What is reflux?

Reflux is when your baby brings the contents of their stomach back up into their food pipe or mouth. They may bring up small amounts of milk along with air when they are burped. Reflux, also called spitting up, posseting or regurgitation, is very common in newborns.

The medical term for reflux is gastro-oesophageal reflux, or GOR. If reflux causes complications, such as refusing to feed or slow weight gain, it is called gastro-oesophageal reflux disease (GORD).

What are the symptoms of reflux?

If your baby has reflux, they may spit up milk, particularly after feeds. Most babies with reflux are otherwise well and show no signs of discomfort or pain. Babies with reflux usually gain weight as expected and have no breathing problems.

What causes reflux in babies?

Reflux occurs because a muscle at the top of the stomach, called the sphincter, is not fully developed. This may allow stomach contents to travel backwards up the oesophagus (food pipe).

Spitting up usually does not cause discomfort. Your baby may not even seem not to notice or be bothered by it.

Reflux is not the same as vomiting. Vomiting is forceful, usually brings up more than a tablespoon or 2 of liquid, and upsets the baby. Vomiting can be a sign of illness.

Reflux is not the same as drooling and blowing bubbles, which is especially common once babies start teething.

When should I see my doctor?

If your baby is otherwise healthy and happy and they are just bringing up milk, nothing needs to be done.

Talk to your doctor or child health nurse if your baby:

• is not gaining weight
• shows signs of discomfort or pain
• has breathing problems
• has a fever
• won’t feed
• has a persistent cough
• has blood or bile in their vomit

How is reflux diagnosed?

Reflux can usually be diagnosed by your doctor without any special tests. Your doctor can diagnose reflux by listening to you talk about your baby’s behaviour and by examining your baby.

How is reflux treated?

Here are some things you can do to minimise your baby’s reflux.

During a feed

• Hold your baby in an upright position, not lying down, while you feed them.
• Feed your baby smaller amounts at a time, while ensuring that they still get the daily amount of milk that they need.

After a feed

• Keep your baby upright for 20 to 30 minutes after feeding. An infant seat or car seat works well.
• If you are supervising your baby, you can place them on their tummy between feeds. Take care not to let baby sleep on their tummy because of the link with sudden unexpected death in infancy. Always place your baby on their back to sleep.

Optimise feeds

• An experienced lactation consultant or child health nurse can observe how your baby feeds, and can help you find ways to reduce reflux, if it becomes a problem.
• They can also advise you on how often your baby needs to feed, and if your baby has formula, your nurse can check they are getting the right amount. Do not reduce your baby’s total daily formula intake without advice from your child health nurse or doctor.

Can reflux be prevented?

Reflux can’t be prevented. Some babies simply spit up more than others.

What are the complications of reflux?

Sometimes reflux can cause complications. This is called gastro-oesophageal reflux disease (GORD). Babies with GORD may have pain in their stomach that causes them to cry, be irritable or arch their back. They may have disrupted sleep and be difficult to settle. If your baby has GORD, they may show slow weight gain or have breathing and swallowing problems.

If your baby has GORD, your doctor may recommend treatments including feeding your baby thickened feeds or prescribing a medicine that reduces the acidity in the stomach. Do not thicken your baby’s feed without first getting advice from your doctor or child health nurse.

Resources and support

Speak to your doctor or child health nurse before you make any changes to how you feed your baby or if you have any questions about reflux.