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Why babies spit up

Spitting up is perfectly normal for infants, who are just getting used to feeding. There are some simple things you can do to help curb the amount of spitting up your baby does.

Why babies spit up

Why does my baby spit up so much?

He's probably just getting the hang of feeding. And he's not alone: Almost half of young babies spit up regularly. The peak age for spitting up – also known as reflux – is 4 months.

When your baby swallows air along with his breast milk or formula, the air gets trapped in with the liquid. The air has to come up, and when it does, some of the liquid comes up too, through his mouth or nose.

Babies take in a lot of nourishment in relation to their size, and some of them really like to eat, so sometimes they become overfilled and, well, overflow.

A newborn's digestive system isn't fully developed, either. The muscles at the bottom of your baby's esophagus, which control whether food is coming or going, may still be getting up to speed. It's no wonder he creates so much laundry.

Is there anything I can do about it?

Try these tips to help your baby keep his food down:

  • Hold your baby in a fairly upright position when you feed him. Feeding him while he's slouched (sitting in a car seat, for example) doesn't give the formula or breast milk a straight path to his tummy.

  • Keep feedings calm. Minimize noise and other distractions, and try not to let your baby get too hungry before you start feeding him. If he's distracted or frantic, he's more likely to swallow air along with his breast milk or formula.

  • Check the bottle nipple. If your baby's drinking formula or pumped breast milk from a bottle, make sure the hole in the nipple isn't too small, which will frustrate him and make him swallow air. On the other hand, if the hole's too large, he'll be gagging and gulping because the fluid will come at him too quickly. Read our advice on choosing nipples and bottles.

  • Burp your baby often. If he takes a natural pause during a feeding, take the opportunity to burp him before giving him more food. That way, if there's any air, it'll come up before even more food is layered on top of it. If you don't get a burp within a few minutes, don't worry. He probably doesn't need to burp just then. Burp him after each feeding, too.

  • Keep the pressure off his tummy. Make sure your baby's clothing and diaper aren't too tight, and don't put his tummy over your shoulder when you burp him. Try to avoid car trips right after feedings, because reclining in a car seat can put pressure on your baby's stomach, too.

  • Limit activity after feedings. Don't jostle your baby too much after he eats, and try to keep him in an upright position for half an hour or so. This way he'll have gravity on his side.

  • Don't overfeed him. If your baby seems to spit up quite a bit after every feeding, he may be getting too much to eat. You might try giving him just a bit less formula or breastfeeding him for a slightly shorter time, and see whether he's satisfied. (He may be willing to take less formula or breast milk at a feeding but want to eat more frequently.)

  • Check his formula. Ask the doctor if your baby might have an intolerance to milk protein or soy protein that's causing him to spit up. She may suggest trying a hydrolyzed (hypoallergenic) formula for a week or two.

When will my baby stop spitting up?

As your baby's muscles develop and get stronger, he'll be able to keep food in his belly. Most babies stop spitting up by around 6 or 7 months of age, or once they learn to sit up on their own, but a few will continue until their first birthday.

How can I tell if he's spitting up or vomiting?

Vomiting is usually more forceful and a greater quantity than if your baby is just spitting up some of his latest meal. If he seems distressed, he's probably vomiting. Spitting up doesn't faze most babies at all.

Is spitting up ever a sign of something serious?

Spitting up is usually just par for the parenting course, but if your baby isn't gaining weight as he should be, schedule a visit with his doctor. Babies who spit up so much that they don't gain enough weight or have difficulty breathing may have gastroesophageal reflux disease, or GERD.

Call your doctor immediately if your baby begins projectile vomiting. Projectile vomiting is when the vomit flies out of a baby's mouth forcefully – shooting across the room, for example. This could be a sign of a condition called pyloric stenosis, in which the muscles at the bottom of the stomach thicken and prevent the flow of food to the small intestine. This typically happens at about 1 month of age.

Also phone your doctor right away if you see blood or green bile in your baby's vomit. This could be a sign of a blockage in his intestines, which would require a visit to the emergency room, a scan, and possibly emergency surgery.

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Is it normal for spit-up to come out of my baby's nose?

Yes, just like your own nose, your baby's nose is connected to the back of her throat. So spit-up will sometimes come out of her nose instead of her mouth. This is more likely to happen if her mouth is closed or her head is tilted in a certain way (allowing the spit-up to take the path of least resistance).

Spit-up can also come out of your baby's nose if her swallowing process gets a little off-kilter when she hiccups, coughs, or sneezes. It even happens to older children – picture kids at the dinner table when they start laughing while trying to swallow milk. If milk comes out the nose, it's the same situation – and perfectly normal.

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