Spit-Up vs. Vomit in Babies

Spit-up and vomit may look similar, but there are some clear differences. While spit-up is typically nothing to worry about, vomit can indicate a health concern. Here’s a deeper look at these tummy issues, including their potential causes and triggers, tips for identifying them, and when to talk to your pediatrician.

Spit-up vs. reflux vs. vomit – what’s the difference?

Spit-up—also called reflux—and vomit all involve stomach contents coming up from a baby’s esophagus and out of their little mouth. Let’s explore a breakdown of these digestive issues.

Spit-up and reflux

Spit-up is a common occurrence in healthy babies under a year old. You may also hear the condition called reflux, acid reflux, or gastroesophageal reflux (GER).

When spit-up is severe, it’s called gastroesophageal reflux disease (GERD). GERD is not considered typical reflux, and if you suspect your baby may have it, it’s important to see your pediatrician.

Spit-up occurs when a tablespoon or two of breastmilk or infant formula flows out a baby’s mouth (and sometimes their nose) and dribbles down their chin. The gentle rush of liquid may be preceded by a burp.

A baby may spit up within two hours after eating, but often reflux occurs right after feeding. The good news is that, in most cases, spit-up won’t bother your baby. In fact, they may be what’s known as a “happy spitter.” Your baby may give you a big smile as you wipe off their face. The mild regurgitation, which could occur once or several times a day, shouldn’t interfere with your baby’s development either. The spit-up stage typically subsides by the time a baby reaches their first birthday.

Severe reflux and GERD in babies

Mild spit-up and reflux are common in babies, but severe spit-up is not. If your little one is experiencing extreme or worsening reflux or if the issue continues past 12 months, it could point to gastroesophageal reflux disease (GERD). In addition to spitting up, babies with GERD may:

• Lose weight or not gain weight
• Refuse to feed or have difficulty swallowing
• Choke or gag while feeding
• Vomit liquid that appears yellow, green, or tinged with blood
• Cry and seem uncomfortable or sick

Reach out to your pediatrician if your baby is experiencing the above or if you suspect they may have GERD. The condition can usually be managed with some behavior and dietary changes and sometimes medication. Avoid giving your baby any medicines or making dietary changes to your diet or your baby’s without consulting your doctor first.

Vomiting

Vomiting is more forceful than spit-up. Your baby may projectile vomit, meaning the stomach contents will shoot out fast and furious and land a few inches away from their mouth. Unlike spit-up, vomit can be uncomfortable, and your baby may appear ill or unhappy. If your baby is vomiting, it could indicate a potential virus, food allergy or sensitivity, or other health issue, so you’ll want to talk to your pediatrician to figure out what’s going on.

Common reasons why babies spit up and have acid reflux

Still-developing digestive function

A newborn’s gastrointestinal system is still learning to work on its own, so some digestive functions are not quite developed yet.

Not sitting up yet

Babies spend a lot of time on their backs, which can exacerbate reflux.

Overstimulation

Bouncing, tummy time, and other playful activities right after feeding can lead to reflux.

Overfeeding

Your baby’s tiny tummy can fill up fast. What can’t fit may come back up.

Swallowing air

Swallowing too much air while feeding can trigger reflux.

Liquid diet

Your little one’s belly may be a bit unsettled from their all-liquid breast milk or infant formula diet. Spit-up sessions often start to ease as they begin to eat solid foods.

^*Based on a clinical study of Enfamil A.R. infant formula before the addition of DHA, ARA, and prebiotics with infants who spit up frequently (5 or more spit-ups per day), comparing frequency and volume of spit-up after feeding Enfamil A.R. to the same babies at the beginning of the study.