Ah, baby puke. Spit happens, right?  That’s why bibs were invented after all. It can be really troubling when your baby spits up.  Well, let’s start with what’s normal, because the world seems to spend too much time talking about what isn’t normal rather than what is normal.

Just to define these terms real quick: 

reflux- a backwards flow of milk (when it goes up instead of down!)

acid reflux– when stomach acid flows back along with the milk up the esophagus causing heartburn like pain. 

(By the way, I should mention that I have a comprehensive set of online courses on everything breastfeeding, if you’re interested 😉

Normal Spitty Baby: 

The normal spitting baby has a small to moderate amount of milk come back out at you. This baby seems to think nothing has happened at all to him and that sitting is a pool of his own vomit is no big deal.  He may have a mouth dripping with spit up and a big ‘ol smile on his cute fat face. 

The normal spitting baby sometimes chokes on his puke little and it might come out his nose. It bothers him and he may get upset for a minute, but that was probably just because he was scared that he couldn’t breathe for a second.  This kid is upset because he seems startled, not in pain.

The normal spitting baby might spit up chunky “curdled” looking milk or it may look exactly like freshly pumped milk. Neither really mean anything, one was just in his tummy a little longer than the other. 

The normal spitting baby may be hungry after spitting up or he may not.  More often then not, he would be interested in sucking, but not eating after spitting up (ie on a pacifier).  This may surprise you since it looked like he just thew up the entirety of his feeding! 

The normal spitting baby doesn’t mind laying flat on his back (not for too long, mom, jeez!). 

The normal spitty baby we will refer to as a “Happy Spitter.” The spitting up bothers you more than it bothers your baby. The worst problem you have is a laundry problem.  Sorry, this seems to be particularly annoying in the summer months when everything smells like well aged cheese. 

Excessively Spitty Happy Baby: 

This is a happy spitter who seriously spits up ridiculous amounts. Like large amounts. All. The. Time.  Again, he doesn’t seem to care much at all, but you are really sick of being wet.

Now, there are 2 categories here. The well gaining spitter and the poorly gaining spitter.  Pay attention. The advice I am about to give it for the well-gaining spitter.  If you have a poorly gaining spitter, do not follow the following advice (see unhappy spitter below. Because a poor gainer is not a happy baby). 

If you have a well gaining spitter, I am going to bet you have a heavy milk supply. When your baby eats, it is fast and furious. Like, it reminds you of chugging a beer in college.  Five minutes of chugging and he is done.  The problem is, everything you have read (not on this blog of course) says that babies are supposed  to nurse for 15 minutes to get the good milk, right? So you coax your baby to nurse longer. He does it begrudgingly because boob juice is soooo good and he really wants to suck, but then he gets even more  milk and gets even more full in another 2 minutes.  

This is like the Ben & Jerry’s phenomenon.  I am going to go out on a limb here and assume everyone does this, not just me. If that isn’t true, just don’t tell me, ok?

So, you are sitting on the couch with your pint of Ben & Jerry’s (because who eats it out of a bowl?).  You get half way through your delicious Phish Food and realize you are full. BUT, it is SO good. And the freezer is far away.  And it is SO GOOD. And it is almost gone anyway….so you finish off the pint.  Then, you sit there feeling disgustingly overly full, but also really satisfied by that delicious treat. 

That is how your baby feels on your boob.  Except, when he feels that full, he pukes. Then he feels better (no, he is not bulimic).  No biggy, just a big puke to take the edge off and now he is comfortable again. See, he told you when he was done at the half way mark on of the Ben & Jerry’s, but you thought he couldn’t possibly be done in 5 minutes so you coaxed him to take more and he did because it was soooo good.  See the analogy? 

So, if your baby shows you signs that he has taken in a lot very quickly and needs a break, give him a break.  Let him digest a little! If he is looking to suck, give him a pacifier and hold him upright so he can let his brain catch up with his belly. 

See, your baby has a really immature digestive tract. The muscles and flaps that are supposed to keep his food down tend to not work so well all the time and the food just sloshes back up into his throat.  Top that off with being supine all the time and you have weak muscles and gravity working again him.  Fat spit up babies remind me of the passengers on the spaceship in Wall-E. They don’t have the muscle tone sit up let alone keep their food down.  So, that advice to hold your baby upright after feedings really does make sense. Gravity keeps food down.

The Unhappy Spitter: 

Sometimes, a baby will spit and then scream. Blood murder scream. The main difference here is that a mom/dad almost always says “my baby seems like he is in pain.”  This is the most important identifying factor of acid reflux.  Mama’s gut really kicks in and says something is not right.

The best thing to do for this baby is to 

1. Prevent the spitting

2. Lessen the acidity of the spit up 

1. Prevent spitting: 

Use gravity to your favor.  Angle the pillow while feeding, have baby sit upright while feeding. Slow the feeding down by taking frequent breaks to burp and have non-nutritive sucking time on the pacifier so he doesn’t accidentally overeat himself.

2. Lessen the acidity of the spit up: 

Meds. Acid reflux hurts!  It is heartburn after all, so if your baby is having painful spit ups, strongly consider talking to your doctor about medication.

FYI:  Sometimes you need to try a few different types and strengths of reflux medication for it to work. Also, this medication is weight dependent, so as baby gets bigger, the medication may need to be increased in order for it to work better. 

Also, your pediatrician will most likely only be able to handle the basics of managing reflux, so if the first few tries of medication aren’t working, you or he should suggest visiting a pediatric GI specialist.

Remember- reflux and food intolerance are different. I DO NOT recommend taking a whole bunch of foods out of your diet and also treating the reflux with medication. Why? Because then you will have no idea which worked. You will be left without ice cream at night when you might not have needed to inflict that unnecessary torture on yourself.

You might think I am going to be all hippy dippy here and tell you to try eye of newt to get your baby’s reflux to feel better, but I am not.  I am a nurse first. When I or my child is in pain, I medicate it.  Drugs work.  Don’t hate, that is just my philosophy.

The Unhappy Eater: 

Now THIS is a tricky one.  The baby that cries at the boob is really hard to figure out.  Ideally, I would like to watch this baby feed to figure it out for you, but since I can’t be in everyone’s bedroom at 3am, I am going to give you the quick run down of what crying at the boob might be.

1. Too much milk– the firehouse is just too fast for your little baby to keep up with.  This baby may look like he is “choking” but he isn’t because there are no bones in milk. The milk just went down the wrong pipe.  Choking in milk is scary so your baby may pop off and cry because he thinks the boob is trying to kill him.  Just give him a second to catch his breath, hold upright, burp, let you milk passively spray if it needs to,  and then go back to business.

2. Not enough milk- This baby is either impatient or hungry. He sucks furiously, then pops off and cries, then tries again.

3. Something is bugging him- a burp, a fart or, you guessed it, reflux.  This is a baby that occasionally or always fusses at the breast.  If this is reflux, your baby may eat because it feels better or avoid eating because it hurts.  This is when back arching really becomes an obvious sign of reflux because the baby will suck and drink while simultaneously arching back and pulling away from the breast, then pop off and scream.

If you baby has acid reflux, my heart goes out to you because it sure is hard to handle.  Seek help and when the help doesn’t help, seek more help. Reach out to other moms. Go to support group.  And, as much as you don’t want to hear this….this too shall past.  A few hundred loads of laundry and months of sleepless nights later, this will all be a distant moist memory.


  • […] list of reasons why your baby cries so much.  I guarantee your top 3 Dr. Google diagnoses will be reflux, foremilk/hindmilk imbalance and dairy intolerance. Please read my blogs before you commit to any […]

  • […] small signs of spit up, but not at every feeding and not copious amounts. It is notable though that babies can spit up for a lot of reasons. It is not a good idea to follow the advice on this blog just based upon your baby spitting […]

  • Jen says:

    As a new mom with a two week old trying to figure out what “normal” is this post was PERFECT!!! I have heavy milk flow and have found no help in blog posts that say you should feed for 15 mins because he gets too full. You’re amazing. Thank you for the advice!!!

  • […] Your baby most likely didn’t just puke the entirety of his feeding up. But, if he seems hungry after puking, go ahead and feed him […]

  • Chaya says:

    This was amazing! I haven’t yet found an article that accurately describes my baby before this one!! I have now found my new favorite blog!

  • Pamela Banerjee says:

    Katie …you are amazing!!! You said exactly what I go through & just did not know how to word it!!! Now I am OK when my 3 months old baby drinks just 5 mins & done!!! Could you tell me when I should start solids and juices? I hear various suggestions & I am totally confused.

    • KatieIBCLC says:

      Hi Pamela! Welcome to the blog! Ideally, you will wait until about 6 months to start solids. Some mamas opt to start as early as 4 months, but very few babies are developmentally ready at that point. No juice until 12 months and even then, it may not be necessary. Check this out for more info: https://balancedbreastfeeding.com/solids/

  • […] you want more information on reflux, read here. This is an entertaining, education article written by Katie Madden, a well known lactation […]

  • allison says:

    I have an excessively spitty happy baby and your description was spot on! I’m constantly soaked and doing laundry. He eats quickly, will push to catch his breath and then go back to nursing. Unfortunately he is not a fan of his pacifier so I don’t know how to calm him other than nursing and (eventually) over-stuffing him.

  • Kristy Stevens says:

    My son is almost 8 months old and is still spitting up… Is this okay? I’m concerned that this has continued on and on and on.

    • KatieIBCLC says:

      Hi Kristy- as long as he isn’t in pain, he is gaining weight well, and he is otherwise healthy and happy, it probably is ok. I am so sorry to hear you are still having such laundry problems!!

  • Lamia says:

    My daughter is almost 12 weeks old. She is a happy spitter but she’s fussy at the breast except when she’s sleeping. My lactation consultant said it’s oversupply and the pediatrician said it’s acid reflux. I’m confused.
    Well my daughter is so gassy and not bothered to lay down on her back.
    Also when she fusses I bicycle her legs and she calms down but when I put her back to the breast she’ll fuss again, she’ll keep doing that till she sleeps and nurses. Could gas bother her when she nurses.
    Thanks for your help

    • KatieIBCLC says:

      Hi Lamia! I am so sorry you are stuck between two sets of advice. Many moms have this issue where the LC says one thing and the pediatrician says another. It is so hard to know what is right! I can’t know for sure what is going on with your baby since I cannot be there with you, but the best I can suggest is that you follow your intuition. You seem to have found that when your baby’s gas is relieved, she nurses better. It is certainly possible that she doesn’t like to nurse when her belly is full of gas. Typically, a 12 week old won’t cry at the breast from oversupply until after the milk has come at her too quickly. Here is more on oversupply: https://balancedbreastfeeding.com/do-you-make-too-much-milk/

      Keep following your baby and your heart. Keep working with your LC and your doctor. I have my fingers crossed that you will figure out what is best for you and your baby sooner rather than later!

  • Roz says:

    This is a great post. I have a four month old who spits up a ton and then cries in the evenings nonstop. I thought by now this behavior should have stopped, but it’s only worsened! The MD doesn’t seem to think it’s GERD. she sleeps through the night with her head of bed elevated in a Rock and Play. Though she hates Tummy time AND being flat on her back, so is carried a lot. She is so much more work than my first!

  • Nusrat Jahan says:

    A really helpful post for new moms..thank you so much.

  • Heather Hirstwood says:

    I have a 7 week old girl (I would label as an unhappy spitter) that has developed gas issues over the last couple weeks. Every evening, for a few hours, she is crying in distress. It is painful to watch and deal with. She has issues with lying on her back and has also been tummy sleeping for the past 3 weeks. Shortly after this started, I talked to my physician about it but she thinks there is no medication needed because it isn’t affecting her sleep. The only time she seems to be fine is when she is sleeping so it is affecting her QOL when she is awake! I am thinking acid reflux medication is needed, thoughts anyone? This is so frustrating!

  • Nikita Zaveri says:

    Really helpful post! Thank you so much.
    DS is 7weeks today, has started spitting up since a week or more. He is in distress before and briefly after a spit up (sometimes projectile, sometimes milk, sometimes curdled milk, sometimes less and sometimes way too much!) but most times he is a calm and happy baby, smiling and looking content. He doesn’t cry at my breast, drinks milk happily. I try and sing to make him remain calm and not drink too fast. I burp him inbetween a feed as well. He does find it difficult to sleep, I feel he is choking and he makes sounds like it’s difficult for him to breathe. My paediatrician said I should wait, not give medication. I’m happy to not give medication, but hate seeing my little one in so much discomfort (even if it’s for a brief while). But what can I do to help him?

  • Carli Neeman says:

    Thank you for this very informative read for a mom who always worries! I have what would seem an Excessively happy spitter! My question is could caffeine (i.e. I drink a cup of coffee a day and a lot of time make it half caff) also be contributing to this?

  • picaflor says:

    So I was doing the block feeding to get to the hinder and creamier milk. Now after reading your block I kind off want to go back to both breast feeding mostly because she does get sprayed with the let down. Gets too much but its hard to tell when she starts to fuss weather its due to gas, too much milk or is it because she wants more.

    If I do the two breasts; How do I know how long at each breast? Do I have to stop her to change breasts? She never seems to stop on her own. My baby is 5 weeks old.

    I bought a wedge for her crib because I was afraid she wad going to choke on her sleep due to the spits. Are you saying its ok for babies who spit and make weird noises to lay flat? I am so confused..its overwhelming!