What to know about reflux in babies and infants

A baby may bring up a small amount of milk during or soon after a feed while otherwise feeding, growing, and settling normally. Spitting up is different from forceful vomiting and does not always cause distress.

Reflux happens when stomach contents move back into the oesophagus, the tube carrying food from the mouth to the stomach. In a young infant, the valve at the lower end of this tube may open at the wrong time, and liquid feeds make backflow easier. A baby can also swallow air during feeding, which may increase posseting or discomfort.

Some babies arch their back, grimace, hiccup, cough, or become unsettled around feeds. These signs can have other causes, so a clinician may consider feeding technique, milk intolerance, infection, or another problem if symptoms are persistent or severe.

Keep your baby upright in your arms during a feed and for a short period afterwards, while staying awake and watching closely. Pause for gentle burping when needed, and check that the teat flow and latch are comfortable. Smaller feeds offered more often may help some babies, but do not restrict milk or change formula without professional advice.

For sleep, always place your baby flat on their back on a firm, clear sleep surface. Do not use pillows, wedges, sleep positioners, or an inclined mattress to treat reflux. Keep a note of feeds, spit-up, crying, stools, and wet nappies if you need to discuss a pattern with a healthcare professional.

Arrange medical advice if reflux is interfering with feeding, sleep, or comfort; your baby is not gaining weight as expected; or there are repeated choking episodes, persistent coughing, or fewer wet nappies. A healthcare professional can assess hydration, growth, feeding, and the need for treatment.

Seek urgent medical help for green or bloody vomit, vomit that is forceful or repeatedly shoots out, a swollen or tender abdomen, difficulty breathing, blue or grey lips, unusual sleepiness, or a baby who cannot keep feeds down. Fever or marked illness in a very young baby also needs prompt assessment.

Ask whether your baby's feeding pattern and growth fit uncomplicated reflux, whether a feeding review could help, and which symptoms should prompt same-day care. If a medicine, thickener, or formula change is suggested, ask how to use it safely and when its effect should be reviewed.