What is baby reflux? Symptoms and support

What is baby reflux?

Baby reflux is when a baby brings up a small amount of milk after a feed on a regular basis – up to six or more times a day (NICE, 2019). It is harmless and the baby is not normally distressed. It can happen however the baby is fed (McKechnie, 2024). ‘Spitting up’ or ‘posseting,’ are terms sometimes used to mean reflux.

It is caused by the stomach contents flowing back into the oesophagus (the tube which joins the throat to the stomach). This is because the muscle at the lower end is not fully developed (King et al, 2025; McKechnie, 2024).

Reflux is very common in babies, with almost half (4 in 10) of babies under a year old having it. Normally no tests or medical treatments are needed (NICE, 2019).

When does reflux start happening?

It usually starts before the baby is 8 weeks old, and peaks at 4-6 months. However, 9 out of 10 will grow out of it by the time they reach one year old (Marsh, 2019; NICE, 2019).

Premature babies are more likely to have reflux as the connection where the stomach joins the oesophagus is looser and less developed (King et al, 2025). It is also common in babies and children with some weakness in their muscles, for example those with cerebral palsy (McKechnie, 2025).

If the baby doesn’t bring up milk but seems unsettled, it may be suggested that the baby has ‘silent reflux.’

What is GORD/GERD?

Gastro-Oesophagal Reflux Disease (GORD) is more serious and less common. It is sometimes referred to as Gastro-Esophagal Reflux Disease (GERD) in American English.

Symptoms of GORD in the baby are usually seen during or after feeds and can be (King et al, 2025 ; Marsh, 2019; McKechnie, 2024; NICE, 2019):

• Projectile vomiting
• Pain in the chest or stomach
• Unexplained crying, although not all crying is caused by GORD
• Distressed behaviour
• Refusal to feed, or only taking a small amount
• Choking, gagging or wheezing

They may also experience:

• Poor weight gain
• Disturbed sleep

Talk to the GP or health visitor for appropriate treatment if you think your baby has GORD. It is important to see the GP if the milk is green or yellow-ish green, or has blood in it (NICE, 2019).

What can I do to help a baby with reflux or GORD?

Although reflux is common, it can be upsetting when your baby is unsettled. 

It may help to (McKechnie, 2024; NICE, 2019):

• Keep the baby held in a more upright position whilst feeding, and then upright for about 20 minutes after feeding.
• In-between feeds, keeping the baby upright or on their tummy may reduce episodes of reflux. Only do this if they are awake and supervised by an adult.
• For breastfed babies, it can be useful to have a breastfeeding assessment by someone skilled in breastfeeding technique, such as a lactation consultant or Breastfeeding Counsellor. Getting breastfeeding positioning and attachment correct can help to reduce reflux symptoms.
• Sometimes it can help to feed your baby smaller amounts, but more often.

What to avoid:

• Don’t raise the head of the cot. This makes it more likely for them to roll onto their side, which can increase the risk of Sudden Infant Death Syndrome (SIDS).
• For the same reason, babies with reflux or GORD should still sleep flat on their backs.

What is the treatment for reflux and GORD?

It can be alarming if your baby is distressed and bringing up a lot of milk. But medical help isn’t usually needed for reflux as the baby should eventually grow out of it as their body develops.

For a baby with GORD, the steps above should be tried first (NICE, 2019; Marsh, 2019). If there is no improvement:

For a breastfed baby with GORD

Be reassured that you don’t need to stop breastfeeding if a baby has GORD and it is almost always possible to treat it (Marsh, 2019).

A healthcare professional can prescribe a medicine called alginate for a short trial period which may help (NICE, 2019).

For a formula-fed baby with GORD

The healthcare professional might suggest changing to a thickened feed, or adding products that make the feed thicker (NICE, 2019). If these do not work, they might suggest trying an alginate (NICE, 2019).

It is worth pausing treatment occasionally to see if the problem has got better on its own (NICE, 2019).

What if those don’t work?

If none of the above work, a medicine to reduce the amount of acid in the baby’s stomach might be suggested (NICE, 2019).

However, the evidence for these medications, called proton pump inhibitors (PPIs)  is uncertain (Tighe et al, 2023). They may have side effects such as:

• Increased risk of infection
• Inflamed bowels
• Changes in bone density
• Childhood obesity

Could it be a cows milk allergy?

Some babies have symptoms of reflux due to a cow's milk allergy. This is more likely if there are other symptoms as well, such as:

• blood in poo
• persistent diarrhoea
• eczema
• unusually severe GORD symptoms
• GORD symptoms non-responsive to other treatments.

If the baby is allergic to cow's milk, then their sickness (vomiting) will reduce substantially over a two-week period if cow’s milk is eliminated from the diet.

• If breastfeeding, this means excluding cow's milk and cow’s milk products from the feeding parent’s diet
• For formula-fed babies, this means using special formulas made for infants with cow's milk allergy. This should be under the supervision of a medical professional, who can advise which formula is best to use.

When cow's milk is eliminated but the baby's (or child's) vomiting remains the same, it is extremely unlikely that the baby (or child) has a cow's milk allergy.

Allergy UK have more information about babies and cow’s milk allergies.