Infants expelling stomach contents can confuse parents about whether it’s normal or a health issue. Differentiating between spit-up and vomit is crucial for knowing when to seek medical attention. This article clarifies their distinctions.
What Is Spit Up?
Spit-up, also known as reflux or regurgitation, is the gentle, effortless expulsion of small amounts of stomach contents. It typically does not cause discomfort. Spit-up usually consists of milk or formula, appearing watery or slightly curdled. The volume expelled is often less than one or two tablespoons.
Common causes include an immature digestive system, specifically the lower esophageal sphincter, which may not be fully developed. Overfeeding, feeding too quickly, or swallowing too much air during feeds also contribute. Spit-up is generally not a concern if the baby is healthy, growing well, and not distressed.
What Is Vomit?
Vomiting involves the forceful expulsion of stomach contents. Unlike spit-up, it can be uncomfortable or distressing for the infant. Vomit varies in appearance, often larger in volume than spit-up, and may have different colors or odors.
Vomiting often indicates an underlying issue, such as viral gastroenteritis. Other causes include food allergies, milk intolerance, or medication side effects. More serious conditions, such as pyloric stenosis, a narrowing of the stomach’s passage to the small intestine, can also cause forceful vomiting.
Identifying Differences and When to Seek Help
Distinguishing between spit-up and vomit involves observing the force of expulsion, quantity, and infant’s demeanor. Spit-up is typically an easy flow, often dribbling from the mouth, whereas vomit shoots out with noticeable force. The amount of spit-up is usually small, a few spoonfuls, but vomit involves a much larger volume.
A baby who spits up is often content and shows no signs of distress. Conversely, a baby who is vomiting may appear distressed, uncomfortable, irritable, or lethargic. Spit-up occurs frequently, often after feeds, as a regular pattern, while vomiting episodes might be sudden, less frequent, or worsening over time.
Seek medical advice if certain warning signs are present. Immediate attention is necessary if vomit is green (indicating bile) or yellow, suggesting a potential bowel obstruction. Vomit containing blood, appearing as red streaks or dark “coffee grounds,” also warrants urgent evaluation. Projectile vomiting, where stomach contents are forcefully ejected, is another concerning sign.
Contact a pediatrician if vomiting is accompanied by fever, severe diarrhea, or signs of dehydration. Signs of dehydration in infants include:
Fewer wet diapers (less than six in 24 hours or no wet diapers for 8 hours)
A dry mouth or lips
Crying without tears
A sunken soft spot (fontanelle) on the head
Other red flags include unusual sleepiness or lethargy, a rash, or severe abdominal pain. Medical consultation is also advised if an infant vomits after a head injury, or if they are not gaining weight or are losing weight.