- What's happening
- An immature valve at the top of the stomach lets milk travel back up. Most reflux is normal posseting.
- What helps
- Smaller feeds, upright after feeds, patient winding, paced bottle feeding.
- When to get help
- Faltering weight, feeding aversion, blood in vomit, severe distress, chest infections.
- One tiny next step
- Try one feed upright with a longer wind today.
What's going on?
Reflux happens because babies are born with an immature digestive system. The valve between the stomach and the food pipe (the lower oesophageal sphincter) is still developing, which makes it easy for milk to travel back upwards. This is why so many babies bring milk up after feeds.
Most reflux is 'physiological' — it is normal posseting and spit-up that doesn't bother the baby beyond the laundry. A smaller proportion of babies experience reflux that is uncomfortable enough to affect feeding, sleep or weight gain. The medical term for this is GORD (gastro-oesophageal reflux disease).
Reflux usually peaks around 4 months and improves significantly between 6 and 12 months as the digestive system matures and babies spend more time upright.
Common signs and symptoms
Very common
- Milk coming back up after feeds — sometimes a little, sometimes a lot.
- Frequent possetting throughout the day.
- Hiccups.
- Being happier upright than lying flat.
- Wet burps.
- Occasional coughing or spluttering at the end of a feed.
Less common
- Arching, screaming or pulling off during feeds.
- Feeding aversion — refusing or fighting feeds.
- Persistent unsettled behaviour despite full nappies and feeds.
- Waking soon after every feed in obvious discomfort.
- Recurrent chest infections.
- Slow weight gain or weight loss.
Many babies who 'possit' a lot are happy, growing well, and just messy. Loud spit-up is not the same as painful reflux.
Is this normal?
Up to half of all babies under 3 months have noticeable reflux. By 6 months it has eased for many; by 12 months it has resolved for most.
If your baby is gaining weight, has wet and dirty nappies, and is generally happy between feeds, frequent spit-up is almost certainly normal — even if your sofa would disagree.
Painful or distressing reflux is less common and deserves a proper assessment.
Practical things that help
Feed smaller amounts more often
A smaller stomach load has less to come back up.
Keep baby upright for 20–30 minutes after feeds
Gravity helps keep milk where it belongs while the valve is still maturing.
Wind gently and patiently
Trapped wind under milk can push milk back up. A slow, calm burp helps.
Try paced bottle feeding
Slower, baby-led pace reduces gulping and overfeeding, both of which worsen reflux.
Hold baby fairly upright during feeds
Reduces pooling of milk at the back of the throat.
Avoid jiggling, bouncing or car seats straight after feeds
Movement immediately after a feed often triggers more spit-up.
What can accidentally make it harder?
Overfeeding
More milk in equals more milk out, and a stretched stomach reflexes back up more easily.
Lying baby flat immediately after a feed
Removes gravity's help.
Rushing the burp
An unburped baby often refluxes the milk on top of trapped wind.
Multiple changes at once (formula, teat, position, sleep setup)
If you change five things you don't know which one helped — and which one might have made things worse.
These are gentle observations, not blame. None of us avoid all of them all of the time.
What should I say?
- “Your tummy is still learning. I've got you.”
- “We can take a break.”
- “I don't have to fix this — most of it just needs time.”
Red flags and when to seek help
Worth an assessment
- Faltering or poor weight gain.
- Persistent feeding aversion or distress with feeds.
- Blood or coffee-ground material in vomit.
- Persistent forceful (projectile) vomiting in a young baby — may need an urgent paediatric review.
- Symptoms still significant beyond 12 months.
- Eczema, blood/mucus in stool, severe reflux together — possible CMPA.
Urgent — same day
- Recurrent coughing, choking or chest infections.
- Lethargy or reduced wet nappies.
- A baby who suddenly seems much more unwell.
Emergency — call 999
- Difficulty breathing, blue lips, unresponsiveness — call 999.
- Projectile vomiting with dehydration in a baby under 12 weeks — urgent same-day medical review.
A GP, health visitor, infant feeding specialist or paediatric dietitian can help if reflux is interfering with feeding, sleep or growth. Medication is not first-line for most babies, and shouldn't be started without an assessment.
If your child is seriously unwell or in danger, get help now.
Common myths
- Most spit-up is not a sign of allergy.
- 'Silent reflux' is a contested label — focus on the symptoms, not the name.
- Adding rice cereal to a baby's bottle is not recommended for reflux and can cause choking.
One tiny next step
Try one feed upright with a longer wind today.
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