Reflux in babies

Reflux is the term to describe what happens when your baby brings up their milk or is sick shortly after or during a feed¹. It’s sometimes called ‘regurgitation’ or ‘posseting’².

Reflux in babies can occur whether they’re breast, bottle or formula-fed, and it affects all babies differently. Some will bring up only a small amount of milk, while others will vomit their entire feed (muslin cloths at the ready!). Whilst some will become fussy during feeding and be hard to comfort, others will be completely unphased².

It can be stressful - not to mention messy - to deal with. However, the main thing to remember is that reflux in babies is very common and, in most instances, isn’t anything to worry about¹.

‘It’s important to know that you’re not alone’, says Sylvie’s mum. ‘Of all the things I thought I’d be dealing with as a parent, reflux came out of the blue, but from one mum to another, you've got this.’

It's all down to physiology - specifically, the development of your baby’s food pipe.

When your baby is born, the muscle surrounding their food pipe (also called the oesophagus) isn’t yet fully developed. This means that your baby's milk and food can travel back up again once they’ve swallowed it¹.

If your baby has reflux, you’ll usually notice the symptoms before they’re 8 weeks old. The good news is that most babies will have grown out of it by the time they’re a year old¹.

Baby reflux symptoms include^{1, 3}:

• Bringing up some or all of their milk either during or after feeding.
• Persistent hiccups or coughing.
• Gulping and swallowing after feeding or burping.
• Being unsettled whilst they feed.
• Gagging or choking while being fed.
• Crying for long periods.
• Frequent ear infections.

Usually, baby reflux gets better without any treatment as long as your baby is thriving and gaining weight³.  

Some symptoms, however, shouldn’t be left to resolve on their own, and you should always speak to your GP if your baby¹:

• Still has reflux after the age of 1.
• Starts to experience reflux after they’re 6 months.
• Isn’t responding to attempts to ease their reflux.
• Is losing weight or not gaining any weight.

Seek urgent medical advice if your baby¹:

• Has a tender or swollen tummy.
• Has vomit that contains blood or that’s green or yellow.
• Can’t keep fluids down, keeps being sick or is projectile vomiting.
• Has blood in their poo. 
• Has had diarrhoea that lasts for longer than a week.
• Shows signs of dehydration.
• Refsuses to feed.
• Is very distressed and won’t stop crying.

If your baby is breastfed and you spot the symptoms of reflux, continue breastfeeding your baby as usual. 

To help ease any discomfort from baby reflux, here are a few handy top tips³:

• Try breastfeeding positions that avoid your baby bending at the waist - this will help prevent pressure on their tummy.
• Keep your baby’s head higher than their tummy when breastfeeding.
• Move to the second breast only when the first is soft and empty.

It’s tempting to eliminate certain foods from your diet if your baby has reflux and you're breastfeeding, especially if you think they might have an allergy or intolerance to cow’s milk.  However, you should always speak to your GP or other healthcare professional before making changes.

If your baby is formula-fed, try to keep track of how much milk they take and how often they bring it back up – this can help your healthcare professional when deciding if any treatment or a change of formula milk is needed.

You could also try the paced feeding technique, which involves following your baby’s lead. This enables them to take breaks when they need to and helps them to have better control over the amount of milk they take, all of which can help to avoid any tummy issues caused by overfeeding⁴.

Silent reflux is where your baby's milk and food come back up their food pipe, but they swallow it down rather than being sick or spitting it out⁵.  

The symptoms of silent reflux are similar to those seen in regular reflux. The main difference between the two is that with silent reflux your baby won’t bring up their milk after a feed, which can make it both confusing and a little frustrating!

From the practical steps you can take at home to recommended treatments, the treatment and management options are the same when managing and treating reflux or silent reflux in babies.  

Let’s take a look. 

Below, you’ll find some helpful top tips for managing your baby’s reflux¹:

• When formula-feeding, try giving your baby smaller amounts more often. ‘My baby’s reflux became noticeably more manageable when I started feeding little and often’, says Sylvie’s mum, ‘whilst he didn’t stop bringing milk up completely, his tummy seemed to cope better.’
• Burp your baby before, during and after feeding. 
• Keep your baby upright during feeding and for about 30 minutes after they’ve finished. Some parents find it helpful to use a baby sling. Why not follow this handy tip from Sylvie’s mum? ‘After every feed I’d pop her in the baby sling and walk her around the house. It meant that I could still get things done too, which was a bonus.’
• Always put your baby to sleep on their back and never on their side or front.
• Dress your baby in loose clothing and make sure the waistband of their nappy isn’t too tight. 

In most cases, following some of the tips above, reflux and silent reflux in infants will settle down over time without any treatment. However, there are a few treatments your GP might recommend if this isn't the case.

If your baby is formula-fed, your GP may prescribe a thickening powder for you to add to your baby’s formula milk or a specific type of pre-thickened formula. If this doesn’t make a difference, or if your baby is breastfed, your GP may discuss your options for medication¹.

In very rare cases, your baby might be offered surgery to strengthen the muscle around their food pipe, but this will usually only be recommended once all other treatment options have been explored¹.  

‘If you’re concerned, and you’re struggling to manage your baby’s symptoms, don’t hesitate to get in touch with your GP’, Sylvie's mum suggests.  ‘It’s never a waste of their time, even if it’s just to put your mind at rest. I also found that talking to other mums about it really helped – you'll be surprised just how many people are dealing with reflux.’

Acid reflux is also known as Gastro-oesophageal reflux disease (GORD). Whilst not too dissimilar to regular baby reflux, it happens when milk or food mixes with your baby’s stomach acid and travels back up the food pipe. This causes irritation and inflammation, which can be sore and uncomfortable for your little one⁶.

Some common symptoms of acid reflux in babies include⁶:

• Being unsettled after feeding.
• Difficulty feeding your baby (such as refusing to feed or crying).
• Your baby spitting up or being sick frequently.
• Abdominal pain.
• Low weight gain or even loss of weight.
• Frequent chest infections.

If you think that your baby might be experiencing acid reflux, it’s always advisable to speak to your GP, as your baby may need medication to help them manage the symptoms.

While reflux is normal and should pass with time, it’s always a good idea to talk to your GP or other healthcare professional if you’re concerned about your baby’s symptoms.

The main thing to remember about reflux is that it’s very common. Talking to friends and other new mums can help to reassure you, and our Careline team is also available to answer your questions or listen to any worries you might have - big or small, anytime, day or night.