Spitting up and Vomiting

Spitting up

Many newborn babies and young infants are prone to spitting up some of their breast milk or formula during or shortly after a feeding. Some newborn babies spit-up only occasionally, and others spit-up with every feeding. Spit-up effortlessly rolls out of the baby’s mouth, sometimes with a burp.

Spitting up, also called gastroesophageal reflux​, occurs when the ring of muscle at the top end of the stomach does not close properly. Spitting up decreases as the baby gets older, and it generally goes away before the baby reaches one year of age.

Ways to help your baby

You can reduce the amount that your baby spits up by trying the following:

  • Feed your baby before she becomes frantically hungry.
  • If you are bottle feeding, feed her smaller amounts, as overfeeding can make spitting up worse. Your baby does not have to finish a bottle.
  • If you are bottle feeding, make sure the nipple is neither too large nor too small. A nipple that is too large will cause the milk to flow too fast; a nipple that is too small will cause your baby to swallow a lot of air.
  • Keep feeding times quiet and calm, and try to minimize distractions.
  • Avoid tight diapers because they put pressure on the abdomen. Don’t put pressure on your baby’s tummy.
  • Burp your baby a couple of times during feedings, to get rid of some of the air in her tummy. Don’t interrupt her feeding, but instead burp her when she takes a break.
  • Hold your baby upright after each feeding.

When to visit the doctor

Usually spitting up is harmless; however, it can pose a problem if it leads to poor weight gain, choking, or acid damage to the esophagus. If your baby experiences any of the following symptoms when she spits up, bring her to the doctor:

  • streaks of blood in the spit-up
  • spit-up that causes your baby to choke or gag
  • spit-up that causes your baby to turn blue
  • problems gaining weight
  • vomiting or projectile vomiting

A note about sleeping position

Putting your newborn baby to sleep on her back is considered one of the best things you can do to help prevent sudden infant death syndrome (SIDS). This is recommended by the Canadian Paediatric Society, the American Academy of Pediatrics, and many other paediatric societies around the world. Although you may be concerned about putting your newborn baby to sleep on her back if she is prone to spitting up, there is no need to worry. There is no increase in choking in newborn babies who are put to sleep on their backs.

Vomiting and projectile vomiting

Vomiting is more forceful than spitting up, and it involves more than just a couple of tablespoons of stomach contents. Vomiting can be a sign of a viral infection in the stomach, a reaction to something the baby ate, or another gastrointestinal problem.

Treatment for vomiting

Initial treatment for vomiting involves feeding your baby in smaller amounts. If you are breastfeeding, reduce the amount of time that your baby spends at the breast at each feeding. You may need to feed your baby more frequently to make up for the smaller feedings.

You may need to temporarily replace breast milk or formula with an electrolyte solution such as Pedialyte. If this is the case, offer your baby the clear fluid for eight hours after the vomiting has stopped. Feed your baby small amounts at frequent intervals: about 5 mL (one teaspoon) every five minutes to start. After four hours without vomiting, double the amount each hour. If your baby vomits at this point, let her stomach rest for one hour and then start the feedings again with smaller amounts.

When vomiting becomes a concern

If there is a viral infection, vomiting is often accompanied by diarrhea​. If there is green bile in the vomit, it could be a sign of a blockage in the intestine, which requires immediate attention and possibly emergency surgery. Contact your doctor immediately if the vomiting appears to be excessive, if there is green bile or blood in the vomit, or if the vomiting is accompanied by diarrhea. Also call the doctor if your newborn baby shows signs of dehydration such as dry mouth, less than six wet diapers per day, sunken eyes, a sunken fontanelle, or dry skin.

Projectile vomiting is when spit-up or vomit forcefully flies out of a baby’s mouth. If your baby begins projectile vomiting, contact your doctor immediately. It could be a sign of pyloric stenosis, which is a common condition in young infants. Pyloric stenosis occurs when there is a narrowing of the lower tubular portion of the stomach that prevents food from leaving the stomach. Surgery is used to correct this problem.

Hazel Pleasants, RN, MN

Andrew James, MBChB, FRACP, FRCPC

Hazel Pleasants, RN, MN

Andrew James, MBChB, FRACP, FRCPC