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On Call: Why Babies Spit Up

Q. Our pediatrician says our 6-week-old baby is a "happy spitter." What does that mean?

A. Your doctor probably means that your child has a mild case of gastroesophageal reflux. This condition, in which the stomach's contents tend to come back up the esophagus (and onto your infant's clothes, or you!), is normal and usually nothing serious—more than half of all babies under the age of 3 months have it.

It happens because babies' digestive systems are still developing; most outgrow it by a year or so. Until then, try:

  • Holding your baby upright after feeding him—gravity helps keep food down.
  • Giving him smaller portions more often.
  • Adding rice cereal, if he's formula-fed, so it's more likely to stay in the stomach. (Check with your doctor first, since this isn't usually recommended for infants.)

When is spitup a concern? If your baby:

  • Has "projectile" vomiting—meaning it shoots out several inches, Exorcist-style. This may not be reflux but something more serious, like a bacterial infection.
  • Isn't gaining weight.
  • Cries when he spits up or is generally very cranky. His esophagus could be irritated (which may require medication).
  • Is having trouble breathing or is coughing a lot, which could be due to spitup getting into his lungs.
  • Has a fever, diarrhea, constipation, or blood in the stool, or is lethargic.

If you see these signs, call your doctor for further treatment.