When to Be Concerned About Spit Up

All babies spit up. It’s only when spit up is accompanied by poor weight gain, forceful vomiting, difficulty breathing, and other troublesome symptoms that you should be concerned.


As a mother to a child with a cow’s milk allergy, I know spit up. When my son was born, he spent most of his first days spitting up every bottle we fed him. The reflux was so severe that he had to spend several extra days in the hospital.

What separated my son’s spit up from normal baby spit up was the quantity and frequency.

“Spitting up is common in healthy babies,” according to the experts at MayoClinic. “About half of all babies during their first three months experience their stomach contents coming back up into the esophagus, a condition known as gastroesophageal reflux, infant reflux, or infant acid reflux.”

Normal spit up often occurs when a baby drinks too fast or too much. Spitting up is also common with burping. Baby reflux issues are caused by an infant’s immature suck and swallow mechanisms and weak digestive systems. When sucking milk, a baby may gulp air which settles in the stomach. As the stomach contracts, the milk will shoot back up into the esophagus and out of the mouth.

What the Experts Say

 “You may notice a white, cheesy material present on your baby’s burp cloth. It should be no cause for concern. When the protein found in milk is exposed to the strong acid found in a baby’s stomach, it undergoes a normal curdling reaction.”

The Essential Library for New Moms, Marc Weissbluth, M.D., Eileen Behan

“The telltale sign of reflux in a baby is the presence of the spit-up or wet burp. But all babies spit up at some point, don’t they? They sure do, and that’s how we can so confidently say that all babies have reflux. In fact, 70% of all 4-month-old babies spit up at least once a day.”

Colic Solved, Bryan Vartabedian

“Sometimes it’s hard to tell the difference between normal spit-up and vomiting. Here’s a basic rule of thumb: spit happens. It’s a result of a weak and immature valve between the stomach and esophagus that usually resolves itself by the time your baby is one year old. Vomiting, on the other hand, is much more forceful.”

The Everything Baby’s First Year Book, Marian Edelman Borden, Alison D. Schonwald

“Some babies spit up regularly due to a reflex action. Others spit up only when they are overfed. Whatever the cause, don’t be overly concerned about it. If you worry that your baby spits up so much that she can’t possibly be getting enough food, wait a minute and offer her some more.”

The Complete Idiot’s Guide to Bringing Up Baby, Signe Larson, Kevin Osborn

“If your baby has projectile vomiting – that is, the spit-up literally flies across the room – another condition might be causing the vomiting. This type of forceful vomiting is very different from the typical spit-ups, not only in its strength but in the consistency of the spit-up.”

The Everything Parent’s Guide to Childhood Illnesses, Leslie Young, Vincent Iannelli

What’s Normal, What’s Not

It can be hard to distinguish between normal baby spit up and vomiting. When your little one spits up, it may seem like a lot of liquid. However, it’s probably not as much as you think. Most babies spit up less than one to two tablespoons at a time. If your little one is spitting up larger quantities of fluid, consult with your child’s pediatrician.

As a parent, you’ll naturally be concerned when your baby vomits. However, the occasional vomiting episode is no cause for concern. In rare cases, frequent episodes could indicate an intestinal obstruction, reflux disease, protein allergy, or infection. Contact your child’s pediatrician if the spit up:

  • Increases in force or volume
  • Appears green or yellow
  • Causes choking or respiratory distress
  • Is frequently projectile in nature
  • Is accompanied by fever or diarrhea

If your baby is gaining weight steadily, does not seem to be in distress, and is getting adequate nutrition, a little spit up is nothing to worry about. Most babies stop spitting up by six to seven months when they’re able to sit up, according to Ask Dr. Sears. In the meantime, continue to care for your baby as normal.

Liz Coyle

Liz is a Scottsdale-based writer and mom to a three-year old boy. She is a lover of cooking, travel, and racing hot wheels with her son. As the mom of an only child, Liz has a unique perspective on parenting. She loves to share her experiences of being a high strung, type a mom in an imperfect world.

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