Breastfeeding FAQs: Spitting Up, Gagging, and Biting

Breastfeeding can take time and practice to get used to. Here's what you need to know about spitting up, gagging, and other concerns during breastfeeding.

Is it Normal for My Baby to Spit Up After Feedings?

Babies often spit up. Sometimes, it might be when they eat too much, or when they burp or drool. Many infants will spit up a little after some — or even all — feedings or during burping. That's perfectly normal.

As long as your baby is growing and gaining weight and doesn't seem uncomfortable with the spitting up, it's OK. The amount of spit-up often looks like more than it really is. But spitting up isn't the same as forcefully vomiting all or most of a feeding.

What’s the Difference Between Spitting Up and Vomiting?

Vomiting is a forceful projection of stomach fluids. Spitting up is a gentler "flow" of fluids that come up. Babies don’t usually react to spitting up, but a vomiting baby might look upset or cry.

If you're concerned that your baby is vomiting, call your doctor. In rare cases, there may be an allergy, digestive problem, or other problem that needs medical care. It helps to keep track of how often and how much your baby is vomiting or spitting up.

How Can I Keep My Baby From Spitting Up?

If the doctor says your baby's spitting up is normal, here are some things you can do to help lessen it:

• Burp your baby after each feed from each breast. Sometimes giving smaller feeds more often can help, rather than giving larger-volume feeds.
• Keep your baby upright after feedings for at least 30 minutes. Holding your baby is best, since the way a baby sits in an infant seat can actually make spitting up more likely.
• Don't jiggle, bounce, or actively play with your baby right after feedings.
• Keep your baby's head above their feet while feeding. Don't hold your baby in a dipped-down position when feeding.
• Protect your baby from exposure to tobacco smoke. Exposure to tobacco smoke, including just on clothes or in a car, makes spitting up worse and more frequent.

If your baby gets bottles of breast milk or infant formula:

• Burp after your baby drinks 1–2 ounces from a bottle.
• Don't give the bottle while your little one is lying down.
• Make sure the hole in the nipple is the right size and/or flow for your baby. For example, fast-flow nipples may cause babies to gag or may give them more milk than they can handle at once. Many babies do well with the slow-flow nipple until they are 3 months old, or even older.

Many babies outgrow spitting up by the time they're 1 year old. But if you have concerns about your baby spitting up, call the doctor. Also call if you notice that your baby:

• is coughing or having trouble breathing after feeds
• has blood in the poop
• seems uncomfortable
• has more than a few episodes of forceful vomiting

How Can I Keep My Baby From Gagging?

Sometimes the force of your milk (especially when it “lets down”) is so strong that it can cause your baby to gag and pull away from the breast. If this happens during feeding:

• Try nursing your baby in a more upright position (head above the breast). This may ease the force of the milk.
• Nurse in a side-lying position, which also might help slow the flow of milk.
• Make sure your breasts are not engorged or over-full. Nursing every 2–3 hours can help prevent engorgement. If your breasts are too full and you’re concerned about a forceful letdown, express or pump a little bit of milk a few minutes before feeding time.

If your baby is pulling off and gagging or coughing during feeding, sit your baby up in a seated burp position. Gently pat your baby's back to help your little one calm down before you continue feeding. If you’ve tried the steps above and this continues to happen, talk to your doctor or lactation consultant.

If your baby sometimes gags or chokes while taking a bottle: 

• Try a different nipple with a slower flow.
• Practice “paced” bottle feeding. This is where you slow down the milk flow from the bottle by holding it at less of an angle and allowing your baby to pause for breaks.

My Baby Bites During Breastfeeding. What Can I Do?

Babies will often play with their mothers' nipples with their gums, not meaning to cause any harm. But once they start teething, a baby might bite down, not knowing this is hurting mom.

Sometimes you can tell when your baby's about ready to bite down — usually when satisfied and starting to pull away from the breast. When you sense that your baby is finished feeding and may be bored or feeling playful, end the feeding. Break the suction by slipping your finger into the corner of your baby’s mouth.

If your baby is already biting down, pull your baby closer to you to make it harder for your little one to pull off easily. Then, break the suction. React calmly without raising your voice.

Here are more ways to make baby less likely to bite:

• Before a feed, give your baby something to chew on. Make sure it's big enough that it can't be swallowed or choked on and that it can't break into small pieces. Rubber teething rings are best. Wash after each use.
• Say, "Mommy is not for biting. You can bite this." Then, offer your little one a teething toy or ring.
• Praise your baby — with a hug, kiss, or cuddle — whenever they nurse without biting or trying to bite.

Usually this is enough to stop the biting, but if your baby continues, talk to your doctor or lactation consultant for advice.