Baby vomiting after eating: common causes and when to worry

Vomiting or spitting up?

The AAP describes two different things:

• Spitting up is milk or food flowing easily out of the mouth, often with a burp. It’s very common in babies under 1 and usually isn’t a problem. See reflux and starting solids.
• Vomiting is forceful: the tummy muscles squeeze hard and push the stomach contents up and out.

Most babies vomit now and then, and one vomit in a baby who then seems well is rarely serious. The pattern is what tells you more: when it happened, how often, and what else you notice.

During the meal: gagging

Gagging is a normal reflex while babies learn to eat. The NHS says that when a baby gags, their eyes may water, they may push their tongue forward, and they may retch to bring the food forward in their mouth, or vomit. It happens because they’re still learning how much food they can chew and swallow at once.

• Stay calm, stay with your baby, and let them clear it themselves.
• Wipe their face, and carry on only if they’re happy to.
• Offer soft textures that suit their stage. See introducing textures and safe food sizes and shapes.

Gagging is noisy. Choking is quiet: a choking baby can’t cough, cry or breathe properly and needs help straight away. Learn the difference in gagging vs choking.

Soon after a meal: too much or too fast

A very full tummy can come straight back up. The AAP says that filling a baby’s stomach too full, or too fast, makes spitting up more likely. Babies also swallow air when they’re very hungry.

• Follow your baby’s lead: stop when they turn away, close their mouth or push the spoon away. See hunger and fullness cues.
• If your baby cries or turns away, don’t make them eat (AAP).
• Keep them upright in a high chair for meals.

Hard coughing can also make a child vomit, the AAP says, especially if they have reflux.

Minutes to 2 hours after a food: allergy

The AAP says vomiting can be the only sign of a food allergy, and it comes on quickly after eating. It names peanut, tree nuts, fish and shellfish as common triggers, and the NHS lists being sick among the signs of a reaction to any food allergen. The NHS says reactions usually start within minutes, but can take up to 2 hours.

• Vomiting once with no other signs, after a new food or allergen: stop offering that food, stay with your baby and watch them closely for the next couple of hours, and call your pediatrician before you try it again.
• Vomiting with hives, swelling, coughing or wheezing, or any sign in another part of the body: treat it as a severe reaction (below).

See how to introduce allergens.

A few hours after a food, again and again: FPIES

FPIES is a less common, delayed food allergy of the gut. The AAP describes severe, repeated vomiting starting several hours after the trigger food, sometimes followed by diarrhea. ACAAI notes that because it’s delayed, the link to the food isn’t always obvious. It often first shows up when solids start, with foods like rice, oats or poultry, or earlier with milk or soy formula (AAP). ACAAI lists severe vomiting, diarrhea, dehydration and a lack of energy among the signs.

If your baby vomits once or twice a few hours after a food and is alert and like themselves, call your pediatrician or GP. Get emergency help if they vomit again and again, or are pale, floppy, very sleepy or hard to wake (below). See FPIES.

With fever, diarrhea or a sick household: a stomach bug

Once a baby is a few months old, the most common cause of vomiting is a stomach or gut infection, usually a virus (AAP). The NHS says vomiting from a stomach bug usually stops within 1 or 2 days. Food poisoning causes vomiting within hours of eating the food (AAP). See feeding a sick baby, diarrhea and feeding and food poisoning in babies.

What to do right after

• Stop the meal and keep your baby upright. Wipe their face and check they’re breathing easily.
• Milk first, in small amounts. The NHS says to carry on breastfeeding or bottle feeding, with smaller feeds more often if your baby is being sick. Make formula at its usual strength, never weaker.
• Pause solids for a while if your baby is vomiting from an illness. The AAP suggests stopping solid foods until there’s been no vomiting for about 8 hours, then bringing them back gradually.
• Hold off on new foods and new allergens until your baby is well, so you can tell what’s causing what.
• Write it down: what your baby ate, when, and how long afterward they vomited. Your doctor will find it useful.

When to call the doctor

Call your pediatrician, GP or health visitor if your baby (AAP, NHS):

• is under 1 year old and vomiting: the AAP says call within 24 hours, and the NHS says to call 111 if you’re worried about a baby under 12 months
• vomits again after the same food, or after a first taste of an allergen
• stops feeding, or has vomited for more than 24 hours

Call right away if your baby (AAP, NHS):

• keeps being sick and can’t keep fluids down, but is still alert (if they become pale, floppy or very sleepy, use the emergency list below)
• shows signs of dehydration, such as fewer wet diapers, a dark yellow pee, a dry mouth or no tears
• has forceful vomiting that shoots out after every feed, especially if they’re under 4 months old: this can be pyloric stenosis (AAP)
• is under 12 weeks old and has vomited 2 or more times, not counting normal spit-up (AAP)
• has a swollen tummy, or tummy pain when they’re not vomiting
• looks or acts very sick

When to get emergency help

Call 911 or go to the emergency room if your baby:Call 999 or go to A&E if your baby:Call your local emergency number (such as 112 in Europe or 000 in Australia) or go to the emergency department if your baby:

• vomits green or yellow-green fluid (bile), blood, or something that looks like coffee grounds (AAP, NHS). Plain yellow stomach juice on its own is not this sign (AAP).
• vomits again and again a few hours after eating a food, which can be FPIES (see FPIES), or is pale, floppy, very sleepy or hard to wake
• is struggling to breathe, or has blue, gray, pale or blotchy skin, lips or tongue (NHS)
• has a sudden, severe tummy ache (NHS), or bouts of intense tummy pain where they suddenly cry and draw their legs up to their chest, or dark, bloody poop with mucus: this can be intussusception, a bowel blockage the AAP calls the most common tummy emergency under age 2
• may have swallowed something poisonous, or a small object such as a coin (AAP, NHS)
• hasn’t had a wet diaper or peed in 12 hours (NHS)
• shows signs of severe dehydration, such as sunken eyes, cool, discolored hands and feet, or being excessively sleepy (AAP)
• has a stiff neck and pain when looking at bright lights (NHS)
• is having a seizure (fit) (NHS)

Signs of a severe allergic reaction (anaphylaxis) are trouble breathing, wheezing or a cough that won’t stop, swelling of the tongue or throat, lips or mouth that suddenly swell, a hoarse cry, turning pale or floppy, or signs in more than one part of the body at once, such as vomiting with hives. If your baby has an epinephrine (adrenaline) auto-injector, use it right away, then call for an ambulance. Call 911.Call 999.Call your local emergency number (such as 112 in Europe or 000 in Australia). If you don’t have an auto-injector, call straight away. Keep your baby lying down, never standing or walking (on their side if they’re vomiting, head and shoulders a little raised if breathing is hard), and go to hospital even if they seem better. See signs of anaphylaxis.

Where US and UK advice differs

• Drinks while vomiting. The AAP suggests oral rehydration solution for formula-fed babies who vomit more than once, and smaller, more frequent breastfeeds. The NHS says babies on formula or solid food can have small sips of water between feeds. Ask your doctor or pharmacist before using an oral rehydration solution.
• When to call. The AAP says call your pediatrician within 24 hours if a baby under 1 is vomiting. The NHS says call 111 if you’re worried about a baby under 12 months, or if a child keeps being sick and can’t keep fluids down.
• Green vomit. The AAP says go to the emergency room for green bile or blood in the vomit, and says yellow stomach juice is not that sign. The NHS treats yellow-green or green vomit in children as a 999 emergency. This page follows the NHS wording, so call the emergency number for yellow-green or green vomit, or blood.