Spit-up and reflux

Spitting up is common and usually harmless. It happens in about half of young babies, and it's common for a baby under 1 to bring up a little milk during or shortly after a feed without being upset. Babies vary a lot, and most grow out of it.

Normal spit-up

• A mouthful or two of milk that comes up easily, with no effort or crying.
• Your baby seems comfortable, feeds well and keeps growing.
• It usually starts before 8 weeks and gets better by age 1. It drops off a lot around 6 months, once babies sit up on their own.

What can help

• Smaller feeds, more often.
• Burping during feeds as well as after.
• Holding your baby upright during feeds and for a while after. The AAP suggests at least 20 minutes, with calm play after meals.
• Holding off on tummy time right after a feed.

Medicines to reduce acid don't help normal spit-up. Ask your pediatrician before trying any medicine.

Sleep stays the same

Babies with reflux still sleep on their back, on a firm, flat surface with nothing else in the crib. Don't raise the head of the crib. It doesn't reduce reflux, and it isn't safe. The AAP doesn't recommend sleep positioners or nests. Inclined sleepers and anything that holds a baby at an angle aren't safe for sleep either. See the safe sleep guide.

When to call your pediatrician

Call your pediatrician the same day if your baby:

• Vomits with force, or spit-up shoots out.
• Has blood in the spit-up or in their poop.
• Refuses feeds, or keeps being sick and can't keep fluids down.
• Has fewer pee diapers than usual, a sign of dehydration.
• Has a swollen or tender tummy.
• Won't stop crying and is very distressed.
• Is under 12 weeks and spit-up changes to vomiting.
• Has a fever. See the fever guide.

Call your pediatrician during office hours if your baby:

• Isn't gaining weight, or is losing weight.
• Chokes on milk a lot.
• Starts spitting up for the first time after 6 months, still has reflux after age 1, or isn't improving with the steps above.

Get emergency help

Call emergency services or go to the emergency room if your baby:

• Has green or yellow-green vomit.
• Chokes on milk and turns blue or goes limp.
• Has severe trouble breathing, or blue, gray or blotchy skin, lips or tongue.