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We look at reflux, gastro-oesophageal reflux disease (GORD) and silent reflux in babies, with suggestions on how to ease a baby’s discomfort

What is reflux?

It’s something many parents talk about but what is reflux? It’s basically when a baby brings milk back up during, or just after, a feed (NHS start4life, 2019).

Babies get reflux when the ring of muscle between the oesophagus (food pipe) and stomach is not fully developed. Food or milk can leak out and travel back up the food pipe (NHS, 2019). Other potential causes for reflux can include an intolerance to cow’s milk protein or other allergies (La Leche League 2017)

Reflux affects at least four in ten newborns and it isn’t usually cause for concern (NICE, 2015). Most of the time, it gets better on its own – often by the time a baby is one (NICE, 2015; NHS, 2019). That’s because over a baby’s first 12 months their digestive system naturally develops and they spend more time upright as they start to sit up (Tighe et al, 2014; NICE, 2015; NHS, 2019).

Is reflux just vomiting?

Reflux is not the same as vomiting, which is when a baby’s muscles contract forcefully (NHS, 2019). Reflux can also be confused for posseting, which is when a baby brings up a small amount of milk (usually a teaspoonful) without seeming to mind (NHS start4life, 2019).

Baby reflux signs and symptoms

Common signs of reflux include:

  • A baby arching their back and turning their head.
  • Crying for long periods and becoming irritable during and after feeds.
  • Choking or coughing during a feed or seeming to have a sore throat.
  • Spitting up milk during or after feeds several times a day, which upsets them.
  • Persistent hiccups.
  • Frequent ear infections.
  • Fighting feeding or refusing to feed.
  • Poor weight gain.
  • Waking very frequently at night.
  • Signs of pain or discomfort when feeding.

(NHS, 2016; La Leche League GB, 2017; Essential Parent, 2019)

Are some babies more likely to get reflux?

Reflux is more common among babies who are born prematurely and babies with low birth weight. It’s also common in babies or children with some impairment of their muscles and nerves, such as cerebral palsy, or those with a cow’s milk allergy (Patient, 2018).

When should you seek medical advice for reflux?

Reflux isn’t usually a cause for concern if your baby is happy and is gaining weight. However, if reflux starts after six months of age, continues beyond a year or if your baby has any problems mentioned below, contact your midwife, health visitor or GP:

  • Spitting up feeds frequently or refusing feeds.
  • Coughing or gagging while feeding.
  • Frequent projectile vomiting (forceful vomiting that lands some distance away).
  • Green or yellow vomit (maybe bile), or blood in vomit.
  • Blood in poo or persistent diarrhoea.
  • Excessive crying or irritability.
  • Swollen or tender tummy.
  • High temperature of 38⁰C or above.
  • Not gaining weight or losing weight.

(NICE, 2015; NHS, 2016)

In a small number of babies, reflux might be associated with a more serious problem, such as gastro-oesophageal reflux disease (GORD). This is a form of long-term reflux where stomach contents are able to rise up and irritate the oesophagus (NHS, 2016).

Silent reflux in babies

Sometimes babies don’t spit out what comes back up but swallow it instead. This is known as ‘silent reflux’. Babies with silent reflux might gain weight normally but show some of the symptoms as reflux (NHS start4life, 2019).

How to ease your baby’s reflux

You can help ease your baby’s reflux by making small changes to the way you feed them. Talk to your midwife or health visitor who might suggest:

  • Gently burping your baby regularly throughout feeding.
  • Ensuring they take breaks during a feed.
  • Giving your baby shorter but more frequent feeds.
  • Keeping your baby’s head higher than their bottom during feeds.
  • Keeping your baby upright for a bit after feeding.
  • Changing baby on their side to avoid any discomfort caused by lifting their legs up towards their stomach.
  • Using thickened ‘anti-reflux’ formula milk. You can buy these without a prescription but it’s important to talk to a healthcare professional before you do. There is some caution about their use, such as the fact that they are made at a lower temperature than is currently recommended to get rid of harmful bacteria. 
  • If your baby has a cow’s milk allergy, your doctor might suggest using special formula milk that doesn’t contain cows’ milk.

(NHS, 2016 ; La Leche League GB, 2017; First Steps Nutrition Trust, 2018; Patient, 2018)

Some parents might be advised to raise the head end of their baby’s cot slightly or place a rolled up towel under the mattress. It’s important to say that there is no scientific evidence that this works and it might increase the risk of sudden infant death syndrome (SIDS) (Lullaby Trust, 2019).

Diagnosis and treatment

Usually, babies with reflux don’t need any tests as the condition can be diagnosed based on their symptoms. But in rare cases and if a healthcare professional thinks they might be helpful, an endoscopy, pH monitoring or barium swallow test can be done (NICE, 2015; NHS, 2016).

Reflux usually doesn’t need any specific treatment but the feeding suggestions above might be helpful. In severe cases, a GP or gastroenterologist can prescribe medicines that might help with pain and discomfort (Tighe et al, 2014). Surgery might also be recommended for a small number of babies who have underlying medical conditions, such as cerebral palsy (NICE, 2015; NHS, 2016).

If you have a baby with a reflux, it can feel stressful and worrying at times. There’s lots of support and information to help you though. Read other parents’ experiences here.

This page was last reviewed in July 2019.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

You might find attending one of NCT's Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

Living with reflux is a UK non-profit for information and support for sufferers of GOR and GORD.

Essential Parent. (2019) Has my baby got reflux? Available at: https://www.essentialparent.com/lesson/has-my-baby-got-reflux-5900/ [Accessed 25th July 2019]

First Steps Nutrition Trust. (2018) Infant milks: a simple guide to infant formula, follow-on formula and other infant milks, page 7. Available at: https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/5b325b5d2b6a28fb4e3d1233/1530026845937/Infant-milks_a_simple_guide_May2018a.pdf [Accessed 25th July 2019]

La Leche League GB. (2017) I think my baby’s got reflux. Available at: https://www.laleche.org.uk/i-think-babys-got-reflux/ [Accessed 25th July 2019]

NHS start4life. (2019) Breastfeeding challenges. Available at: https://www.nhs.uk/start4life/baby/breastfeeding/breastfeeding-challenges/reflux/# [Accessed 25th July 2019]

NHS. (2016) Reflux in babies. Available at: https://www.nhs.uk/conditions/reflux-in-babies/ [Accessed 25th July 2019]

NICE. (2015) Gastro-oesophageal reflux disease in children and young people: diagnosis and management. Available at: https://www.nice.org.uk/guidance/ng1/ifp/chapter/reflux-in-babies [Accessed 25th July 2019]

Patient. (2018) Childhood gastro-oesophageal reflux. Available at: https://patient.info/health/childhood-gastro-oesophageal-reflux-leaflet [Accessed 25th July 2019]

The Lullaby Trust. (2019) The best sleeping position for your baby. Available at: https://www.lullabytrust.org.uk/safer-sleep-advice/sleeping-position/ [Accessed 25th July 2018]

Tighe M, Afzal NA, Bevan A, Hayen A, Munro A, Beattie R. (2014) Pharmacological treatment of children with gastro-oesophageal reflux. Cochrane Database of Systematic Reviews. (11):CD008550. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008550.pub2… 25th July 2019]

Today’s Parent. (2018) Symptoms and remedies for silent reflux in babies. Available at: https://www.todaysparent.com/baby/symptoms-and-remedies-for-babies-with-reflux/ [Accessed 25th July 2019]

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