Reflux in Babies & Newborns

What is newborn reflux?

Reflux, very simply put, is when food or milk from your baby’s stomach flows back up into their throat or mouth (which may or may not include visible vomiting). It is often referred to interchangeably as either reflux, regurgitation or gastroesophageal reflux (GER). Infant or newborn reflux is common among babies in their first year of life for both breast-fed and formula-fed, and is often a reason parents consult their doctor for advice. In most cases your baby won’t even notice they are doing it and won’t cause discomfort even if they do spit up, but for some it may cause a little discomfort. Reflux in newborns and babies often peaks at around 4 months of age and is usually resolved by the age 12 months.

While occasional spitting up is normal, frequent or severe reflux may need medical intervention. General ‘regurgitation’ or ‘positing’ is not to be confused with a more complicated condition of Gastro Oesophageal Reflux Disease (GORD or GERD). GORD is a more severe form of reflux that can lead to persistent vomiting, poor weight gain, and other complications. Differentiating between GER and GORD is essential for appropriate treatment.

What can cause reflux in babies?

Reflux in newborns and babies may occur for a variety of reasons, some common causes are listed below:

• Your baby may have ingested too much milk and reflux is simply clearing the excess.
• An immature valve at the top of the stomach may not be closing and keeping food down in the stomach as it is designed to do. This is common in babies.
• Feeding your baby when they are over tired or over-stimulated.
• Consuming a large feed quickly.
• Already full with undigested milk in the stomach.
• Putting upward pressure on the tummy when sitting or nappy changing, after a feed.
  A tummy bug.
• Allergy or intolerance to what was ingested. Always discuss these reactions with your healthcare professional.

When your baby is vomiting or positing it is important they are not becoming dehydrated. Watch for at least six wet nappies in a 24-hour period and continue to offer your baby regular feeds during the day. Avoid offering a replacement feed immediately after your newborns reflux as the tummy needs a chance to settle. Seek professional help immediately if your baby becomes increasingly lethargic, limp or refuses to drink.

It can be a hectic time for everyone involved and good support from family and friends is vital!

What are reflux symptoms in newborns and babies?

Reflux symptoms in newborns and babies may vary. Recognising the symptoms and understanding the causes of reflux in babies can help you manage the condition effectively. Common symptoms of newborn reflux and reflux in babies include:

• Frequent spitting up or small vomits, especially after feeding.
• General fussiness or irritability after a feed.
• Discomfort, particularly after a feed.
• You may notice they cry whenever they lie on their back for a play, sleep, or nappy change.
• Back arching or pulling off the breast while feeding.

Difficulty sleeping due to being uncomfortable on their back, which may cause your baby to be more tired.
 

How to manage and relieve reflux in babies?

In some instances it will get better with time and won’t need treatment, for most there are a few things that might help in the meantime:

• Check your breastfeeding technique. Make sure baby is latching on well — your healthcare professional or lactation consultant could help with this. You could always read our breastfeeding guide to getting a good latch. Make sure your baby’s head and body are in a straight line when breastfeeding.
• Ask your healthcare professional about thickening milk feeds. This can be done in the following ways:
  • If breastfeeding, add food thickener to a small amount of water or expressed breast milk to make a paste and give before or during a breast feed.  Alternatively, it can be mixed with an expressed breastmilk feed.
  • For formula fed infants, pre-thickened infant formulas are available. Seek professional advice before changing your current formula. Some formulas thicken with mixing; others thicken in the stomach. Alternatively, you can also add thickener to the infant formula you are already using.
• Avoid feeding too much at one time. Try giving smaller meals more often.
• Sit your baby upright while feeding and keep them upright for up to 30 minutes after the feed. Stick to calm cuddles and gentle activities, save playing airplanes for later.
• Change their nappy before or mid-feed to avoid changing at the end when their tummy is full.
• Have your baby resting in an upright sling as much as possible.
• Ask your healthcare professional about a probiotic suitable for infants to help balance the microflora in the gut.
• Keep a diary of your baby’s regurgitation episodes and height gain to help your healthcare professional assess your situation better.
• Burping baby:
  • If your baby is relaxed, they will expel wind more easily than if they are tired, jiggled constantly or kept awake too long after they should be asleep. Physical tiredness and stress will tense the tummy rather than relax it, making it difficult to expel air.
  • When burping, keep your baby’s back vertical or horizontal rather than curved. If your baby has not burped but is ready for sleep, put them to bed anyway even if it means getting them up to burp when they cry in 30 minutes time. They will have relaxed during this time making it easier to burp.
• Changing your own diet while breastfeeding is rarely necessary when managing infant and newborn reflux.  
• Make sure you’ve got clean towels or burping cloths on hand for clean-ups.
   

When to see a doctor if your baby has reflux?

While reflux in babies is common, if you feel your baby is experiencing more than normal regurgitation or positing and when no practical measures listed above have given your baby any relief, talk to your doctor for specific advice or for appropriate medication.

Symptoms to look out for that need medical advice, include:

• You may notice poor weight gain, or difficulty gaining weight.
• Frequent large volumes of vomit, especially if it’s projectile like.
• If your baby suffers oesophageal pain, they will be very unsettled and crying in pain not just discomfort.
• You may notice they cry unconsolably whenever they lie on their back for a play, sleep, or nappy change.
• You may also find they often only sleep for short periods which can then develop into a cat napping habit when older.
• You may also find your baby hiccoughs and constantly swallows even when they are not feeding. Also look out for gagging, choking or wheezing during or after a feed.
• They are usually reluctant to smile and often have a worried look on their face. They are clearly miserable and often you are too.

Don’t ever feel you’re overreacting to your newborns reflux signs, every baby is different, if in doubt get it checked out by your healthcare professional.
 

Frequently asked questions about reflux in babies

How do you know if your baby has reflux?

If you suspect your baby has reflux, there are several signs to look for. Common symptoms include frequent spitting up or vomiting after feeds, irritability during or after feeding, arching of the back, and a persistent cough or wheezing during or after a feed. You might also notice your baby being unusually fussy or having difficulty sleeping as lying on their back can be uncomfortable. While some amount of spitting up is normal for infants, if these symptoms persist or are severe and causing your baby distress, it's important to consult your healthcare professional to get a proper diagnosis and appropriate management strategies.

What helps reflux in babies? 

To help manage reflux in babies, several strategies may be beneficial, including getting the feeding position right (hold your baby in an upright position during and after feeds); try smaller feedings more frequently (to help prevent overfilling the stomach); burp your baby during and after a feed to release any trapped air). Always talk to your healthcare professional if you have questions about feeding choices and thickening feeds, or any medications or over-the-counter treatments, in order to get tailored advice specific to your baby’s needs.

Does tummy time help with reflux?

Tummy time is beneficial for all babies as it helps strengthen their neck, shoulder, and back muscles, which can improve overall motor skills and development. However with reflux, it is important to approach it with caution.

It is crucial to ensure that tummy time is done when your baby is calm and not immediately after feeding, as this can increase the risk of discomfort or spitting up due to the pressure of laying on their tummy. Start with short sessions of tummy time, not immediately after a feed, and gradually increase the duration as your baby becomes more comfortable. Always supervise your baby during tummy time.

What time of day is reflux worse for babies? 

Every baby is different and so the time of day your baby is affected by reflux may be different to another. Reflux in babies can worsen after feeding and for some in the late afternoon and evening as increased feeding and activity over the day can lead to discomfort as they settle down for the night. Keeping your baby upright after feeding and offering smaller, more frequent meals over the day may help alleviate symptoms. If your baby’s reflux is getting worse over time it’s important you speak to a healthcare professional for tailored advice.

How do you settle a baby with reflux?

Settling a baby with reflux is not always easy but you may consider some strategies such as holding your baby in an upright position for 20-30 minutes after feeding; providing smaller more frequent feedings; burping during and after a feed; and gentle rocking or motion as they are upright after each feed.  Creating a calm and quiet environment when they are upset will help to keep your baby relaxed and if symptoms persist or get worse then always talk to your healthcare professional for further guidance.