22/04/2026
Reflux in Newborns
Reflux, spitting up or possetting are all names used to describe babies bringing back some of the milk that they swallowed earlier. Some spitting up is quite normal in young babies, this may simply be how they deal with too much milk or anything that doesn’t agree with them.
How common is reflux in babies?
Reflux is very common in young babies. Infants with reflux are generally happy and thriving babies who spit up at least once or more per day most days and are sometimes referred to as “happy spitters”.
What is silent reflux?
Silent reflux (laryngopharyngeal reflux) is the name coined for when regurgitated milk comes part way up the oesophagus towards the voice box and back of the throat then goes back down to the stomach without any spilling out of the mouth. This could potentially interfere with breathing causing wheezing or coughing.
Why do babies have reflux?
Immune system protection
Spitting up regularly may have a protective function if the baby is otherwise happy and gaining weight:
Breastmilk is full of immune factors (not just antibodies, but dozens of factors that interact with each other) that protect the baby from invasion by bacteria and other microorganisms (fungi, viruses, etc.) by forming a protective layer on his mucous membranes (the linings of the gut, respiratory tract and other areas). This protective layer prevents micro-organisms from invading the body through these mucous membranes. A baby who spits up gets extra protection, first when the milk goes down to the stomach, and again when he spits it up.
Protection against over feeding
Babies consume a large volume of milk compared to their size. Combined with a small tummy and a short oesophagus (the tube that carries food from mouth to stomach) some of the milk simply spills back out through the mouth after a feed. This is likely a protective mechanism if a baby has too much milk at once.
What causes excessive reflux in babies?
Although some spitting up is normal, and may prevent overfeeding and protect the gut, some babies have more reflux than others. Possible causes include:
1. Too much milk (oversupply of breast milk)
Babies may spit up more if they’re getting too much milk, this is not necessarily a problem for mother or baby. However, sometimes a baby who is getting too much milk might gain weight well but be uncomfortable and fussy, and his mother may constantly have engorged breasts and blocked ducts. Sometimes the flow of milk from the breasts can be very fast with oversupply, especially at the start of the breastfeed—causing a baby to gulp, gasp and choke or let go of the breast. How well a baby can handle milk flow can depend on whether he has a deep latch (the way a baby is attached at the breast), and the position they are held in. Your lactation consultant can check whether your baby’s latch, or positioning could be improved or whether any steps need to be taken to manage your supply.
2. Cows’ milk allergy and reflux
Studies have shown a link between reflux and having an allergy or intolerance to cows’ milk protein. There could also be a sensitivity to some other food allergen, excess caffeine or second hand smoke. If a mother tries removing dairy products or other known allergens from her diet, the symptoms of reflux will improve if food sensitivity is involved.
3. Immature sphincter muscle
Reflux is sometimes attributed to an immature or undeveloped sphincter muscle—a ring of muscle between the stomach and the oesophagus (food pipe) preventing spillage of the stomach contents.
4. Tongue movement
The tongue moving in the right direction may play a role in the swallowing reflex down the oesophagus and into the stomach and intestines. Being tongue tied could interrupt this reflex action and could lead to sluggish digestion, inflammation, gas, trouble pooping and may contribute to symptoms of reflux, or colic in babies.
5. Swallowing of air
Swallowing of air is sometimes said to be a cause of colic or reflux.
HOW CAN I HELP MY BABY WITH REFLUX?
Rule out other causes of symptoms
When spitting up is accompanied by a fussing or crying baby it can be easy to assume that “reflux” is the cause. However the fussing may have a separate cause and spitting up milk might be unrelated or simply be following on from a crying burst due to raised pressure on the stomach
Could baby be hungry?
A baby fussing during feeds, pulling at the breast, refusing the breast, not wanting to lie flat, or being fretful might typically be blamed on reflux but these same symptoms can be seen in the baby who is not getting enough milk or not gaining weight normally. Oversupply can also be confused with not enough milk and rigid approaches to a perception of “oversupply” can quickly become “not enough milk”
Tips to help a baby with reflux
1. Try frequent smaller breastfeeds rather than large feeds further apart.
2. Try keeping baby in upright positions for feeding and carrying. A baby carrier or sling may be helpful for upright carrying as long as it doesn’t increase the pressure on the abdomen.
3. Avoid using a car seat or baby seat after feeds. Poor positioning can compress the stomach and increase reflux
4. Handle baby gently to minimise spitting up.
5. Elimination diet. If symptoms of allergy are present alongside reflux, consider if an elimination diet could help.
6. If oversupply is suspected check latch, positioning and breastfeeding management with your breastfeeding specialist
7. If formula fed assess whether baby is on correct formula
8. Burping your baby regularly may help prevent milk travelling back out with gas bubbles and ensuring you aren’t overburping (longer than 2min).
9. No Comfort sucking on an empty breast.
10. Massage. Some parents have felt that baby massage helped with their babies’ symptoms of colic and reflux.
Medication
Medications such as alginates and antacids are often prescribed. Alginates eg gaviscon help to prevent stomach contents from moving back up the oesophagus. In adults, antacids reduce the acidity of gastric secretions and offer short term acid reduction and symptom relief for GERD. However, as discussed above, most baby reflux is not acidic and medication will not be helpful for normal reflux.
In the case of infants, most reflux is buffered by frequent feeds and seldom is of acid pH, which seems to have been largely ignored by prescribers of medication.
The largest randomized, controlled study to date in infants showed that for symptoms purported to be those of GERD, a PPI [proton pump inhibitor] such as Nexium was no better than placebo.
In addition, adverse events associated with some medications may outweigh their benefits
• Reflux medications and simple antacids may cause constipation in babies
• Reflux medications may affect protein digestion and result in food intolerances.
• Suppressing normal acid secretions can have health implications such as gastroenteritis, or necrotising enterocolitis in preterm babies
• There may be an increased risk of developing asthma or respiratory tract infections
• Acid suppression therapy early in life is linked to an increased risk of fractured bones.
Rather, before medicating your baby, contact an infant feeding specialist and see if this won’t help instead. Often reflux can be sorted out with changes in Feeding methods or techniques.
Contact Sr Teresa at 0824009501 and she will definitely be able to assist
