Spitting up soon after a feed is completely normal for young babies. Their digestive tracts are immature and the muscle connecting the esophagus and the stomach (the lower esophageal sphincter) may need a little bit more time to develop and strengthen (which will happen with time). If your baby is happy and growing well, and doesn’t seem uncomfortable, occasional spit-up is no cause for concern (other than loads and loads of laundry). This usually resolves by 6-12 months of age.

However, if you notice that your baby is spitting up or vomiting often, shortly after breastmilk or formula feeds (or even a couple of hours afterwards), it may mean one of three things:

Possibility #1: Your baby is being over-fed or fed too fast

If you’re breastfeeding and have a forceful let-down, an over-supply of milk or over-full breasts, your baby may be feeding too fast and perhaps drinking too much in a short period of time, which could be causing her to spit up or vomit soon after. The amount of spit-up usually seems much more than it actually is. Parents might worry that their babies aren’t actually keeping enough milk down. This generally isn’t the case at all.

If you think this is the case for you (it was for me!), it might be a good idea to have a meeting with a lactation consultant who can give you some tips on how to slow the flow of milk and manage your supply. I know for me, feeding from one breast over the period of a few hours (block feeding), manually expressing some of the fore milk that forcefully comes out at the beginning of each feed prior to latching my baby, and limiting the time that I fed all helped to regulate my supply and therefore prevent my baby from constantly spitting up after feeds.

If you’re bottle feeding your baby (or breastfeeding for that matter), it’s important to closely watch your baby’s cues when they are feeding. If your baby shows any signs of being done (slows down his sucking significantly, turns his head away or starts “playing with” the nipple), than he’s likely done. Forcing the bottle back into your baby’s mouth so that he finishes the feed, or turning your baby’s head to continue breastfeeding (to empty your breast let’s say) is not a good idea and will likely result in baby over-feeding and spitting up or vomiting afterwards. Watch your baby’s cues closely. He will actively suck on his own if he is still hungry.

Possibility #2: Your baby has GER (Gastroesophageal Reflux)

This simply means that the breastmilk or formula that has made its way down to your baby’s stomach, is returning up the esophagus and into (and out of) the mouth. GER effects about 40 to 65 % of babies ages one to four months and typically resolves around about one year of age.

What causes GER in babies?

Simply put, in most cases, GER is a result of an immature digestive system. It takes some babies a little bit longer than others to develop a strong and fully functional digestive system. The muscle connecting the stomach and the esophagus (esophageal sphincter) seems to mature fully by about 6 to 12 months of age (this ranges from baby to baby), allowing most babies to grow out of the “spit-up” phase by their first birthdays.

In most cases, reflux is harmless and normal, especially if you have a happy baby who is growing well.

Possibility #3: Your baby has GERD (Gastroesophageal Reflux Disease) or another serious condition

While most cases of GER are no cause for concern, occasionally babies suffer from what’s known as Gastroesophageal Reflux Disease (GERD) which is more severe version of GER, or even more worrisome, a gastrointestinal obstruction. These possibilities are very rare, but nonetheless good to be aware of.

If your baby is failing to thrive (not gaining weight or losing weight), refuses to eat, frequently vomits forcefully (projectile), frequently spits up large amounts (and/or unusual colours such as green or yellow) these might be signs that there is a more serious problem that needs immediate attention from a pediatrician. Severe reflux that continues for more than two to three months can cause damage to a baby’s stomach, esophagus and throat.

Even though GER–the more typical, and less problematic, root of the cause for your baby’s spitting up or vomiting–isn’t harmful, it can be worrisome, and let’s be honest–messy! Here are five top tips for preventing, managing and minimizing GER symptoms in your baby:

Top five tips to prevent GER and frequent spitting up in babies

1) Feed on demand, ideally in smaller, more frequent meals

Whether breast or bottle-fed, your baby may experience less reflux and spit up episodes if offered smaller, more frequent “meals” (versus fewer and larger feeds). If you’re breastfeeding, try cutting back on the amount of time you spend nursing if you find that your baby is getting too full and spitting up after feeds. If your baby’s stomach becomes too full, this puts pressure on their lower esophageal sphincter (mentioned above), which can cause it to stop doing what it’s supposed to do (keep stomach contents down) and allows stomach contents to creep back up. Feeding on demand, following your baby’s cues closely, is the best bet.

2) Burp your baby more frequently

Burping your infant during and after each feed is important in order to relieve some of the pressure in the stomach, helping to prevent reflux. Continue to burp every hour or so after a feed if you find that your baby is gassy.  Burp bottle-fed infants often during feedings–about every one to two ounces. If you’re breastfeeding, burp your baby every time he or she pulls off of the nipple.

3) Experiment with different nipple sizes

If your baby is bottle-fed, he or she may be drinking either too fast, or too slow–both of which can cause excess gas to form, often triggering reflux and spitting up. The cause of too-fast or too-slow drinking is often the size of the nipple. If the opening is too large, your baby might be guzzling milk too fast, causing the stomach to over-fill with milk and air, and if the opening is too small, he or she will likely swallow excess air, which we now know can spur on reflux. Experiment with different nipples with various shapes and opening sizes.

It may surprise you as to what a difference a nipple can make! Using a nipple shield if you’re breastfeeding can also slow your milk flow, preventing your baby from swallowing air or gulping milk too fast. Talk to a lactation consultant if you’re considering a nipple shield to make sure it’s the best choice for you and your baby.

4) Keep your baby upright at least 30 minutes after feeding

Babies are more susceptible to reflux because they spend a lot of their time lying down, not to mention the fact that their diet is mostly of liquids AND the muscle tone of their esophageal sphincter isn’t fully finished developing. It’s a good idea to keep baby upright for about 30 minutes after a feed. This will allow gravity to do its thing–help the milk make it’s way down the digestive tract (and stay down). You can also elevate the head of your baby’s crib by rolling a towel or using a wedge pillow (to about 30 degrees) so as to slightly elevate your baby while sleeping.

5) Continue to breast-feed

At this point, there is no research to show that a mother’s diet causes reflux in her breast-fed baby. (Although many believe that it does). See a Registered Dietitian Nutritionist, who can help you with an elimination diet if you feel strongly that your diet is effecting your baby’s digestive health. Talk to a lactation consultant for help if you feel your baby’s reflux is a result of physiological breastfeeding issues. (baby isn’t latching correctly, you have an over-supply or under-supply of milk or a fast let-down)

If you’re bottle feeding, your pediatrician may recommend a thickened formula or perhaps a hypoallergenic formula if he or she suspects that your baby isn’t tolerating the proteins the present formula.

Sarah Remmer is a registered dietitian and mom of three. She writes all about kids nutrition over on her blog Nutrition From Stork to Fork. For free daily advice on nutrition for your little ones, follow Sarah on Facebook.