My baby just spit up. Or vomited. I’m not sure. But should I be worried?

All things considered, baby spit-up usually is not an issue. Also called reflux, it is the flow of food from the stomach to the mouth. It is common, not painful, and might continue until your baby is a year old. Often, it is simply the result of a still-developing digestive system or of overfeeding. Learn how to tell how baby spit-up is different from vomit, and when is too much of either one.

Why do babies spit up?

At birth, your baby’s tummy is about the size of a small marble. After three days, it is about the size of a ping-pong ball, but still can’t hold much.1

Until she is about 4 months old, your baby’s tummy can hold only small amounts of milk at a time. Too much milk during feedings can cause your baby to spit up or be fussy.

Spitting up can happen when your baby:

  • Burps (called a wet burp)
  • Eats too much
  • Swallows too much air

There is no reason to worry about these common causes of spitting up. It is not painful to them, and most babies don’t even realize they have done it. As long as your baby is healthy and gaining weight, it is simply part of the development process.

Quantity is the key

It might seem like a lot, but the amount of liquid your baby spits up might not be as much as you think.

If your baby spits up more than 1 or 2 tablespoons at a time (or if spitting up is associated with respiratory symptoms such as choking, coughing, or wheezing), ask your healthcare professional if there is a reason to be concerned.

How can you lessen the spit-up?

To help your baby spit up less often, try:

  • Holding her in a more upright position while feeding
  • Burping her after every 1-2 ounces while feeding
  • Making sure the hole in your bottle's nipple is not too large (for bottle-fed babies). If milk continues to drip out when you turn the bottle upside down, the hole is probably too large. Try replacing the nipple with one with a smaller hole
  • Keeping your baby in an upright position after eating. Lying flat on a full stomach can lead to spit-up
  • Avoiding too much activity immediately after feeding
  • Feeding your baby less food, but more often

How much and how often to formula feed

Your newborn will probably be hungry six to 10 times in a 24-hour period. As she gets bigger, her stomach will grow, so she will eat more at each feeding and eat less often.

Number and Volume of Feedings During the First Year2,3,4
Age Average number of feedings per day Average amount per feeding
Birth to 1 week 6–10 2–3 fl oz
1 week to 1 month 7–8 2–4 fl oz
1 to 3 months 5–6 4–5 fl oz
3 to 6 months 4–5 6–7 fl oz
6 to 9 months 3–4 7–8 fl oz
9 to 12 months 3 7–8 fl oz

The best way to feed your baby is to allow her to take as much as she seems to need. If she is fussy and has not been fed in more than two hours, it is probably time for a feeding.

How is baby spit-up different from vomit?

If spitting up is making your baby uncomfortable, and gets more forceful with more volume than usual, it might mean it is vomit.

When babies vomit more than once, it is usually caused by a virus that includes diarrhea. Although these viruses usually are not dangerous, they can cause dehydration.

Because babies younger than 1 year old are at greater risk of dehydration, consult your healthcare professional immediately if you think your baby might be dehydrated.

When should you be concerned?

Although it can be alarming, an occasional vomiting episode is usually not cause for concern. Frequent vomiting can indicate reflux disease, intestinal obstruction, infection, or a protein allergy. Contact your healthcare professional if your baby's usual spit-up:

  • Increases in volume or force
  • Causes choking episodes or respiratory difficulty (wheezing or coughing)
  • Leads to other issues (discomfort, fussiness, poor weight gain, or weight loss)
  • Is accompanied by a fever, diarrhea, bloody mucus in the vomit, or a bloated abdomen
  • Is green or yellow
  • Is frequently projectile

Sometimes repeated vomiting in babies between 2 weeks old and 4 months old can be a sign of a blockage at the stomach. Contact your healthcare professional if your baby vomits repeatedly.

Watch for dehydration

When babies have sudden bouts of vomiting associated with diarrhea, it is usually caused by a virus. Although these viruses usually are not dangerous, they can lead to dehydration, which can be a serious problem. It is important to know the signs of dehydration and what you can do to prevent it.

What are the signs of dehydration?

If your baby:

  • Has fewer wet diapers than normal
  • Seems very tired or weak
  • Has tearless, sunken eyes, dry skin, and little saliva

The younger your baby, the greater the concern for dehydration. While she is ill, it is important to replace the fluids your baby is losing with small, frequent feedings. In many cases, an oral rehydration solution such as Pedialyte® is recommended. Check with your healthcare provider for advice.

1Spangler AK, et al. J Hum Lact. 2008;24:199-205.
2Behrman RE, et al. Nelson Textbook of Pediatrics. 16th ed. Philadelphia: WB Saunders Co. 2000:165.
3Samour PQ and King K. Handbook of Pediatric Nutrition. 3rd ed. Sudbury, MA: Jones and Bartlett Publishers. 2005:90.
4Fomon SJ. Infant Nutrition. 2nd ed. Philadelphia: WB Saunders Co.1974:24.