Is it normal for a toddler to spit up or vomit after eating?

It depends. Frequent vomiting or spitting up is called gastroesophageal reflux (or reflux). It's most common in babies and they generally outgrow it during the first year. Older children occasionally have reflux, though.

If your child has other symptoms along with spitting up or vomiting – such as irritability during and after eating, breathing problems, coughing, gagging, or growth problems – she may have gastroesophageal reflux disease, or GERD.

Should I call the doctor?

If your child spits up quite a bit but doesn't seem uncomfortable and is gaining weight just fine, you probably don't need to call the doctor. Just mention it at the next checkup.

On the other hand, if you think the reflux is distressing your child or affecting his weight gain, schedule an appointment as soon as you can. Your child's doctor can tell you whether it could be GERD and help you ease your child's suffering.

What causes reflux?

A child may have reflux when her esophageal sphincter (the valve connecting the esophagus to the stomach) is weak or not working properly. This allows food and gastric juices to flow back up out of her stomach and into her mouth. This is what causes heartburn in adults, as well.

How is GERD diagnosed and treated?

The doctor will examine your child and ask you to describe the symptoms. To reduce the reflux, she'll likely suggest a few things you can try at home. These may include giving your child smaller, more frequent meals; keeping your child upright during and after meals; not giving your child spicy or carbonated foods; and elevating the child's upper body during sleep. (See more about these techniques below.)

If these measures don't work, she may prescribe medication. Some children respond right away to antacids or acid blockers. (But never give these medications to your child without consulting a doctor.) Your child may be on the medication for a few months.

If these medications don't help, the doctor might do further tests or refer you to a gastroenterologist to be sure that GERD is the problem.

The tests may include X-rays of the upper gastrointestinal tract. (This is called an upper GI series.) Your child will have to drink a chalky substance called barium beforehand. The X-rays will show any structural problems that could affect swallowing or digestion.

The doctor might also do a "scope" of the digestive tract, including taking some biopsies (small tissue samples). This is an inpatient procedure in which the child is sedated and a tiny camera is threaded down through the esophagus, stomach, and sometimes small intestines to see whether there's any inflammation or damage to the tissues.

Another test your child may have is a 24-hour pH probe study. In this procedure, the child is checked into the hospital overnight and a very thin tube is threaded through his nose down to the base of his esophagus. Over the next 24 hours, the test measures the frequency and severity of reflux episodes as well as the child's breathing and heart rate.

If your child continues to spit up a lot, your doctor will also want to monitor his weight. Some children with GERD don't gain weight properly because they aren't keeping enough food down. Others lose their appetite because all that stomach acid pushing up into the esophagus can hurt the throat and, in severe cases, make it hard to swallow.

Also, if some of the stomach contents get into the nose or lungs, a child with GERD might develop respiratory problems like pneumonia, a cough at night, or sinus or ear infections. The stomach acid can also damage tooth enamel.

What can I do to ease my child's reflux symptoms?

Try to make sure that she's in a relaxed atmosphere when she eats. You might also try giving her small, frequent meals rather than a few large ones. Don't let her eat right before bed or while she's lying down. It's best for her to eat in an upright position and remain upright for half an hour or so after eating.

As your toddler tries new foods, keep an eye on how she responds to them. Some – like spicy and greasy food, chocolate, tomato products, citrus, carbonated beverages, and caffeine – may make matters worse. (Of course, you wouldn't want your toddler to consume too much greasy food, chocolate, or caffeine even if she didn't have GERD.)

Keeping your child away from tobacco smoke can reduce reflux symptoms and is a good idea anyway.

One last thing you can try is elevating your child's head when she sleeps. Put a crib wedge or a towel under the end of the mattress to raise it by a few inches. (Don't put anything under the legs of the crib because that could make it unstable.) 

While other parents may suggest letting your child sleep in a car seat, experts don't recommend this because it seems to put more pressure on the stomach and may increase reflux symptoms.