Spitting up is when the breastmilk, formula or food that was in the baby’s stomach comes out through their mouth or nose. Stomach contents can include a variety of colors depending on what your baby just ate or drank, along with saliva and digestive enzymes.  

Spitting up is common for babies in the first year of life since their stomachs are small and continue to grow over time. Babies who regularly spit up and are otherwise healthy are often called “happy spitters.” 

For full-term babies born after 39 weeks’ gestation, development of the flap that separates the stomach from the esophagus and throat happens around 9-12 months of age. Spitting up will typically go away on its own over time as your baby’s muscles in the digestive system continue to mature. 

Several factors can cause your baby to spit up including: 

• Overfeeding.
• Swallowing air during feeding.
• Crying excessively while trying to feed.
• Positioning during and after feeding.
• Wearing the diaper too tight or restrictive clothing.

Many parents wonder if their breastmilk or formula is causing their baby to spit up. Before changing your diet or switching your baby’s formula, contact your local WIC clinic to speak to an International Board Certified Lactation Consultant (IBCLC) for breastfeeding guidance or a registered dietitian for formula advice.

Here are a few tips to help lower the chance of breastmilk, formula, or foods from reappearing.

Hunger and Fullness Cues

No matter if your baby is breastfed or bottle fed, it is important to look for your baby’s cues to understand when they are hungry. Looking for your baby’s hunger and fullness cues can help prevent overfeeding and reduce the risk of spitting up. 

Signs that your baby may be hungry include: 

• Sucking.
• Moving hands to mouth.
• Searching for a breast.
• Sticking out the tongue.
• Lip-smacking.  

Signs that your baby may be full include:

• Letting go of your breast.
• Falling asleep.
• Relaxing the hands or face.
• Turning away from your breast or bottle.
• Letting milk spill from the mouth.
• Stopping or changing the sucking pattern.

Paced bottle feeding

Paced bottle feeding is another method to help prevent overfeeding your baby. To practice paced bottle feeding, first look for hunger cues. Next, position your baby at a 45-degree angle supporting the head and neck. Offer the bottle in spurts of 5 to 10 seconds at a time. When feeding, aim to keep the bottle horizontal to the ground to control how fast the formula or breastmilk flows. Learn more about paced feeding from this video and at BreastmilkCounts.com.

Positioning

Moving your baby too quickly during and after a feeding can cause him to spit up. It’s important to keep your baby upright during a bottle feeding. If he is awake after eating, continue to hold him upright. However, when baby falls asleep, place him on his back as this is the safest way for your baby to sleep. Because of this it is never recommended to place babies to sleep on their stomach or their side in an effort to prevent spit-up. Learn more about safe sleep at dshs.texas.gov/SafeInfantSleep.

Additional tips:

• Take time to burp halfway through the feeding.
• Offer smaller, more frequent feedings.
• Ensure feedings are calm and relaxed.
• Make sure clothing and diapers fit comfortably and are not too tight.

While spitting up can be normal for babies, it is more concerning if your baby has a condition called gastroesophageal reflux disease. This condition is more commonly known as GERD or acid reflux and is associated with painful spitting up. This is different from the “happy spitter” because it can continue beyond 12 months of age and is associated with more severe symptoms. Talk to your pediatrician if your baby is:

• Vomiting forcefully or vomiting blood, green, or yellow fluid.
• Crying and irritable when spitting up.
• Refusing or having trouble eating.
• Having trouble breathing while eating.
• Coughing or wheezing during or after feeding.
• Having fewer wet and dirty diapers.
• Having blood in his stool.
• Having recurrent ear infections.

For more information on spitting up, please visit your WIC clinic or talk to your baby’s healthcare provider.