Most spit-up is normal and doesn’t need a formula change. A small stomach and a valve that hasn’t matured yet explain nearly all of it. If your pediatrician thinks the spit-up has become a problem, ask whether a formula thickened with rice starch may help. Enfamil A.R. is the one we carry.
Spit-up vs. reflux vs. GERD: what your pediatrician means
Parents use these words interchangeably. Your baby’s doctor doesn’t.
Plain old spit-up, which doctors call GER (gastroesophageal reflux), is “the movement of stomach contents into the esophagus,” and it’s considered a normal part of infancy. Babies who spit up but stay content through it are sometimes called “happy spitters,” per HealthyChildren.org (AAP): Gastroesophageal Reflux (GER) & GERD. It happens because a baby’s stomach is small, the muscle that keeps food down is still immature, and swallowed air can add to it. As HealthyChildren.org: Why Babies Spit Up puts it, “all babies spit up,” and for most, “it often just takes time” for it to fade as those muscles mature.
GERD, gastroesophageal reflux disease, is different. Pediatricians use that label when reflux comes with other symptoms or doesn’t fade the way ordinary spit-up does. It’s a diagnosis your doctor makes, not something you decide from a formula label.
When a thickened formula makes sense, and when it doesn’t
A thickened formula is not a default upgrade for every spit-up baby. It’s for one situation: frequent, larger-volume spit-up that a pediatrician has looked at and wants to address on the formula side.
The AAP’s own guidance is direct about the boundary here: “Never add solids to the bottle unless your pediatrician advises it,” according to the HealthyChildren.org GERD/Reflux page. Stirring rice cereal into a regular bottle at home is not the same as a commercially thickened formula that still delivers complete nutrition, and it’s not something to try on your own.
If your baby is happy, feeding well, and gaining weight on schedule, a thickened formula usually isn’t needed, even when the volume on your shoulder looks alarming. Ask your pediatrician before switching anything. If you suspect a cow’s milk protein allergy, talk with your pediatrician; it calls for a different approach.
Enfamil A.R.: what’s in it and how it works
Enfamil A.R. is the anti-reflux, rice-starch-thickened formula in our catalog. The idea is mechanical: added rice starch keeps the formula thin enough to flow through a standard nipple, then thickens once it reaches the stomach. That’s the manufacturer’s stated mechanism, and it’s why it behaves differently from cereal stirred into a bottle.
It’s milk-based, contains DHA and ARA, includes GOS and polydextrose as prebiotics, and lists rice starch, lactose, and maltodextrin among its carbohydrate sources. One tradeoff: the rice starch can lead to firmer stools or mild constipation. Tell your pediatrician if that happens.
Looking for Similac for Spit-Up?
If you came here searching for Similac for Spit-Up, we couldn’t find it in stock as of September 2026. We checked similac.com, Abbott’s own store, Target, and Walmart: it’s no longer listed by Abbott, Target doesn’t carry it, and Walmart shows it out of stock. We don’t know whether it has been discontinued. Right now it is hard to find.
Enfamil A.R. is the rice-starch thickened formula that Target and Walmart stock, and it plays the same role: it thickens in the stomach rather than in the bottle.
If it’s fussiness or gas rather than reflux
Spit-up and fussiness get lumped together, but they’re usually different problems with different fixes. If the main issue is gas or crying rather than spit-up, a thickened formula probably isn’t the right tool.
Enfamil Gentlease uses partially hydrolyzed protein, broken down into smaller pieces that are easier to digest, and is aimed at gas and fussiness rather than reflux. Similac Sensitive takes a different route, reducing its lactose content for babies who seem sensitive to it.
Our Enfamil A.R. vs. Enfamil Gentlease comparison lays out the differences if you’re still working out which symptom you’re solving for. If you do change formulas, our guide to switching baby formula safely covers how to do it.
Feeding habits that reduce spit-up
Before or alongside any formula change, a few feeding habits may help reduce spit-up:
- Smaller, more frequent feeds: smaller feeds may reduce spit-up. HealthyChildren.org recommends you “feed your baby smaller amounts more frequently.”
- Burp during the feed, not just after: swallowed air can contribute to spit-up. The AAP suggests you “burp not only after, but also during meals,” and for bottle-fed babies, burp “after every 2 to 3 ounces,” per HealthyChildren.org: Baby Burping, Hiccups & Spit-Up.
- Stay upright after feeds: HealthyChildren.org recommends holding your baby upright for “at least 20 minutes” after a feed, and avoiding active play right after eating.
- Feed at a relaxed pace, semi-upright: HealthyChildren.org: Bottle Feeding Basics recommends supporting your baby “in a semi-upright position” and specifically advises against feeding while your baby is lying flat on their back.
None of this costs anything. Try it before or alongside a formula switch, and let your pediatrician help you judge whether it’s working.
When to call the doctor
Ordinary spit-up doesn’t come with these signs. If you see any of them, call your pediatrician instead of waiting it out:
- Forceful or projectile vomiting, especially after every feeding (seek care right away)
- Blood in the vomit, or a green or yellow tint to the spit-up
- Poor weight gain, or fewer wet and dirty diapers than expected
- Crying or arching the back during feeds, as if in pain
- Refusing feeds
- Wheezing, coughing, or other breathing trouble during or after feeds (seek care right away)
These come from HealthyChildren.org’s GERD/Reflux page and its Why Babies Spit Up page, both of which list forceful vomiting and blood in vomit as reasons to call right away. When in doubt, contact your pediatrician promptly.