Patient information · Paediatrics
Reflux in babies
usually a laundry problem, not a medical one
Bringing up milk is normal in babies — the valve at the top of the stomach is immature, and around half of infants posset regularly. It becomes a medical problem only when it causes distress, poor weight gain or other complications, and the medicines commonly prescribed for it work far less often than people expect.
Seek same-day assessment if your baby has
- green or bile-stained vomit, or blood in the vomit
- forceful, projectile vomiting after most feeds, particularly at 2–8 weeks
- a swollen, tender abdomen, or blood in the stool
- poor weight gain, or weight loss
- arching, stiffening or blue episodes, or difficulty breathing during feeds
- vomiting starting after six months of age, or with fever or a bulging fontanelle
Green vomiting suggests obstruction and is always urgent. Projectile vomiting in a young baby, particularly a firstborn boy at three to six weeks, may indicate pyloric stenosis, which needs a scan and surgery. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
What is normal
- milk coming back after feeds, sometimes in surprising quantities
- starting in the first eight weeks, often several times a day
- a baby who is otherwise content, feeding well and gaining weight — the 'happy spitter'
- improving as the baby sits up and starts solids, and resolving in around 90% by 12 months
- It looks like a great deal more milk than it is — a tablespoon spreads alarmingly.
Reflux or something else?
Crying, arching and unsettled behaviour are frequently attributed to reflux and treated as such. In many babies the cause is feeding technique, overfeeding, wind, colic or cow's milk allergy rather than acid. A feeding assessment is more likely to help than a prescription. Genuine reflux disease causes distress with feeds, feed refusal, poor weight gain, or recurrent chest problems — not simply crying in the evenings.
What actually helps
- Review the feed. Overfeeding is common. If bottle feeding, check volume and teat flow; if breastfeeding, have the latch and positioning assessed.
- Smaller, more frequent feeds rather than large ones.
- Wind thoroughly during and after feeds.
- Keep upright for 20 to 30 minutes after a feed — held against your shoulder rather than in a car seat, which curls the abdomen and can make it worse.
- Avoid tight nappies and waistbands, and vigorous bouncing straight after a feed.
Always on the back to sleep
Whatever the reflux, babies must be placed flat on their back to sleep. Sleeping on the front or side, and raising the head of the cot, are not recommended — the evidence does not support them for reflux and they increase the risk of sudden infant death. Wedges, sleep positioners and anti-reflux pillows should not be used. This advice overrides any suggestion that propping helps.
Medication — and why it is used less than it was
- Alginate (Gaviscon Infant) may be tried for one to two weeks where a baby is distressed and simple measures have failed. It can cause constipation.
- Acid-suppressing medicines such as omeprazole are not recommended for reflux without complications. Trials show they are no better than placebo for crying and irritability in infants, and they are associated with increased rates of chest and gut infections and possibly allergy. They have a place in babies with proven oesophagitis or faltering growth — not in unsettled babies generally.
- Thickened formula may reduce visible vomiting in bottle-fed babies, though it does not always reduce discomfort.
- If cow's milk allergy is suspected, a proper trial of exclusion with reintroduction is more useful than acid treatment.
When to be seen
- poor weight gain, or crossing down growth centiles
- distress during or after most feeds, or refusing feeds
- recurrent chest infections, wheeze or persistent cough
- vomiting continuing beyond 12 months, or starting after six months
- if you are exhausted and not coping — that is a legitimate reason on its own
Why come to us. Most babies with reflux need a feeding assessment and reassurance, not a prescription — and that takes an unhurried appointment. We see babies seven days a week including weekends, weigh and plot growth, examine your baby, and observe a feed, then give you an honest answer about whether this is normal posseting, a feeding problem, cow's milk allergy or genuine reflux disease. Where medication or further assessment is warranted we arrange it promptly.
A feed watched, before anything is prescribed
Babies seen seven days a week, weekends included.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.