Mother holding her baby whom has reflux.

When you’re a new mama, spit up (and the wardrobe changes that accompany it) just become part of the typical daily newborn routine. While it can be frustrating to deal with the constant cleanup, it’s important to know that a certain amount of spit up is a totally normal part of being a baby. Here’s everything you need to know about why babies spit up, how to help them spit up less, and when to be concerned.

Why Do Babies Spit Up So Much?

When breastfeeding or eating from a bottle, babies naturally gulp in a bit of air while they’re eating. The combination of air, a full tummy and stomach acid—or a sudden change in position—can cause the stomach contents to make their way up and out of baby’s mouth (and sometimes nose!). Why? Because the muscle at the junction of the esophagus and stomach in babies is very loose and open, allowing stomach contents under any pressure to easily pass into the esophagus.

Spit up (also known as reflux or “physiologic gastroesophagael reflux”) is different from vomit, as the stomach contents flow easily out of baby’s mouth (typically along with a burp). It's not forceful, and doesn’t distress your baby or make them uncomfortable. In fact, babies who have this normal level of reflux are known as “happy spitters,” and it might even make them feel a bit more comfortable when they spit up!

Most babies begin experiencing normal reflux when they’re two to three weeks old, with peak reflux occurring between four and five months. Many little ones who experience normal levels of spit up will stop spitting up regularly once their upper digestive tract matures, and they can sit up on their own (usually between nine months to a year old).

What Can I Do To Reduce Spit Up?

For most babies, it just takes time. As your little one’s body and muscles mature, they simply won’t spit up as much. Here are a few things you can try to minimize spit up episodes:

  • Avoid Overfeeding: You might consider beginning a feeding before baby is super hungry to help prevent them from eating too much, too fast.
  • Ensure Baby Stays Upright: let their belly settle by holding them upright for about 20 minutes before beginning playtime (word to the wise: avoid tummy time right after a feeding)
  • Consider a Formula Change: while your baby might not have an actual intolerance to their formula, they simply might fare better with another one. See if a switch helps their belly—you can always ask baby’s provider for a recommendation.
  • Continue “Back to Sleep:" DO NOT place baby to sleep on their stomach or use any sleep props to elevate them, even if they have reflux. There is no evidence that healthy babies placed on their backs will choke due to spit up—in fact, in some cases an inclined position could make reflux worse. Remember, babies have nerves that detect and prevent any refluxed material from entering the lungs.

When Should I Be Concerned About Spit Up?

While a certain amount of spit up is simply the norm for most babies, there are several things to look out for that aren’t so normal. If you notice any of the following, contact baby’s provider as there could be an underlying issue that may require treatment:

  • Forceful vomiting after most feedings
  • Blood in baby’s spit up or vomit
  • Refusal to feed
  • Crying and/or arching the back while eating as if they’re in pain
  • Baby’s belly is swollen, distended or feels hard 
  • Baby has respiratory symptoms (such as wheezing and coughing)
  • Baby doesn't seem to be gaining weight 
  • A decrease in wet and dirty diapers

If you have any concerns about baby’s spit up or eating habits, you should always talk to your little one’s provider. And while the amount of laundry (and sometimes showers) that spit up incidents require can feel overwhelming at times, remember mama—this too shall pass!