Some of the most commonly asked questions that parents come in and ask me are, “My baby spits up a lot. Is this normal? Is it too much? Is it reflux?” What I tell my parents is that babies can spit up and it can be absolutely normal. Babies spit up for a lot of different reasons. Some babies spit up, because they eat too much. Some babies spit up, because they eat too fast. Some babies just spit up. Other babies spit up, because they have reflux. There’s a term in pediatrics where we refer to children as ‘happy pukers’ – these are babies that are happy, they are gaining weight well, they’re content, they feed well – these are the kind of babies that are sitting in your lap and laughing and smiling at you and puking at the same time. These babies do not have reflux. You do not need to worry about spit-up in these babies. Then there’s another type of patient. This type of patient is a really uncomfortable baby; a baby that is arching when they’re feeding, they’re writhing around, they aren’t gaining weight well. This is the kind of baby where you’re worrying about reflux. There are a lot of different ways to treat reflux. What I usually tell my patients is start with some behavioral changes. Burp your child frequently. Feed your child small, frequent feeds. Keep your child’s head elevated for 20 minutes after the feed. Don’t bounce your child around a lot after the feed. If these techniques have not helped your child, then you should speak to your child’s doctor about the possibility of needing a prescription medication.