ounces at each of 4 or 5 feedings in 24 hours. Also at about 4-6 months old, solid foods should start to be added to a baby's diet.
When to contact your baby’s healthcare team:
Your baby looks sick.
Your baby has a fever.
Your baby’s symptoms are not improving.
Your baby is uncomfortable when spitting up.
Your baby has less than three wet diapers in 24 hours.
Your baby has gone from spitting up to vomiting.
You think your baby needs a change in formula.
You think your baby needs to be seen.
This publication was adapted from information from American Academy of Pediatrics Patient Education materials.
Reviewed by: TT DO | 05/2024