Reflux in babies: symptoms, causes, and how to help your baby

Reflux can be very common in babies. And while it usually goes away on its own, it can be very stressful for parents to cope with. Here's how to spot the signs and symptoms of reflux, as well as silent reflux, in your newborn baby – and how to help them.

What is reflux?

Reflux is when your baby brings up milk or is a bit sick after a feed¹.

If your baby is going to get reflux, it will usually start before they're eight weeks old and can last until they're one¹.

Reflux is different to vomiting².

Official NHS guidance says:

If your baby vomits, you’ll see their muscles contract². 

If your baby has reflux, the milk travels back up their food pipe very easily².

What are the symptoms of reflux?

According to Dr Diana Gall from Doctor4U, it's fairly easy to tell when your baby is just spitting up a bit of milk, or if it's something that may need a bit more attention like reflux.

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Dr Gall says:

'As adults, we know when we’re suffering with heartburn or acid reflux, but babies don’t have the ability to tell us what they’re feeling.

'That’s why it’s important to look out for the following symptoms which might indicate that they’re suffering with reflux.'

Reflux symptoms include:

• bringing up milk or being sick during or after a feed¹
• regularly crying, fussing and being generally unsettled during or after feeds¹
• coughing or hiccuping during a feed¹
• obvious swallowing after burping or feeding¹
• not gaining enough weight¹
• frequent waking at night²
• frequent ear infections²

However, some babies have silent reflux which is harder to spot².

What is silent reflux?

If your baby has some of these symptoms but isn’t bringing up any milk, they may have silent reflux².

This is when milk travels back up your baby’s food pipe but, rather than spit it out, your baby swallows it².

If you think your baby has reflux, your health visitor can provide advice and support¹.

What causes reflux in babies?

Reflux happens because the muscles at the bottom of your baby’s food pipe (oesophagus) and leading into the stomach aren’t fully developed². This means milk can easily travel back up your baby's oesophagus, usually when they're full from a feed².

As your baby’s muscles develop and the ‘door’ between the food pipe and stomach closes properly, the reflux should stop¹. 

However for some babies, this reflux is very painful and is called gastro-oesophageal reflux disease (GORD)².

Dr Gall says:

'Reflux can have many different causes, including gastro-oesophageal reflux disease, or even food intolerances.

'Your baby may even have some underlying health issues that could be causing his reflux.

'Your family doctor should be able to determine the cause of the symptoms and whether it’s something that will need long-term or specialist treatment.

'But most often, reflux in babies can disappear on its own, or with a little help from mums and dads.'

What is gastro-oesophageal reflux disease?

Mild reflux is fairly common. However there is also a more serious type of reflux called gastro-oesophageal reflux disease (GORD)².

This is when your baby’s stomach acid irritates his food pipe, making it sore and inflamed². The NHS lists the symptoms of GORD² as: 

• spitting up frequently
• abdominal pain
• difficulty feeding
• your baby appearing unsettled and upset after a feed
• your baby not gaining, or even losing, weight

If you think your baby has GORD, talk to your pharmacist, GP or health visitor.²

How can I help my baby with reflux?

Most babies with reflux have it very mildly and don’t need to see a doctor¹. Instead, Dr Gall says there are lots of ways you can help your baby at home. These include:

1 Hold your baby upright during feeding and for as long as possible after feeding¹.

2 If your baby's formula-fed, offer smaller amounts of milk but more often¹.

3 Make sure your baby sleeps flat on their back — do not raise the head of their cot or Moses basket¹.

4 Wind your baby frequently before, during and after feeds².

When does reflux improve?

For most babies, the reflux goes away when the muscles between their food pipe and stomach develop properly¹. However, reflux can last until your baby is 12 months old¹.

Talk to your GP if your baby still has reflux after the age of one¹.

Dr Gall adds:

'Reflux is a fairly common problem in newborns and often resolves within a few weeks to a few months.

'Most parents notice that reflux either improves or disappears when their baby starts to eat solid foods, but you should follow your health visitor or doctor’s advice when it comes to weaning your child.'

Is reflux as bad at night?

If your baby has reflux, they may be waking up a lot in the night². This, says Dr Gall, is because reflux can be made worse by lying down.

Try keeping your baby upright for a while after a feed² to reduce the risk of them experiencing reflux in the night.

Is reflux made worse by bottle/breastfeeding?

There's some evidence to suggest that formula-fed or combi-fed babies may bring up milk more often than babies who are exclusively breastfed³'⁴. However, both formula-fed babies and breastfed babies can get reflux.

If you're breastfeeding, switching to formula is unlikely to help your baby's reflux, and may even make it worse³'⁴. But if you're formula-feeding, switching to a different type of formula might help. Speak to your health visitor for advice².

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When to see your GP

If you’ve tried to ease your baby’s reflux and there is no improvement after a couple of weeks, make an appointment with your GP¹.

You should also speak to your doctor if your baby¹:

• develops reflux for the first time after they're six-months-old
• is over 12 months old and still has reflux
• is not putting on weight or is losing weight

There are more serious symptoms to look out. The NHS advises you make an urgent appointment with your GP or phone 111 if your baby¹:

• has sick that's green or yellow, or has blood in it
• has blood in their poo
• has a swollen or tender tummy
• has a very high temperature or feels hot or shivery
• keeps being sick and can't keep fluid down
• has diarrhoea that lasts for over a week or is dehydrated
• won't stop crying and is very distressed
• is refusing to feed

Dr Gall adds:

'It’s also important to look out for any wheezing or difficulty in breathing, as sometimes gastric fluid may end up on your baby’s lungs during a reflux episode.'

Looking for more information on feeding and soothing your baby? Read our articles below.

And if your baby has silent reflux, why not share your experience and advice in the forum below?

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Sources

• ¹ NHS. 2019. Reflux in babies. [^]
• ² NHS Start4Life. nd. Breastfeeding challenges. [^]
• ³ Hegar et al. 2009. Natural evolution of regurgitation in healthy infants. [^]
• ⁴ Chen et al. 2017. Association Between Infant Feeding Modes and Gastroesophageal Reflux: A Repeated Measurement Analysis of the Infant Feeding Practices Study II. [^]