Clinical Reference Systems: Pediatric Advisor 10.0
Spitting Up by Infants (Reflux)
Spitting up (also called reflux or regurgitation) is the
effortless spitting up of one or two mouthfuls of stomach
contents. Formula or breast milk just rolls out of the
mouth, often with a burp. It usually happens during or
shortly after feedings. It begins in the first weeks of
life. More than half of all infants spit up to some degree.
Spitting up is harmless as long as your infant doesn't spit
up large amounts that interfere with normal weight gain.
This condition is also called gastroesophageal reflux (GE
reflux) or chalasia.
Spitting up results from poor closure of the valve (ring of
muscle) at the upper end of the stomach.
Spitting up improves with age. By 7 months of age, most
reflux has decreased or is gone. The reasons for this are
probably because the baby is old enough to sit up or is
eating solid foods. By the time your baby has been walking
for 3 months, even severe reflux should be totally cleared
- Feed smaller amounts.
Overfeeding always makes spitting up worse. If the
stomach is filled to capacity, spitting up is more
likely. Give your baby smaller amounts (at least
1 ounce less than you have been giving). Your baby
doesn't have to finish a bottle. Wait at least 2 and
1/2 hours between feedings because it takes that long
for the stomach to empty itself.
- Avoid pressure on your child's abdomen.
Avoid tight diapers. They put added pressure on the
stomach. Don't double your child up during diaper
changes. Don't let people hug your child or play
vigorously with him right after meals.
- Burp your child to reduce spitting up.
Burp your baby two or three times during each feeding.
Do it when he pauses and looks around. Don't interrupt
his feeding rhythm in order to burp him. Keep in mind
that burping is less important than giving smaller
feedings and avoiding tight diapers.
- Keep your child in a vertical position after meals.
After meals, try to keep your baby in an upright
position using a frontpack, backpack, or swing for 30
minutes. When your infant is in an infant seat, keep
him from getting scrunched up by putting a pad under his
buttocks so he's more stretched out. After your child
is over 6 months old, a jumpy seat or walker can be
helpful for maintaining an upright posture after meals.
To make the walker safe, remove the wheels or buy one
- Use a proper sleep position.
Most infants with spitting up can sleep on their back,
the position recommended by the American Academy of
Pediatrics to reduce the risk of SIDS. Another option
for severe reflux is sleeping on the right side. If the
esophagus becomes irritated (esophagitis), talk to your
doctor about sleeping prone (face-down). Try to elevate
the head of the bed a bit.
- Clean up messes.
One of the worst aspects of spitting up in the past was
the odor. This was caused by the effect of stomach acid
on the butterfat in cow's milk. The odor is not present
with commercial formulas because they contain vegetable
oils. A more common concern is clothing stains from
milk spots. Use the powdered formulas; they stain the
least. Also, don't pick up your child when you have
your best clothes on. Try to confine your baby to areas
without rugs (for example, the kitchen).
Call Your Child's Physician Immediately If:
- Any blood is seen in the spit-up material.
- The spitting up causes your child to choke or cough.
Call Your Child's Physician During Office Hours If:
- Your baby doesn't seem to improve with this approach.
- Your baby does not gain weight normally.
- You have other concerns or questions.