Newborn Spits Up Formula: Causes, Solutions, and When to Worry

Watching your newborn spit up formula is worrying, surely, as it can feel like your entire focus is ensuring they're getting enough to eat. In most cases, when a newborn spits up formula or breastmilk, it's usually not a big cause for concern. Babies' digestive systems are still developing—and their stomachs are still quite small. Sometimes they self-regulate by spitting up the excess. But how can you help your baby stop spitting up, and when is spit-up something to see a doctor about? Here's what to know.

Table of contents

Why Does My Newborn Spit Up Formula?

How to Reduce Spit-Up in Formula-Fed Newborns

Special Cases: Formula Spit-Up Symptoms

When to See a Doctor About Newborn Spit-Up

FAQs About Spitting Up Formula

Why does my newborn spit up formula?

All babies spit up, although some may spit up more than most. What's key is how your baby seems to feel about the spit-up. If it doesn't seem to bother them when it happens, and if they're growing, gaining weight and developing well, then even if you have a newborn spitting up a lot of formula, it's generally considered normal.

“All babies will spit up in the first 6 months of life, because the valve between the esophagus and stomach is not well formed and becomes functional over time. So, the gut is just a tube. The milk goes down and the milk comes up. Sometimes out of the mouth or even the nose,” says Ari Brown, MD, FAAP.

Note that the amount that your baby is spitting up may look more significant than it actually is—think about a tablespoon of spilled milk. Volume-wise, it's really just a small amount, but it can spread pretty quickly. If you have concerns about your newborn spitting up after formula feeding or breastfeeding, be sure to bring it up with your child's pediatrician.

What is the difference between GER or GERD?

GER is normal newborn reflux. GER is effortless and does not cause discomfort. “It’s a laundry problem. Not a medical problem,” says Dr Brown, “However GERD is D for Disease. It's a problem when the stomach acid comes up into the esophagus and causes pain (and feeding aversion or difficulty settling), or so much volume comes up that babies don't gain weight.”

Understanding newborn digestion

At birth, your baby's stomach is about the size of a toy marble, and by day 10, it's about the size of a ping-pong ball—those tiny tummies can't hold very much food at one time. Babies' digestive systems are still considered immature for at least the first six months of life.

Breastmilk or formula (or a combination of the two) are all they need to grow and thrive in this first half of their first year—but they may also go through phases where spit-up seems more common.

It's important to recognize what's considered to be normal spit-up and what's considered vomiting, as vomiting could signify a food intolerance or digestive issue that's more critical.

Spit-up in babies is usually a gentle regurgitation of a small amount (think 1-2 tablespoons) of stomach contents that dribbles out of the mouth or nose. (Yes, it's normal if your newborn is spitting up formula through their nose.)

Vomiting in babies is a more forceful projection involving big muscle groups, and may involve the full contents of the stomach, including yellow or greenish bile. Vomiting in infants is a cause for concern and should be investigated by a doctor.

Common reasons for formula spit-up

There are several reasons why a newborn spits up formula or breastmilk:

Air swallowed during feeding

If a baby is taking in too much air with their breastmilk or formula (you might notice them gulping), it can cause their tiny bellies to fill up more quickly, leading to possible spit-up.

This could be related to an improper latch or feeding position that might inadvertently be increasing their air intake.

Signs of improper latch or feeding position:

Baby makes clicking or smacking sounds while feeding
Baby's lips are tucked in when feeding
Latch seems shallow on the nipple or bottle nipple
Milk leaking from corners of mouth
Fussiness and frequent pulling away during feeds

Perhaps you're seeing your newborn spit up breast milk but not formula? Be sure to check the feeding position and latch. A certified lactation consultant can help assess your baby's latch on both breast and bottle to ensure it's sufficient.

Quickly changing positions after feeding

Changing positions after eating can cause the esophageal sphincter to open up and release some of the stomach contents back into the mouth. The best way to avoid this is to keep baby's head elevated above their heart for at least 20 minutes after eating, and to avoid vigorous playtime immediately after feeds. You might also want to change the baby's diaper before their feeding session begins to avoid having to lay them down soon after eating.

Overfeeding

It's difficult to overfeed a breastfed baby, as breastmilk tends to flow more slowly out of the nipple, and babies will often self-regulate and stop sucking when they're full. With bottle feeding, overfeeding can be slightly more common, as the bottle nipple may deliver formula or breastmilk faster. Be sure to watch for signs your baby is full and take regular breaks for burping.

Signs of overfeeding include:

Excessive spit-up
Gaining weight faster than recommended
Refusing the bottle or pushing it away
Gassiness and stomach pain

Gastroesophageal reflux

Mild reflux can be common in infants during the first year and will generally lessen with time as their tiny digestive systems mature. Be sure to raise any questions about possible reflux with your baby's pediatrician, who can assess their symptoms and severity and suggest a treatment plan, if needed.

Formula intolerance or food allergy

Wondering if your baby has a formula intolerance that could be causing their spit-up? Keep an eye out for the following symptoms of formula intolerance1 and be sure to make note of any concerns for your pediatrician.

Signs of formula intolerance in babies:

Baby seems uncomfortable after feedings
Inconsistent bowel movements
Extremely fussy and/or difficulty settling or staying asleep
Struggles with gas and bloating

Rarely, some infants may have a cow's milk protein allergy (CMPA), which means they are allergic to the proteins in cow milk-based infant formula. While CMPA is rare, affecting just 3% of infants, your child's pediatrician may recommend an extensively hydrolyzed infant formula (sometimes called hypoallergenic or HA infant formula).

How to reduce spit-up in formula-fed newborns

Looking to reduce your newborn's spit-up? Follow these best practices when it comes to feeding, and be sure to speak with your child's pediatrician to determine if an infant formula switch or adjusted amount of infant formula is warranted.

Proper feeding techniques

Feeding positioning tips

During feeding, keep the baby in a semi-upright position.
Ensure that during and immediately after feedings, your little one's head is elevated above their body.
Avoid the side-lying feeding position or feeding while the baby is lying flat.

Bottle feeding techniques

Use slow-flow nipples on baby bottles to reduce the speed of milk intake.
Hold the bottle at a slight angle when feeding.
Make sure that when bottle feeding, you're tilting the bottle so that the nipple is always filled with milk—this helps reduce air bubbles.

Feeding pace reminders

Aim to feed your baby in a calm environment
Follow baby's hunger and fullness cues—avoid forcing them to finish a bottle if they're showing signs that they're full
Take short breaks during bottle feeding to allow for natural pauses

Burping techniques to minimize spit-up

If your baby is having trouble keeping down formula or breastmilk, it can be helpful to stop midway through the feeding to burp the baby, and again at the end of feeding. For bottle-fed babies, that means burping after the first 2-3 ounces.

Here are several burping methods to try:

Over-the-shoulder: Holding baby's chest against your chest, support their head and neck, with their head above your shoulder. Gently pat or rub baby's back, helping them to release any gas bubbles.
Seated lap method: Sitting baby on your lap, support their chest and head with one hand. Gently rub or pat their back with your other hand, leaning them slightly forward to encourage a burp.
Lying across lap method: While seated and with your feet on a flat surface, gently place baby tummy-down across your lap, working to support their head so it stays higher than their chest. Gently pat their back or rub in a circular motion.

Adjusting formula feeding amounts

It's best to consult with your pediatrician first before adjusting infant formula feeding amounts for your infant. Aim to keep a tracking log of how much infant formula or breastmilk your baby is currently consuming on average in a 24-hour period, along with their diaper output. At your next well-child visit, share these data points with your child's pediatrician, who can assess proper weight gain and healthy growth and make sure that the feeding amounts are sufficient.

Switching to different formula

Formula intolerance can be a cause of excess spit-up in babies, and it's worth keeping an eye on how your baby is tolerating their current infant formula. "Babies who spend several hours a day crying and have extreme difficulty settling, and/or who are constantly spitting up, and/or have constipation, and/or who have severe eczema should be evaluated by their pediatrician to discuss making a formula switch," says Dr Brown.

In some cases, switching to a gentle infant formula may be helpful, as this type of formula features partially smaller proteins that can be easier for babies to digest.

For babies who have difficulty digesting traditional cow milk-based infant formula, you may consider switching to goat milk-based infant formula, which features a protein composition that's more similar to breastmilk than cow milk-based infant formula.2 Discuss this with your pediatrician.

"Goat milk protein is naturally more similar to human milk protein, and as a result, babies have fewer issues with discomfort," says Dr. Brown. Goat milk protein naturally contains more Beta casein, similar to human milk, and less Alpha-S1 casein, Dr. Brown explains, which is a key component of cow milk protein. "It's this combination that makes goat milk protein more easily digested," she says.

However, if your infant is diagnosed with CMPA, goat milk-based infant formula is not recommended, due to potential cross-reactivity of the milk proteins.3

Special cases: Formula spit-up symptoms

Watching your newborn spitting up after formula feeding can be worrying, for sure. Here's how to tell if it's a cause for concern.

Normal vs concerning spit-up

When it comes to spit-up and babies, here's what's considered normal:

Small amounts of spit-up (1-2 tablespoons; or about a mouthful or two)
Gentle flow or effortless dribble out of mouth
Occurs shortly after feeding
Baby seems content and is gaining weight despite frequent spit-up
Spit-up decreases as baby gets older

The following signs could be more cause for concern, or specifically, could be signs of gastroesophageal reflux disease (GERD) in infants:

Frequent spitting up and/or vomiting
Crying, discomfort or irritability that seems unusual for your baby
Refusal to nurse or drink or only eating small amounts
Arching back during/after feeding
Slow weight gain or losing weight
Vomiting blood
Wheezing or cough
Noisy breathing

If your infant is showing any of the above possible signs of GERD, have them evaluated by their pediatrician for best next steps.

Difference between spit-up and projectile vomiting

Spit-up is typically described as a gentle flow of undigested milk from the mouth—you might see it dribble out. Baby typically remains comfortable and generally content when this happens, and it usually occurs during or shortly after a feeding.

Projectile spit up, on the other hand, is usually described as a forceful ejection of stomach contents—it may even project several inches or feet.

Spitting up through the nose

Watching your baby spit up through their nose can cause you as their caregiver some discomfort—it seems like it might hurt! But as long as your baby seems relatively unbothered, it's not a major concern. Due to the anatomical connection between the nose and throat, spitting up through the nose is still considered generally normal, though it may happen more when your baby is lying down. The immature sphincter muscles sometimes allow for the regurgitation of stomach contents to come back up through the mouth—and even out the nose, causing what's known as nasal reflux.

The best way to reduce your newborn spitting up formula through nose is to:

Keep baby upright after feeds
Ensure a more upright position during feeding
Use a slow-flow nipple on baby bottles
Clear nasal passages with saline drops if needed

Be sure to speak to your child's pediatrician for more tailored recommendations.

Newborn yellow spit up in formula-fed babies

When you see your baby spit-up yellow liquid, it could be partially digested infant formula mixed with bile. When seen in conjunction with other more serious signs, like forceful vomiting, refusal to eat or trouble gaining weight, this could be a sign of an underlying condition that's definitely worth speaking to your pediatrician about.

When to see a doctor about newborn spit-up

Red flags to watch for

Be sure to seek immediate medical care for your newborn if you notice the following signs:

Blood in spit-up or vomit (may appear bright red or dark brown, like coffee grounds)
Blood in stool
Projectile vomiting in large amounts, especially if occurring repeatedly, and if seems painful, or is green or bright yellow in color
Difficulty breathing or choking
Signs of dehydration, like reduced diaper output, dark urine, lack of tears when crying, sunken fontanelle
Weight loss or poor weight gain
Refusing feeds
Taking in significantly less formula than usual
Not urinating at least every 8 hours by day 3 of life

Contact your child's pediatrician immediately if you notice any of the above symptoms.

FAQs about spitting up formula

Is it normal for newborns to spit up formula?

Yes, spitting up is very normal in newborns, with some estimates showing that around 70% to 85% of newborns spit-up daily by the age of 2 months.4 This generally happens because of the immaturity of the esophageal sphincter. Spit-up frequency tends to decrease as babies get older, typically around 6 months but can continue up to age 1.5

Does spit-up mean I’m overfeeding my newborn?

Not necessarily, but it is possible. Keep a log of your baby's feeding patterns including how much formula or bottled breastmilk they drank (or how long they breastfed) and how frequently they fed in a 24 hour period—keeping track of this for several days or weeks will help you have a good picture of your baby's feeding schedule to share with their pediatrician, who can help determine if you should adjust their feeding amounts.

How do I know if formula isn’t agreeing with my baby?

Signs of formula intolerance include:

Baby seems uncomfortable after feedings
Inconsistent bowel movements
Extremely fussy and/or difficulty settling or staying asleep
Struggles with gas and bloating

If your baby is showing several of these symptoms consistently, be sure to bring it up with your pediatrician, who can help determine if a formula switch is necessary.

Can I switch between breastmilk and infant formula?

Yes, you can switch between breastmilk and infant formula feeding for your baby (this is known as combination feeding) and offer them each to your baby throughout the day. This can also help the primary feeding parent get more support in feeding from other caregivers. Here are a few tips on getting started with combination feeding:

Introduce formula how it works best for you: right away, gradually, or by giving breast milk first then following with formula (called topping off)
Maintain a consistent breastfeeding and pumping schedule, if desired, to keep milk supply up
Choose an infant formula type that works well for your baby: goat milk-based infant formula is often very well tolerated by breastfed babies as it's more similar in protein composition to breastmilk than cow milk-based infant formula.

How do I stop my formula-fed baby from spitting up?

Newborn spitting up a lot of formula? It can be stressful to watch your baby dribble out all that good milk or infant formula you just fed them, but as long as they still seem content, are gaining weight and growing well, it's not a significant cause for concern. Check your baby's feeding position and aim to sit them slightly more upright. Burp them frequently, building in natural pauses, but also aim to make sure that when feeding, the bottle nipple is full of milk. Switch to a slow-flow nipple size to help control intake, and keep baby upright after feeds for about 20 minutes. Also ask your doctor if you should consider feeding smaller amounts of formula more frequently to reduce the chance of spit-up.

Remember, spit-up happens

Spitting up in newborns is very common, and should decrease in frequency as your baby grows. Their gut matures, specifically the esophageal sphincter, by around 6 months of age. In the early months, it can seem alarming to watch your baby spit up breastmilk or formula, but keep a close eye on their symptoms and signs and how satisfied they seem after feedings. Be sure to bring up any concerns with your child's pediatrician, especially if you notice any unusual symptoms or different feeding patterns. Your baby's doctor is your best resource for any questions you have about your baby's feeding needs.

References

Bajerova K, Salvatore S, Dupont C, et al. The Cow's Milk-Related Symptom Score (CoMiSS™): A Useful Awareness Tool. Nutrients. 2022;14(10):2059. Published 2022 May 14. doi:10.3390/nu14102059
Park YW, Haenlein GFW. Handbook of milk of non-bovine mammals. 2nd ed. 2017, Ames, Iowa: Blackwell Pub.
Mansor M, Al-Obaidi JR, Ismail IH, Abidin MA, Zakaria AF, Lau BY, Mohsin AZ, Sukor R, Selamat J, Mahmud NK, Jambari NN. Cross-reactivity analysis of milk proteins from different goat breeds with cow’s milk allergens using a proteomic approach. Molecular Immunology. 2023 Mar 1;155:44-57.
Czinn SJ, Blanchard S. Gastroesophageal reflux disease in neonates and infants: when and how to treat. Paediatric Drugs. 2013;15(1):19–27. doi:10.1007/s40272-012-0004-2
Vandenplas Y. Chapter 10: Gastroesophageal reflux. In: Guandalini S, Dhawan A, Branski D, eds. Textbook of Pediatric Gastroenterology, Hepatology, and Nutrition. Springer International Publishing; 2016:105–130.