By Kandis Lake, RN
Spit-up is normal. As both a registered nurse and mom to four kids, I've cleaned up more baby spit-up than I can count – both at work and at home. Here's what you actually need to know about reflux in babies, when to worry, and what helps.
What's Normal vs. What's Not
Most babies spit up daily, especially during their first four months. This is called gastroesophageal reflux (GER), and it's completely normal. About 40% of infants experience this daily, with symptoms typically beginning before 8 weeks of life and peaking around 4 months.
The good news? Your baby is probably fine. The majority of "happy spitters" grow out of this phase by 9 to 12 months without any treatment.
When reflux becomes a problem: If your baby shows signs of pain, feeding difficulties, or poor weight gain, they may have gastroesophageal reflux disease (GERD), which does require medical attention.
Why Babies Spit Up So Much
Three main reasons explain why reflux is so common in infants:
Immature muscles: The ring of muscle between the stomach and esophagus (called the lower esophageal sphincter) isn't fully developed yet. It opens when it shouldn't, allowing milk to flow back up.
Liquid diet: Breast milk and formula move easily compared to solid foods.
Lying down: Babies spend most of their time horizontal, so gravity can't help keep food down.
Red Flags: When to Call Your Pediatrician
Most reflux is harmless, but contact your baby's doctor if you notice:
- Frequent, forceful, or projectile vomiting
- Blood or green color in spit-up
- Crying or arching back during or after feeds (signs of pain)
- Refusing to eat or extremely fussy during feedings
- Hard or swollen belly
- Choking, gagging, or breathing troubles
- Poor weight gain or fewer wet diapers than usual
- Vomiting more than spitting up
What Actually Helps
Natural remedies that work:
Feed upright and stay upright: Hold your baby in an upright position during feedings, then keep them upright for 20-30 minutes afterward. Babywearing is often helpful to keep them upright and your movement will also help with digestion.
Burp frequently: Don't wait until the end of the feeding. Burp your baby during natural breaks after every 1-2 ounces of formula or when switching breasts.
Smaller, more frequent feeds: Overloading a tiny stomach makes reflux worse. I learned to offer less at each feeding and feed more often throughout the day.
Check the latch: A poor latch causes babies to swallow air, leading to gas and more spit-up. If you're struggling, a lactation consultant can help evaluate this. With my second, we discovered a tongue tie that was causing both feeding problems and excessive reflux.
Avoid smoke exposure: Keep your baby away from all secondhand smoke.
What your doctor might suggest:
Your pediatrician may recommend thickening feeds with a small amount of rice cereal but ONLY try this if they specifically advise it. They might also suggest eliminating dairy from your diet if breastfeeding, or switching formulas if bottle-feeding.
About Reflux Medications
Medications like H2 blockers and proton pump inhibitors reduce stomach acid but don't actually prevent reflux or spitting up.
These medications (famotidine/Pepcid, omeprazole/Prilosec, lansoprazole/Prevacid) are typically reserved for babies who are:
- Extremely irritable with feeds
- Not eating well or losing weight
- Showing signs of an inflamed esophagus
- Not improving with home treatments
Most babies who do need medication only take it for a few months before symptoms naturally improve with age.
Common Questions I Hear From Parents
Do pacifiers help or hurt? It depends. Pacifiers can cause babies to swallow air, potentially worsening reflux. But they can also prevent the intense crying that leads to swallowing even more air.
For comfort sucking, a pacifier is actually better than constantly nursing, which can overfill your baby's stomach.
Does milk temperature matter? No. Cold, warm, or room temperature milk all work fine for reflux. Just ensure bottles aren't too hot.
Should I use gripe water? Many parents try gripe water (which typically contains fennel and ginger), but there's no solid evidence that it helps reflux specifically.
Can I still breastfeed? Absolutely. There's no need to stop breastfeeding because of reflux or GERD. Breast milk is still ideal for your baby.
Safe Sleep Still Applies
Even with reflux, always place your baby on their back to sleep on a firm, flat surface with no surrounding blankets or pillows. Don't use sleep positioners or elevate the mattress – these increase SIDS risk.
What to Expect: The Timeline
Reflux typically appears around 2-3 weeks of age and peaks at 4 months. After 6 months, when babies sit up more and start eating solid foods, symptoms usually improve. Most cases resolve by 9 to 12 months.
One of my babies had reflux until nearly her first birthday. It felt endless, but it did eventually resolve completely.
The Bottom Line
Reflux is messy and frustrating, but it's usually not dangerous. The vast majority of babies outgrow it without medical intervention. Focus on keeping feedings upright, burping well, and offering smaller amounts more frequently.
If you're concerned about your baby's symptoms—especially if they seem in pain or aren't gaining weight well—don't hesitate to reach out to your pediatrician. They can help determine whether your baby needs further evaluation or treatment.
About the Author: Kandis Lake is a freelance writer, registered nurse, and mom to four kids. She writes to educate, empower, and tell stories. You can also find her reading a good book or daydreaming about travel.
Our next reco: Bobbie Infant Formula Review (Plus a Discount Code)
Related Reading:
Leave a Comment