What is reflux in babies?

Introduction

It’s normal for babies to vomit or ‘spit up’ milk after a feed. It’s sometimes referred to as ‘reflux’ or ‘gastro-oesophageal reflux (GOR)’. It affects around half of babies under two months old and usually resolves itself by the time they’re one year old^1,2. It can be worrying if your baby is vomiting repeatedly, not to mention the stress from all the extra washing it creates.

For most babies, GOR causes mild discomfort and can be managed at home with a few small changes to their routine. But if spitting up (reflux) happens a lot and causes your baby significant discomfort, it could be a sign that they have a more serious condition called gastro-oesophageal reflux disease (GORD). If you think your baby has GORD, it’s important to speak to your GP.

This article covers what is baby reflux, how to tell if your baby has reflux, the difference between reflux, GORD and silent reflux, possible causes of reflux, how to help a baby with reflux, and when to get help from a doctor.

What is baby reflux?

The full medical term for baby reflux is gastro-oesophageal reflux (GOR). It’s more commonly referred to as ‘reflux’, ‘regurgitation’, ‘spitting-up’ or ‘posseting’^3,4. Reflux is not the same as vomiting. The easy way to tell the difference is with reflux the milk is burped or dribbled out with no effort, whereas with vomiting you can see the muscles tensing up in baby’s throat.

It happens when the content of your baby’s tummy travels back up into their food pipe (oesophagus) or mouth instead of passing through to the large and small intestines³.

Reflux affects at least 40% of infants under one year old⁴ and is more common in those under 6 months of age and before weaning. However, if you’re worried about how much feed your baby is bringing up, speak to your healthcare professional such as your GP, health visitor or public health nurse.

How do I know if my baby has reflux?

Commons baby reflux symptoms include:

• Regularly bringing up milk or being sick. You may notice it’s worse after feeding or when your baby is lying down^2,4,5.

• Coughing and hiccupping when feeding⁶. This can cause your baby to become irritable or distressed during or after feeding.

Some babies bring up a lot and others very little, but in general, it’s unlikely to cause your baby any distress⁷. They can continue to feed and gain weight well without having any other symptoms. These babies are described as ’happy spitters’ and if your baby is continuing to feed and putting on weight, there’s most likely nothing to worry about, except a bit (OK maybe a lot) of extra laundry².

What is Gastro-oesophageal Reflux Disease (GORD)?

Regurgitation is considered entirely normal in babies younger than one year of age⁴. However, if your baby frequently regurgitates, their food pipe may become irritated and inflamed from the stomach acid which can cause pain and distress⁴. This could mean they have a more serious form of reflux known as gastro-oesophageal reflux disease (GORD) which may need treatment³. If your baby has GORD, your doctor may prescribe certain medications or treatments⁴.

The signs and symptoms of GORD can include:

• Irritability, excessive crying or crying while feeding².

• Faltering growth (a medical term used when your baby isn’t gaining enough weight)^3,4.

• Refusing feeds, gagging or choking mid-feed for no apparent reason⁴.

• Hoarseness and/or a chronic cough⁴

• An episode of pneumonia⁴.

• Recurrent middle ear infections (more than three episodes in 6 months)⁴.

If you’re concerned that your baby is experiencing any of the symptoms above, contact your GP, health visitor or public health nurse for an assessment.

What causes reflux?

Your baby’s digestive system is still developing when they’re young. Reflux occurs in babies when the muscle at the base of the food pipe (oesophagus) is not fully developed^1,2. In babies with reflux, this muscle isn’t strong enough which means it opens when it shouldn’t, allowing stomach contents to travel back up the oesophagus. This causes common symptoms of reflux such as regurgitation or being sick after a feed. It doesn’t help that gravity isn’t on their side as most young babies spend most of their day lying down⁵. But as your baby grows, this muscle will develop, and they should grow out of it.

How to help a baby with reflux

Reflux in babies is often mild and doesn’t require treatment [4]. It usually resolves in 90% of babies before they’re one year old⁴. But that doesn’t make it any easier when you’re quickly running out of clean muslins, changing bibs every ten seconds and the sofa and your clothes are covered in regurgitated milk.

The good news is that there are special techniques to feed a baby with reflux and methods to help soothe a baby with reflux. Here are some suggestions:

• Try smaller, more frequent feeds to stop their tummy getting too full^1,4.

• Burp your baby during and after feeding. If you’re unsure, ask your health visitor or midwife to show you some effective techniques [1], or read our tips on how to wind your baby

• Try feeding your baby in an upright position^8,1. If you’re breastfeeding, it can help to have a lactation consultant or midwife observe you breastfeed your baby to check that your baby is latched well. A poor latch can worsen reflux as your baby may swallow air whilst feeding⁸.

• Keep your baby upright for at least an hour after feeding, to help keep the milk down¹.

• Babies with reflux should continue to be placed in a flat position on their back to sleep unless they have been advised differently by a medical professional^9,6.

• If you’re breastfeeding, friends and family might suggest that you change your diet. Breastfeeding mums shouldn’t change their diet unless advised to do so by their GP or dietitian⁶.

• It’s been suggested that pacifier or ‘dummy’ use after feeding can help soothe babies with reflux and reduce crying and fussiness, however, there’s not enough research to support this¹⁰. Pacifiers are a personal choice and they’re not something to feel guilty about if it helps your baby. Speak to your health visitor for more advice about the pros and cons of pacifier use.

• If you’re bottle feeding, check the hole in the teat isn’t too big or too small

• Keep muslins and bibs in every corner of the house to protect you and your baby’s clothes from vomit!

If you’re concerned about your baby’s reflux, seek the advice of a healthcare professional. For formula-fed babies they may recommend you change to a thickened feed such as an anti-reflux formula – but only do this on their advice. And don’t forget, you can always talk to our Careline for tips on how to cope with newborn reflux.

What is silent reflux?

Silent reflux happens when babies swallow the regurgitated food instead of spitting it up. Babies with silent reflux have reflux without any of the obvious symptoms. This can make it harder to spot – hence the term ‘silent reflux’.

How do I know if my baby has silent reflux?

If your baby is showing symptoms of GORD without regurgitation, speak to your health visitor, GP or public nurse.

When should I speak to a doctor?

You know your baby better than anyone else. Reflux in babies is usually mild and isn’t a problem if your baby is otherwise healthy and content. It often resolves itself with time.

If you’re worried about your baby or notice any changes it’s important that you seek advice from your health visitor, GP or public health nurse. In some cases, reflux is the result of another condition that needs to be diagnosed and treated. Speak to a doctor if:

• The regurgitation ends in projectile vomiting⁴

• There is yellow or green vomit⁴

• There is blood in your baby’s vomit or poo⁴

• Your baby develops new symptoms such as a fever, swollen stomach, weight loss or no weight gain⁴

• Your baby has reflux which doesn’t clear after the first year of life⁴.