How much spit up is normal?
Babies spit up a lot. But how much is typical, and how much is too much?
As a new parent, there’s a lot to learn. From how to change a diaper and how to bathe a newborn to how much to feed your baby and how fast they should grow, the daily questions can feel daunting at times.
One question new parents often ask is: how much spit up is normal? We all know babies spit up a lot, thanks to their underdeveloped digestive systems. Eventually, your baby will grow out of the spit-up phase — in the first year of life, spit up is considered typical. Still, how much, how often, and how forcefully your baby spits up can offer clues into their digestive health.
Let’s break down the most frequently asked questions about spit up, so you know what to expect, and when to talk to a doctor.
How much spit up is normal?
Normal spit up can look (or feel!) like a lot — especially when it’s on your shoulder and in your hair. But in reality, most babies will only spit up a couple of tablespoons at a time.
That said, differentiating between “normal” spit up and spit up that is cause for concern usually comes down to how your baby is acting. If your baby is unphased by the spit up, and it comes up and out rather easily and with no discomfort, it’s likely not concerning.
On the other hand if your baby is in distress, appears uncomfortable or stiff, or if the spit up makes them cry, choke, gag, or fuss, there may be something more going on.
Another factor to consider over the long term is weight gain. Is your baby steadily gaining weight, or is your doctor concerned with their growth? If your baby is gaining weight, and is not bothered by the spit up, then the spit up is likely normal. On the other hand, if weight gain is a problem, it’s best to talk to your doctor about your concerns.
What can cause excessive spit up?
Spit up happens for every baby. But excessive spit up happens when babies drink too much, too fast. Factors that can contribute to excessive spit up include:
Swallowing air during feedings
Fast let-down in breastfeeding mothers
A large milk supply in breastfeeding mothers
Eating in a reclined position or with rounded back
Using a bottle with a nipple flow that is too fast
Being too active after eating
Or, in some cases, there may be more serious issues causing excessive spit up, like:
Food sensitivities
Tongue tie or lip tie
GERD (gastro-esophogeal reflux disease)
What does normal spit up look like?
Normal spit up can have many different textures and appearances. It may appear watery and thin, or thick and mucus-like. If the spit up happens immediately after eating, or during a feeding, it will usually look like the milk your baby ingested. If some time has passed, it may look more like curdled milk.
Usually spit up is white, creamy, or clear in color. If your baby is spitting up liquid that is green, pink, black, or bright yellow, give your pediatrician a call, because this can indicate the presence of blood or bile.
What is the difference between spit up and vomit?
Spit up is usually non-eventful — meaning it comes up easily and without discomfort. Often it leaves the mouth in a trickle, or with a moderate amount of force, like a burp or a bubble is behind it.
If your baby is forcefully ejecting liquid that shoots out, this is more likely to be vomit. Vomiting is usually accompanied by a fever or diarrhea, and your baby will likely be in distress.
Vomiting can also lead to dehydration, which is cause for concern. If your baby is crying without tears, has gone longer than 6 hours without a wet diaper, and has a dry mouth, your baby may be dehydrated, and a call to your doctor is warranted.
When does spit up indicate GERD?
Often babies with reflux will spit up more frequently than other babies, even hours after eating. GERD, or gastro-esophogeal reflux disease, is usually very painful, so your baby may also start gagging or crying out of nowhere, even if they are not spitting up.
If your baby appears uncomfortable or stiff, arches their back during feeding, or stops feeding to cry, scream, or whine, they may be experiencing reflux.
Reflux is painful and frequent heartburn that may either cause a vicious cycle of overfeeding, or in some cases, make your baby want to stop eating altogether. How is this possible?
Well, if your baby has mild heartburn, they may want to suck for comfort to soothe their throat and wash down the heartburn. But that in turn can lead to overeating, which will worsen reflux, leading to more pain, and continue the cycle of sucking for comfort.
If you suspect that is what is happening with your baby, it can be helpful to keep a pacifier nearby during feedings. When your baby pulls away from the nipple and cries out in pain, give them a minute or two with the pacifier to help them wash down the reflux and soothe their throat. Then begin the feeding again.
How can I reduce spit up?
To reduce spit up, try the following:
Smaller, more frequent feedings
Feed your baby in a more upright position, with their bottom below their ribs
Burp your baby frequently, even during feedings
Wait 30 minutes after a feeding to resume play
Keep your baby upright for 30 minutes after a feeding
Use a bottle with a slower nipple flow
If you are breastfeeding and have oversupply or fast letdown, pump for 30 seconds to 1 minute first before offering your baby the breast
If you are breastfeeding, try not to go too long between feedings or feed your baby when you are engorged
The bottom line
Spit up is completely normal, and if your baby is gaining weight appropriately, seems happy and content, and is hydrated, there is usually no cause for concern.
If you suspect that your baby is uncomfortable when feeding or losing weight, call your doctor right away.
With a little patience, time, and practice, you’ll quickly learn to recognize your baby’s normal spit up patterns.