Reflux

Worried baby

Reflux (spitting up milk during or after a feed) is messy, frustrating and can drive you to the end of your tether. But it's also pretty common, as the many Mumsnet discussions on the topic attest, and usually resolves itself when your baby's digestive system has matured. Here's our guide to the symptoms, ways to ease your baby's suffering and how to look after yourself too during what can be an exhausting and upsetting time

What is reflux in babies?
What causes reflux in babies?
What are the symptoms of gastro-oesophageal reflux (GOR) in babies?
What are the symptoms of gastro-oesophageal reflux (GORD) in babies?
How can I treat reflux?
How to cope if your baby has reflux
What Mumsnetters say about reflux

What is reflux in babies?

Reflux is what happens when babies bring up milk after feeding. They spit up what they’ve swallowed, combined with the acid in their stomach that’s supposed to break up their milk. This generally leaves an icky white mess around their mouths, on you and on the arm of the sofa. The acid makes it quite uncomfortable so a baby with reflux will often cry a lot, particularly after a feed.

Types of reflux:

  • Gastro-oesophageal reflux (GOR). This is the technical term for this fairly common condition. It isn’t a serious problem and most babies bring up a little milk at some point – this is called “possetting” and it can often happen when a baby burps. However, around 40% of babies suffer from persistent reflux, with a small number bringing up milk more than five times a day. Reflux affects both breastfed and formula-fed babies.
  • Silent reflux. This is the same as the condition described above except that the reflux doesn’t bring the milk and acid all the way up and out of the baby’s mouth. But she still feels the effects inside. Silent reflux is difficult to detect as there are few outward symptoms, but it can cause coughing and signs of discomfort when your baby is lying down.
  • Gastro-oesophageal reflux disease (GORD). This is the far less common and more serious form of reflux, where the contents of the stomach are able to rise up and irritate the oesophagus. It's a longer-term problem and can eventually cause damage to the oesophagus so it requires treatment.
My son had terrible reflux. Sometimes whole bottles were thrown up but mostly it was a constant dribble of sick, really heavy on the washing machine. All health professionals said it would only last until he was one and standing upright more than sitting and crawling. They were totally right.

What causes reflux in babies?

Reflux occurs when the muscle that controls food entering your baby’s tummy doesn’t work properly, usually because it’s insufficiently developed. This means that, when her tummy is full, the milk comes back up her oesophagus (food pipe), along with some stomach acid, causing her discomfort. If you’ve ever had heartburn, the feeling is similar.

It’s perfectly normal for a baby to bring up some milk from time to time – after all, her stomach is tiny. But the muscular valve, which controls what enters your baby’s stomach, will develop and, as that happens, there will be less and less reflux until she eventually grows out of it altogether.

If you think your baby is suffering from reflux, do remember that it's quite common and will pass fairly soon. It's not nice to have to watch your baby suffer, but rest assured that it isn’t serious. Ninety percent of babies who suffer from reflux overcome the problem by their first birthday.

What are the symptoms of gastro-oesophageal reflux (GOR) in babies?

While reflux is usually not a serious condition, it can cause your baby discomfort. If she's bringing up food several times per day, and you recognise any of the other symptoms below, take her to your GP:

  • Spitting up milk after feeds
  • Waking often during the night
  • Hiccups
  • Coughing
  • Refusing feeds
  • Arching her back during feeds.
  • Comfort-feeding to alleviate pain
  • Gagging during feeds
  • Crying during feeds
  • Weight loss or slow weight gain
  • Regular ear infections
Snivelly baby with mum

What are the symptoms of gastro-oesophageal reflux disease (GORD) in babies?

If your baby is suffering from GORD, they will exhibit some of the symptoms listed above and some of those listed below as well. You should take your baby to your doctor if they are doing any of the following:

  • Vomiting bile
  • Projectile vomiting
  • Relentlessly crying
  • Experiencing breathing problems
  • Becoming constipated
  • Having abdominal distension (ballooning abdomen)
  • Passing bloody or black feces
  • Running a fever
  • Choking

What are the medications for treating gastro-oesophageal reflux disease (GORD) in babies?

Most reflux does not require medicine but, if your doctor thinks your baby is suffering from GORD, she might be prescribed the following medicines:

  • Alginates. If changing the way you feed doesn’t reduce your baby’s reflux then alginates might be used to prevent stomach contents from floating up and irritating the oesophagus.
  • Proton pump inhibitors (PPIs) and H2-receptor antagonists. These might be used if your baby is refusing feeds. They sound quite terrifying but all they do is reduce the level of acid in the stomach, which in turn prevents irritation to the oesophagus.
When my daughter had reflux, we tried Gaviscon and Infacol. Eventually, the doctor put her on Enfamil which is available on prescription and is specifically designed for reflux. Since then she has been fine.

How can I treat my baby's reflux?

You can’t prevent reflux but you can ease it and the following suggestions might help to alleviate your baby’s suffering:

  • Change your feeding routine. Reduce the size but increase the frequency of feeds, so that she eats smaller, more easily digestible amounts, while still getting enough nourishment.
  • Keep her upright. Feed her in an upright position then hold her upright for 20 to 30 minutes after a feed.
  • Peace and quiet. Have calm and quiet time after feeding; relaxation might aid her digestion.
  • Try cutting out cows' milk. The symptoms of cows' milk allergy are similar to reflux, so it’s worth asking your doctor to check to make sure this isn’t the real problem if your baby is old enough to be having cows' milk.
  • Gentle movement. Try carrying her about in a baby carrier or sling. Motion can help babies to stop crying and crying makes reflux worse.
  • Burp her. If you’re bottle-feeding, burp her every couple of minutes. Formula takes slightly longer to digest than breastmilk. Also make sure the hole in the bottle’s teat isn’t too big and therefore letting out milk too quickly.
  • Try infant antacids. Check the dosage on the packet or speak to your pharmacist before giving this to your baby. Antacid can be added to formula, breast milk or boiled water after cooling.
  • Baby massage and cranial osteopathy. These techniques might help to relax your baby when she’s in pain and some Mumsnetters find that it helps to ease reflux. This might be because massage stimulates the nervous system, including the vagus nerve, which controls parts of the digestive system.
  • Raise the head end of her cot. She should still sleep on her back but, if her head is raised, she might find digestion easier.
My son was finally diagnosed with silent reflux at four months, after I cried at the baby clinic and pleaded for help. Different medicines work for different babies, so when you see your GP you should be very specific about the symptoms.

How to cope if your baby has reflux

While your priority is your baby’s wellbeing, there’s nothing wrong with admitting that watching her suffer with reflux is distressing for you. Reflux can be frustrating, time-consuming and several Mumsnetters describe the distress it causes. Reflux can lead to even less sleep for everyone at night, and your baby might not nap so well in the day either. Here are some suggestions that might help you cope:

  • Keep a supply of muslin squares handy. You’ll need lots of these and will want to put one on your shoulder (within perfect puking range) when you feed or cuddle your baby. You might also want to keep handy the supplies you need to mop up projectile vomit.
  • Stick to the same chair/sofa when sitting with your baby. Put a throw, to which you don’t feel too attached, over it. It might sound shallow, worrying about stains on your furniture when your baby is suffering, but any reduction in stress is a good thing.
  • Have a steady supply of sleepsuits. These are inexpensive, easy to wash and you can get your baby in and out of them in no time.
  • Wear white. We were thinking primarily of your baby but, actually, you might benefit from wearing white outfits on which milk stains won’t show (as much).
  • Pack a change of clothes. Always take spare clothes for your baby, and plenty of muslin cloths, when going out. If you've room, a change of top for you might be a good idea, too.
  • Talk to your doctor or health visitor. Reflux is common but it can still make you anxious, so speak to the professionals, even if you just want reassurance – providing it is part of their job.
  • Talk to other Mumsnetters. Reflux is a popular topic of discussion amongst Mumnsetters who are going through it and those who have been there and can offer advice.
  • Check out the Living with Reflux charity. This is an excellent source of information and advice about reflux.

What Mumsnetters say

“My son was a 'little and often' feeder as he just couldn’t handle bigger feeds, and on the rare occasion that he did take more milk, he puked it up. It is hard, and I was in tears many times when my son had reflux, but it does get better.”

“If your baby has reflux, keep him tilted at all times – sleeping, feeding, changing nappy etc – and certainly don't lay him flat until at least 20 mins after each feed.”

“You can try different medications, different thickening agents in her feeds and different formula till you find the right combination that works for her. It's head-wrecking but you get there eventually.”

“If you think your baby has reflux you should go to see your GP. My daughter had reflux and it was awful, feeding her became a nightmare and we could never feed her in our arms, as she used to arch her back. She was prescribed infant Gaviscon and we noticed a big improvement.”

“Both my sons had reflux. They projectile-vomited everywhere after every feed. My eldest was on medication for reflux until his first birthday and my youngest was very, very poorly with silent reflux: his oesophagus was damaged and he stayed on medication until he was about two. I will say, however, that it definitely gets better as they grow!”

“I feel for any parent whose baby has reflux. I have had two babies with reflux and I remember saying to the consultant, ‘Shouldn't he be better by now?’ He said, ‘There are always exceptions.’ That was worrying. But it does get better.”