Newborn Vomiting vs. Spitting Up: A Parent’s Guide to What’s Normal

Mar 05, 2025

Is your infant vomiting or spitting up? Pediatrician Cindy Gellner, MD, breaks down the sometimes-confusing differences with practical advice and explains the mechanics behind each response. She also outlines clear signs of when spitting up might be symptomatic of something more serious like pathologic reflux or anatomical issues, guiding parents on how to respond effectively.

Transcript

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Understanding Your Baby’s Symptoms: Spitting Up vs. Vomiting

Parents come in often telling me their baby is vomiting, and after we talk a little, it's clear the baby isn't vomiting. They're spitting up. To a pediatrician, there is a big difference between those.

If your baby has true vomiting, that can be a medical emergency, especially if it's due to a blockage in the digestive system or a virus that can lead to dehydration.

Spitting up, on the other hand, yeah, we expect that. The muscle at the bottom of the esophagus stays pretty open until babies get older and start sitting and walking and strengthening their abdominal muscles. Food doesn't know it's only supposed to go one direction. So if there's a gas bubble or your baby has too much food in their stomach, it will come back up, usually with that burp or while lying down.

When to Be Concerned About Vomiting

True vomiting in a baby is more concerning because they can get dehydrated quickly, and often, it makes us worried there is an anatomical problem, like a blockage. If we are concerned about a blockage, your pediatrician will send them to the emergency room for an urgent evaluation with an ultrasound or other imaging and possibly get surgeons involved. If we are concerned about dehydration, your baby will also be sent to the emergency room for IV fluids.

Recognizing Pathologic Reflux

Finally, there is reflux, pathological reflux, not just normal physiologic reflux, which is spitting up due to those weak muscles. Your pediatrician will be able to tell the difference. My boys had pathological reflux, and it was very clear. They would have breathing issues with feeds. They weren't gaining weight properly, and when they spit up, it was very forceful and painful. In those cases, we can give babies medicine and hopefully can let them outgrow their doses as they get older. Sometimes, like my kids, they need to go to the operating room or have additional testing by specialists to determine if there are other anatomical causes to their symptoms.

There are big differences between spitting up, true vomiting, and pathologic reflux. Your pediatrician will be able to help you figure out which your baby has, what you can do to help them, and when you need to worry.

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