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From the very minute you meet, your baby will amaze — and alarm — you. It can feel like there’s just so much to worry about. And baby vomiting is a pretty common cause for concern among new parents — who knew such volume and projectile throw-up could come from such a tiny baby?

Unfortunately, you’ll probably have to get used to this to some extent. Many common baby and childhood illnesses can cause vomiting. This can happen even if your baby doesn’t have a fever or other symptoms.

But on the plus side, most causes of baby vomiting go away on their own. Your baby likely won’t need treatment — except for a bath, change of clothes, and some serious cuddling. Other, less common, causes of vomiting might need a visit to your baby’s pediatrician.

It can be difficult to tell the difference between vomit and spit-up. Both might look the same since your baby is currently on a steady of diet of milk or formula. The main difference is in how they come out.

Spit-up usually happens before or after a burp and is most common in babies under the age of 1 year. Spit-up will easily flow from your baby’s mouth — almost like white, milky drool.

Vomit typically comes out forcefully (whether you’re a baby or an adult). This is because vomiting happens when the muscles around the stomach are triggered by the brain’s “vomiting center” to squeeze it. This forces whatever is in the stomach to be hurled out.

In a baby’s case, vomit may look like milky spit-up but have more clear stomach juices mixed into it. It may also look like milk that has been fermented for a little while — this is called “cheesing.” Yes, it sounds gross. But the texture probably won’t bother you when you see it — you’ll be more concerned with baby’s well-being.

Your baby may also cough or make little retching noises before they vomit. This is likely the only warning you’ll have to grab a towel, bucket, burp cloth, sweater, your shoe — hey, anything.

Additionally, spit-up is normal and can happen at any time. Your baby will only vomit if there’s a digestive issue or they have another illness.

Feeding difficulty

Babies have to learn everything from scratch, including how to feed and keep the milk down. Along with spit-up, your baby may vomit occasionally after being fed. This is most common in the first month of life.

It happens because your baby’s tummy is still getting used to digesting food. They also have to learn to not gulp milk down too fast or overfeed.

Post-feeding vomiting typically stops after the first month. Give your baby more frequent, smaller feeds to help stop the vomit.

But let your pediatrician know if your baby vomits often or has very forceful vomits. In some cases, it might be a sign of something other than feeding difficulty.

Stomach flu

Also known as the tummy bug or “stomach flu,” gastroenteritis is a common cause of vomiting in babies and children. Your baby may have cycles of vomiting that come and go for about 24 hours.

Other symptoms in babies may last for 4 days or longer:

  • watery, runny poop or mild diarrhea
  • irritability or crying
  • poor appetite
  • stomach cramps and pain

The tummy bug can also cause a fever, but this is actually less common in babies.

Gastroenteritis usually looks a lot worse than it is (thank goodness!). It’s typically caused by a virus that goes away by itself in about a week.

In babies, severe gastroenteritis can lead to dehydration. Call your pediatrician immediately if your baby has any signs of dehydration:

  • dry skin, mouth, or eyes
  • unusual sleepiness
  • no wet diapers for 8 to 12 hours
  • weak cry
  • crying without tears

Infant reflux

In some ways, babies really are like tiny adults. Just like adults of any age can have acid reflux or GERD, some babies have infant reflux. This can lead to baby vomiting in the first weeks or months of your baby’s life.

Vomiting from acid reflux happens when the muscles at the top of the stomach are too relaxed. This triggers baby vomiting shortly after feeding.

In most cases, the stomach muscles strengthen, and your baby’s vomiting goes away on its own. Meanwhile, you can help slow down the vomiting by:

  • avoiding overfeeding
  • giving smaller, more frequent feeds
  • burping your baby often
  • propping your baby up in an upright position for about 30 minutes after feeding

You can also thicken milk or formula with more formula or a bit of baby cereal. Caveat: Check with your pediatrician before you try this. It might not be suitable for all babies.

Cold and flu

Babies catch colds and flus easily because they have shiny new immune systems that are still developing. It doesn’t help if they’re in day care with other sniffling kiddos, or they’re around adults that can’t resist kissing their little faces. Your baby may have up to seven colds in their first year alone.

Cold and flu can cause different symptoms in babies. Along with a runny nose, your baby may also have vomiting without a fever.

Too much mucus in the nose (congestion) can lead to a nasal drip in the throat. This can trigger bouts of forceful coughing that sometimes cause vomiting in babies and children.

As in adults, colds and flu in babies are viral and go away after about a week. In some cases, sinus congestion may turn into an infection. Your baby will need antibiotics to treat any bacterial — not viral — infection.

Ear infection

Ear infections are another common illness in babies and children. This is because their ear tubes are horizontal rather than more vertical like in adults.

If your little one has an ear infection, they might have nausea and vomiting without a fever. This happens because an ear infection can cause dizziness and loss of balance. Other symptoms of ear infections in babies include:

  • pain in one or both ears
  • tugging or scratching at or near the ears
  • muffled hearing
  • diarrhea

Most ear infections in babies and children go away without treatment. However, it’s important to see a pediatrician in case your baby needs antibiotics to clear up the infection. In rare cases, a serious ear infection can damage a baby’s tender ears.

Overheating

Before you swaddle your baby or put them in that adorable fluffy bunny suit, check the temperature outside and in your home.

While it’s true that the womb was warm and cozy, babies can overheat quickly in hot weather or in a very warm house or car. This is because their tiny bodies are less able to sweat out heat. Overheating might cause vomiting and dehydration.

Overheating can lead to heat exhaustion or in much more serious cases, heatstroke. Look for other symptoms like:

  • pale, clammy skin
  • irritability and crying
  • sleepiness or floppiness

Immediately remove clothing and keep your baby out of the sun and away from heat. Try to breastfeed (or give your baby water if they’re 6 months or older). Get urgent medical attention if your baby doesn’t seem their usual self.

Motion sickness

Babies below the age of 2 years don’t commonly get motion or car sickness, but some babies may get sick after a car ride or being twirled around — especially if they’ve just eaten.

Motion sickness can make your baby dizzy and nauseous, leading to vomiting. It might be more likely to happen if your baby already has an upset tummy from bloating, gas, or constipation.

Strong smells and windy or bumpy roads can also make your baby dizzy. Nausea triggers more saliva, so you might notice more dribble before your baby vomits.

You can help prevent motion sickness by traveling when your baby is ready to sleep. (Great trick if your baby loves to sleep in the car!) A sleeping baby is less likely to feel queasy.

Keep their head well supported in the car seat so it doesn’t move around too much. Also, avoid going for a drive right after giving your baby a full feed — you want your baby to digest the milk, not wear it.

Milk intolerance

A rare kind of milk intolerance is called galactosemia. It happens when babies are born without a certain enzyme needed to break down sugars in milk. Some babies with this condition are even sensitive to breast milk.

It can cause nausea and vomiting after drinking milk or any kind of dairy products. Galactosemia can also cause a skin rash or itching in both babies and adults.

If your baby is formula fed, check the ingredients for any dairy, including milk proteins.

Most newborns are screened at birth for this rare condition and other illnesses. This is usually done with a heel prick blood test or a urine test.

In the rare event that your baby has this, you’ll know it very early on. Make sure your baby completely avoids milk to help stop vomiting and other symptoms.

Pyloric stenosis

Pyloric stenosis is a rare condition that happens when the opening between the stomach and intestines is blocked or too narrow. It can lead to forceful vomiting after feeding.

If your baby has pyloric stenosis, they may be hungry all the time. Other symptoms include:

  • dehydration
  • weight loss
  • wave-like stomach contractions
  • constipation
  • fewer bowel movements
  • fewer wet diapers

This rare condition can be treated with surgery. Tell your pediatrician immediately if your baby has any of the symptoms of pyloric stenosis.

Intussusception

Intussusception is a rare intestinal condition. It affects 1 in every 1,200 babies and most commonly happens at the age of 3 months or older. Intussusception can cause vomiting without a fever.

This condition happens when the intestines are damaged by a virus or other health conditions. The damaged intestine slips — “telescopes” — into another part of the intestine.

Along with vomiting, a baby may have severe stomach cramps that last for about 15 minutes. The pain can cause some babies to curl their knees up to their chest.

Other symptoms of this intestinal condition include:

  • fatigue and tiredness
  • nausea
  • blood or mucus in bowel movements

If your baby has intussusception, treatment can push the intestine back into place. This gets rid of vomiting, pain, and other symptoms. Treatment includes using air in the intestines to gently move the intestines. If that doesn’t work, keyhole (laparoscopic) surgery heals this condition.

See your baby’s pediatrician if your baby has vomiting for longer than 12 hours. Babies can get dehydrated quickly if they’re vomiting.

Get immediate medical attention if your baby is vomiting and has other symptoms and signs like:

  • diarrhea
  • pain or discomfort
  • constant or forceful coughing
  • hasn’t had a wet diaper for 3 to 6 hours
  • refusing to feed
  • dry lips or tongue
  • few or no tears when crying
  • extra tired or sleepy
  • weakness or floppy
  • won’t smile
  • swollen or bloated stomach
  • blood in diarrhea

Baby vomiting without a fever can happen because of several common illnesses. Your baby will likely have one or more of these several times in the first year. Most of these causes go away on their own, and your little one will stop vomiting without any treatment.

But too much vomiting can lead to dehydration. Check for signs of dehydration and call your pediatrician if you’re not sure.

Some causes of baby vomiting are more serious, but these are rare. Your baby will need medical care for these health conditions. Know the signs and remember to keep the doctor’s number saved in your phone — and take a deep breath. You and baby got this.