All babies have reflux. Some babies have acid reflux. 

Reflux: backwards flow of milk (when it goes up instead of down). Think “Happy Spitter.”

Acid Reflux: when stomach acid flows back along with the milk up the esophagus, causing heartburn-like pain. This is an “Unhappy Spitter.”

Silent Reflux: acid or non acid spit up that you don’t see come out baby’s mouth. He may seem to throw up in his mouth, then swallow it back down. This may or may not be painful for him.

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

A baby with normal reflux: 

  • Has a small to moderate amount of spit.
  • Is rarely bothered by spitting up.
  • 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.
  • Has spit up that looks like 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.
  • May or may not be hungry after spitting up. More often than not, he would be interested in sucking, but not eating after spitting up (i.e. on a pacifier).  This may surprise you since it looked like he just threw up the entirety of his feeding!
  • Doesn’t mind laying flat on his back (not for too long, Mom, jeez!).

The baby with normal reflux 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. 

A baby with excessive reflux: 

  • Has a moderate to very large amount of spit.
  • Is rarely bothered by spitting up.

Now, there are two 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. Instead, 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 that 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 two minutes.  

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, offer him a pacifier and hold him upright so he can let his brain catch up with his belly. 

A baby with acid reflux: 

  • Seems to be in pain after spitting up.

Sometimes, a baby will spit and then 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 that something is not right. If this is the case, it is time to get your baby’s health care provider involved in the conversation. 

What to do about reflux:

  • Keep the baby upright.

Babies have immature digestive tracts. 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. Holding a baby upright helps keep the food in his tummy and out of his throat. 

During feedings, try to angle the pillow while feeding so baby’s head is higher than his hips. If you think you have too much milk or a fast let down, check out those techniques here. 

A realistic word to the wise:  There is no exact number of minutes that a baby should be held upright in order to decrease the risk of spitting up. Pediatricians will recommend  holding baby upright for as long as thirty minutes after feeding! However much this might be helpful, it is rarely reasonable. Try this: if 30 minutes works, try 25 minutes. Then, try 20. You get the point.

  • 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.

Still not sure what is up with your unhappy baby?

Try this:

The Unhappy Eater: A baby who is crying while eating, popping on and off, or popping off and crying. 

21 Comments

  • […] 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.
    Thanks
    Pamela

    • 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:

    Hi!
    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:

    Hi
    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!