Spitting Up or Reflux? How to Tell What’s Normal and When to Worry

If your baby is used to breastfeeding, the bottle may feel unfamiliar: different texture, flow, position. 

The flow might be too fast or too slow for them. 

The timing might be “late” if bottle introduction happens after a strong breast-feeding routine, babies may resist. 

They might associate feeding with you, skin contact, warmth the bottle might feel disconnected.
 

Let someone else (not mom) offer the bottle, so baby doesn’t feel “cheated”. 

Offer the bottle in a calm, familiar place, when baby is slightly hungry (not screaming) and relaxed. 

Try bottle & nipple combos: slower flow, breast-like shape, soft silicone. 

Make the first few tries playful: let baby “chew” the nipple when empty, then add a few ml of milk.  

Be patient: introduce the bottle before you absolutely need it (e.g., before returning to work), so it’s not rushed. 

Begin the bottle feed when mom is around, so baby is comfortable first. 

Then gradually have someone else feed while mom still present, then step out. 

Use familiar milk (either expressed breastmilk or the same formula) and maintain the same nipple/flow. 

If baby accepts only when drowsy, that’s a sign they associate the bottle with comfort, not hunger, try offering when awake, calm but slightly hungry. 

Many babies spit up after feeds because the muscle “gatekeeper” between stomach and oesophagus is not fully mature.  

If the baby is feeding well, gaining weight, seems comfortable, it’s usually just “physiologic reflux”. 

Curd-like milk is very often normal: milk in the stomach curdles and a small amount comes up. 

But if there is green/yellow fluid, blood, projectile vomiting, poor weight gain — these are red flags. 

Feed smaller amounts more frequently, instead of large feeds 

Burp during the feed (when baby pauses) and after feed.  

Keep baby upright for 20-30 minutes after feed, gravity helps.  

Avoid jostling baby or active play right after feed. 

Make sure diapers are not too tight, avoid pressure on abdomen.  

If baby is not feeding, not gaining weight, spitting up large amounts forcefully, showing green/yellow fluid, blood, or breath-difficulty. 

If spit-up begins after 6 months or continues beyond 12 months — time to check. 

Newborns usually need slow flow (S/XS) so they don’t gulp air or choke. 

If the flow is too fast: baby may cough, choke, gulp too much air – leading to gas and spit-up. 

If it’s too slow: baby may get frustrated and refuse. 

Bottle shape matters: anti-colic venting systems reduce swallowed air → less gas/spit-up. 

Babies switched too late to a bottle after breastfeeding may resist bottles.  

The feeding mechanics differ (breast vs bottle), this mismatch can cause confusion.  

Changing bottle brands/nipples can help according to some studies. 

Look for “anti-colic bottle”, “slow flow” newborn nipple.

Compare venting system, ease of cleaning (extra parts), material (BPA free plastic, or stainless-steel option). 

“Colic” often means intense evening crying for no obvious reason, gas, legs drawn up. 

Tummy time, bicycle leg movements, baby massage can help release gas. 

Some parents use drops (e.g., simethicone) but always consult a paediatrician before starting. 

Warm tummy wrap (safe, thin) for comfort but avoid overheating. 

Keep an eye on feeding: over-feeding or swallowing too much air can trigger gas. 

Make the evening calm: dim lights, fewer stimulus, gentle movements. 

After feeding, hold baby upright (on shoulder or front-carry) for 20-30 minutes. 

Burp mid-feed (when baby pauses) and end of feed. 

Position: semi-upright during feed, avoid flat-lying for bottle. 

Teething, growth-spurts, ear-pain: yes, they can trigger feeding refusal or increased spit-up (baby may swallow more, gape, have pain). 

Sleep position: Even if spit-up, baby should sleep on back (per safe-sleep guidelines) 

Introduce bottle when you (mom) are still home, so baby is relaxed and not missing you hugely. 

Use expressed milk at first (same taste, no formula shock). 

Keep the same pace as usual feed: same nipple/flow, same temperature, same calm environment. 

Gradually increase bottle feeds, reduce direct breastfeeding if the plan. 

Ensure the person feeding baby uses a comfortable position for baby: perhaps semi-upright, quiet room, warm skin contact. 

Don’t make the first few bottles a high-pressure event, avoid doing it when baby is hugely hungry or cranky.