My baby spits up a lot. Do I need to change her formula? Is it the iron? 
Is she getting enough to eat?

All babies spit up at one time or another, some more than others. 

We all have a sphincter between our esophagus and stomach that loosens when food and liquid go down, but tightens while the stomach churns the food to prevent everything from coming back up. Infants tend to have a sphincter that is a little loose, resulting in spit-ups. There are other reasons babies might spit up. Pressure on the belly (many women who have experienced pregnancy can attest to this) can overcome the resistance in the sphincter and lead to stomach contents coming up. Some babies whose stomachs are irritated for whatever reason will spit up or vomit (e.g. stomach virus or formula allergy). Finally, obstruction somewhere between the mouth and intestines can also cause spit ups or vomiting.

Most spitting by babies is completely benign, nothing to worry about. If your baby is generally happy, growing well, and does not have frequent cough or gagging, nothing more than buying extra spit cloths is necessary. As the famous bib slogan says, “spit happens”. I often find that parents think their baby spit up the whole feed. That is rarely the case. Try this experiment at home. Pour 3-4 oz of water in a glass and watch it as you throw it into the sink. Then compare that to the amount of milk that comes out of your baby’s mouth.

There are some simple steps to reduce spitting. Keep your baby upright for 20-30 minutes after feeds. Decrease the volume of feeds, but increase the frequency (for example, instead of 4 oz. every 4 hours, give 3 oz. every 3 hours). Breastfeeding certainly helps as breast milk leaves the stomach and passes into the intestines more quickly than formula. If you are bottle feeding, I can promise you that iron is not the reason. Formula fed babies need the extra iron in formula (iron in formula is not as well absorbed into the infant’s body, so they need more). A low iron formula just about guarantees the infant will have anemia.

The following lists circumstances in which spitting may be concerning:

1. Is your baby unusually fussy throughout the day? (Read our section on colic in the Newborn Booklet; colicky babies tend to be fussy mostly toward evening, extreme fussiness throughout the day suggests another problem) . Does your baby seem unsatisfied after feeds? Does he/she arch her back during or after feeds? Does he/she seem hungry all the time, yet pulls back from the breast or bottle when offered. Your baby may be having severe heartburn (burning in the esophagus) and should be seen within a day or so.

2. Are the contents of the spit up green? This may be a surgical emergency; your baby needs to be seen immediately.

3. Is your baby regularly gagging, coughing, or turning blue during feeds? If so, have her seen for this. There may be an obstruction or abnormal connection between the esophagus and windpipe.

4. Are the spit ups occurring quickly after feeds and progressively more forcefully as days go by? Call your doctor or nurse practitioner, as there may be a developing obstruction in the stomach outlet called pyloric stenosis. If your baby does not appear ill or lethargic and is well hydrated (wetting at least one wet diaper every 6-8 hours, mouth looks wet, soft spot on scalp is not sinking in when you have him sitting up), an urgent trip to the emergency room may not be necessary. While this typically requires surgical correction, the surgery is not needed urgently like in the scenario with green vomiting.

5. Does your baby have an associated fever? Please refer to our fever blog.

6. Have you seen blood or mucus in your baby’s stools? This could be a sign of formula allergy or intestinal infection (if you have a pet reptile, salmonella is a concern!). Call your doctor or NP.


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