Milk on your shoulder after a feed is part of life with a baby. But when more comes up, or it comes out with force, it is hard to know whether it is still normal. Understanding spitting up vs vomiting helps you relax about everyday spit-up and recognise when your baby might be unwell.
Quick answer: spitting up vs vomiting
- Spitting up: an easy flow of milk from the mouth, often with a burp; your baby seems comfortable.
- Vomiting: a forceful bringing up of stomach contents; your baby may seem distressed or unwell.
- Spit-up is very common and usually improves by 12 months.
- Warning signs: green or bloody vomit, projectile vomiting, dehydration or poor weight gain.
Spitting up
- happens during or soon after feeds
- flows gently out of the mouth
- your baby is usually happy and gaining weight
- caused by an immature valve at the top of the stomach. See baby reflux
Vomiting
- forceful, sometimes shooting out
- larger amounts
- may come with fever, diarrhoea, crying or tiredness
- often caused by tummy bugs or other infections. See baby vomiting and diarrhea
Reducing spit-up
- Feed upright and keep your baby upright for 20 to 30 minutes after. See baby feeding positions.
- Burp during and after feeds.
- Offer smaller, more frequent feeds.
- Avoid tight nappies and clothes around the tummy.
- Avoid active play straight after feeding.
How much is too much?
Spit-up often looks like more than it is; a tablespoon of milk spreads widely on fabric. If your baby has plenty of wet nappies and is growing well, spit-up is unlikely to be a problem.
When to talk to your doctor
- green, yellow or bloody vomit: seek urgent help
- projectile vomiting after most feeds, especially between 2 and 8 weeks
- signs of dehydration, such as fewer wet nappies or a dry mouth
- poor weight gain, or refusing feeds
- vomiting with fever, a swollen tummy or unusual sleepiness
- spit-up starting after 6 months
Frequently asked questions
Should I feed my baby again after they spit up?
You can offer a feed if your baby seems hungry, but do not force it.
Is curdled spit-up a concern?
No. Milk curdles when mixed with stomach acid.
Can my baby choke on spit-up while sleeping on their back?
Healthy babies protect their airway. Back sleeping is still the safest position.
Sources
- NHS: Reflux in babies; Vomiting in children and babies
- American Academy of Pediatrics, HealthyChildren.org: Spitting Up in Babies
This guide is general information, not medical advice. If you are worried about your baby, contact your doctor.