Spit-up or Vomit—How Can You Tell the Difference?

Your baby just spit up. Or maybe he vomited. You’re not sure which it was or whether you should be worried. If he spit up, probably not. Baby spit-up isn’t usually an issue. 

Also known as reflux, spit-up is simply the flow of food from your little one’s stomach to his mouth.  

It’s common, not painful, and might happen from time to time until your baby is about a year old. Baby spit-up is often just the result of a still-developing digestive system or overfeeding. 

The difference between spit-up and vomit is outlined below. If you have further questions or concerns, contact your healthcare provider.  

Spitting up is a common occurrence in healthy infants early in life. This is partly because of immaturity of their digestive system. It’s relatively harmless and usually resolves as the digestive system matures, when your baby reaches 12 to 14 months of age.    

Spit-up is sometimes called by other terms like “regurgitation” and “gastroesophageal reflux.” They’re just fancier ways of saying spit-up, with a minor difference. Regurgitation and reflux refer to the backwards movement of the stomach (gastric) contents up into the esophagus—and at times into the mouth. When the contents of your baby’s tummy spill out of his mouth, it’s called spit-up.

It’s all about tummy size. At birth, your baby’s tummy is about the size of a small marble. After 3 days, it is about the size of a ping-pong ball, but still can’t hold much.¹ Until he’s about 4 months old, your baby’s tummy can hold only small amounts of milk at a time. Too much milk during feedings can cause your baby to spit up or be fussy.  

Babies also have less developed muscles in the upper esophagus, which makes it easier for fluids to flow back up from the stomach.  

Spitting up can also happen when your baby burps (called a wet burp) or swallows too much air. It isn’t painful to your baby, and most babies don’t even realize they have done it.

As long as your baby is healthy and gaining weight, spit-up should be seen as just a normal part of his development.  

It may look like a lot when it’s on your shirt, but the amount of liquid your baby spits up isn’t as much as you think. Usually, it’s just 1 or 2 tablespoons at a time. If your baby spits up more than this—or if his spitting up is the effect of respiratory events like choking, coughing, or wheezing—ask your pediatrician if there is a reason to be concerned. 

To help your baby spit up less often, here are a few things you can try: 

• Hold him in a more upright position while feeding 
• Burp him after every 1 to 2 ounces while feeding 
• If you bottle-feed your baby, make sure the hole in the bottle's nipple is not too large. If milk drips out when you turn the bottle upside down, replace the nipple with a smaller one 
• Keep your baby upright after eating. Laying him flat on a full stomach can lead to spit-up 
• Avoid too much activity for your baby immediately after he eats 
• Feed your baby less food, but more often 

Your newborn will probably be hungry 6 to 10 times in a 24-hour period. As he grows, so will his stomach, so he’ll begin to eat more at each feeding and eat less often, as the chart below shows.

The best way to feed your baby is to allow him to take as much as he seems to need. If he’s fussy and has not been fed in more than 2 hours, it is probably time for a feeding.  

When spitting up begins to make your baby uncomfortable, and more liquid than usual comes up with greater force, this is probably vomit. When a baby vomits more than once, it’s usually caused by a virus. Viruses usually aren’t dangerous, but they can cause your little one to get dehydrated. If your baby is less than 1 year of age, he is at more risk for dehydration. Consult your healthcare professional immediately if you think your baby might be dehydrated.  

When your baby has a sudden bout of vomiting along with diarrhea, it usually means he has a virus. A virus usually isn’t dangerous, but it can lead to dehydration, which can be a serious problem. It’s important to know these signs of dehydration in your baby: 

• Fewer wet diapers than normal 
• Seems very tired or weak 
• Has tearless, sunken eyes
• Has dry skin and little saliva  

The younger your baby, the more concerned you should be about dehydration. There are things you can do to help when your baby is ill. Replace the fluids your baby is losing by giving him small, frequent feedings. In many cases, an oral rehydration solution such as Pedialyte^® is recommended. Check with your healthcare provider for advice. 

Although it can be alarming, an occasional vomiting episode is usually nothing to worry about. If your baby vomits often, this can be a sign of reflux disease, intestinal obstruction, infection, or a protein allergy. Get in touch with your pediatrician if your baby's usual spit-up: 

• Increases in amount or force 
• Causes choking or respiratory difficulty like wheezing or coughing 
• Leads to other issues including discomfort, fussiness, poor weight gain, or weight loss 
• Is accompanied by a fever, diarrhea, bloody mucus, or a bloated tummy 
• Is green
• Is “projectile,” meaning very sudden and with great force  

Repeated vomiting in babies between 2 weeks and 4 months of age can be a sign of a blockage at the stomach. Contact your healthcare professional if your baby vomits repeatedly. 

Consult your pediatrician before changing your baby’s formula. 

Similac^® offers several easy-to-digest formulas designed to be gentle on your baby’s tummy. For help choosing a formula, check out our Tummy Trouble Tool.

Questions about formula feeding? See our Frequently Asked Questions.

References: 1. Spangler AK, et al. J Hum Lact. 2008;24(2):199-205. 2. Behrman RE, et al. Nelson Textbook of Pediatrics. 16th ed. Philadelphia: WB Saunders Co; 2000:165. 3. Samour PQ, et al. Handbook of Pediatric Nutrition. 3rd ed. Sudbury, MA: Jones and Bartlett Publishers; 2005:90. 4. Fomon SJ. Infant Nutrition. 2nd ed. Philadelphia: WB Saunders Co; 1974:24.