Reflux in babies

Babies often bring up milk during or shortly after feeding – this is known as possetting or reflux.

It's different from vomiting in babies, where a baby's muscles forcefully contract.

Reflux is just your baby effortlessly spitting up whatever they've swallowed.

It's natural to worry something is wrong with your baby if they're bringing up their feeds. But reflux is very common and will usually pass by the time your baby is a year old.

Signs and symptoms of reflux in babies

Signs that your baby may have reflux include:

• spitting up milk during or after feeds – this may happen several times a day
• feeding difficulties – such as refusing feeds, gagging or choking
• persistent hiccups or coughing
• excessive crying, or crying while feeding
• frequent ear infections

When to get medical advice

Reflux isn't usually a cause for concern and you don't normally need to get medical advice if your baby seems otherwise happy and healthy, and is gaining weight appropriately.

But contact your midwife, health visitor or GP if reflux starts after six months of age, continues beyond one year, or your baby has any of the following problems:

• spitting up feeds frequently or refusing feeds
• coughing or gagging while feeding
• frequent projectile vomiting
• excessive crying or irritability
• green or yellow vomit, or vomiting blood
• blood in their poo or persistent diarrhoea
• a swollen or tender tummy
• a high temperature (fever) of 38C (100.4F) or above
• not gaining much weight, or losing weight
• arching their back during or after a feed, or drawing their legs up to their tummy after feeding

These can be signs of an underlying cause and may mean your baby needs tests and treatment.

Causes of reflux in babies

It's normal for some babies to have reflux. It usually just occurs because a baby's food pipe (oesophagus) is still developing.

It normally stops by the time a baby is a year old, when the ring of muscle at the bottom of their oesophagus fully develops and stops stomach contents leaking out.

In a small number of cases, reflux can be a sign of a more serious problem, such as:

• gastro-oesophageal reflux disease (GORD) – a long-term form of reflux where stomach contents are able to rise up and irritate the oesophagus
• a cows' milk allergy – this can also cause a rash, vomiting and diarrhoea; many babies will eventually grow out of it and can be treated by removing cows' milk from their diet
• a blockage – rarely, reflux may occur because the oesophagus is blocked or narrowed, or there's a blockage in the stomach and small intestine

Tests that may be needed

Most babies with reflux don't need any tests. It can usually be diagnosed based on your baby's symptoms.

In rare cases, the following tests may be recommended if your baby's reflux is severe or persistent:

• endoscopy – a narrow, flexible tube with a camera at the end is passed down their throat to look for any problems
• barium swallow – this where your baby is given a drink containing a substance called barium before an X-ray is taken; the barium shows up on the X-ray and helps highlight any problems in their digestive system

These tests will normally be carried out in hospital.

Treatments and advice for reflux in babies

Reflux doesn't usually require treatment if your baby is putting on weight and seems otherwise well.

The following treatments and advice may be offered if your baby appears to be in distress or their reflux has a specific, identified cause.

Feeding advice

Your midwife or health visitor may want to check how you feed your baby and suggest some changes to help with their reflux.

These changes might include:

• burping your baby regularly throughout feeding
• giving your baby smaller but more frequent feeds
• holding your baby upright for a period of time after feeding
• using thicker milk formulas that are less likely to be brought back up – these are available to buy without a prescription, but only try them if advised to by a healthcare professional

If your doctor thinks your baby could have a cows' milk allergy, they may suggest trying special formula milk that doesn't contain cows' milk.

Read more general breastfeeding advice and bottle feeding advice.

Medication

Babies with reflux don't usually need to take any medication, but sometimes the following medicines may be offered if your doctor feels the problem is severe:

• alginates – these form a protective barrier over stomach contents, stopping them travelling up and irritating the oesophagus
• proton pump inhibitors (PPIs) and H2-receptor antagonists – these reduce the level of acid in the stomach, so the stomach contents don't irritate the oesophagus as much

Alginates may be used if changing the way you feed your baby doesn't help. PPIs and H2-receptor antagonists may be recommended if your baby appears to be in discomfort or is refusing feeds.

Surgery

In a very small number of babies – most often, babies with serious underlying conditions such as cerebral palsy – an operation may be needed to treat GORD by tightening the ring of muscle at the bottom of the oesophagus.

Surgery may also be needed if there's a blockage or narrowing in the oesophagus, stomach or small intestine.