saudigastro.com/patients/infant-reflux
Category
Common
Red flags
6
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
Reflux means that milk from the stomach flows back up into the food pipe (oesophagus) and sometimes out of the mouth. In babies this is called "spitting up" or "posseting". It happens because the muscle valve between the food pipe and the stomach is still immature. When a baby is happy, feeds well and gains weight normally, this is called physiological reflux and is not a disease. When reflux causes poor feeding, poor weight gain or real distress, it is called gastro-oesophageal reflux disease (GERD) and needs a doctor's assessment.
How common is it?
Spitting up is one of the most common reasons parents worry in the first months of life. Many healthy babies do it, often after feeds. In most babies it becomes less frequent over the first year as they sit up, eat more solid food and the valve matures.
Why does it happen?
Babies have a short food pipe, a small stomach, spend a lot of time lying down, and drink a lot of liquid for their size. Overfeeding, swallowing air, and an immature valve all contribute. Sometimes reflux-like symptoms are actually caused by another problem, such as cow's milk protein allergy, so persistent or severe symptoms should be checked.
Symptoms
- Spitting up small amounts of milk after or between feeds
- A happy baby who is feeding well and gaining weight (normal reflux)
- Occasional burping, hiccups or a wet-sounding cough
- Fussiness or crying during or after some feeds
- Arching the back or turning away from the breast or bottle
- Frequent gagging or refusing feeds (suggests more than simple reflux)
Red flags — seek urgent medical care
Green (bile-stained) or yellow-green vomit
This can be a sign of a bowel blockage. Take your baby to the emergency department immediately.
Forceful (projectile) vomiting after most feeds, especially in a baby under 3 months
May suggest a narrowing at the stomach outlet (pyloric stenosis). Your baby needs to be seen urgently.
Blood in the vomit or blood in the stool
Needs urgent assessment to find the source of bleeding. Do not wait.
Swollen, hard belly, or a baby who is very sleepy, floppy, or has a fever
May signal a serious infection or blockage. A baby who needs urgent care should be seen immediately.
Poor weight gain or weight loss, refusing feeds, or fewer wet nappies than usual
Suggests dehydration or that reflux is affecting nutrition. See a doctor the same day.
Choking, blue colour, breathing pauses or repeated chest infections
Milk may be entering the airway. Call emergency services immediately if your baby turns blue or stops breathing.
How is it diagnosed?
In a happy, thriving baby the diagnosis is made from the history and examination, and no tests are needed. The doctor will ask about the feeding pattern, the vomit, growth and stools, and will plot your baby's weight on a growth chart. Tests (such as an ultrasound, a swallow study, or pH monitoring) are kept for babies with red-flag signs or poor growth, and are chosen by the doctor.
Outlook — what to expect
For most babies the outlook is excellent. Symptoms usually fade over the first year of life without any medicine. Babies with true reflux disease or an underlying cause (such as milk allergy) generally improve once the cause is identified and treated by the doctor.
Treatment
Habits & Lifestyle
Simple steps are the first treatment and are usually enough.
- Burp your baby gently during and after feeds.
- Hold your baby upright for a short time after feeding, if they are awake and you are watching them.
- Avoid tight clothing or nappies around the belly.
- Always put your baby to sleep on their back on a firm, flat surface. Do not raise the head of the cot, use pillows, wedges or sleep positioners, and do not put a baby to sleep on their side or tummy to treat reflux, as these increase the risk of sudden infant death.
- Keep your baby away from tobacco smoke, which can make reflux worse.
Diet
Small changes to feeding can reduce spitting up.
- Continue breastfeeding if you are breastfeeding. Breast milk is still the best choice.
- Offer smaller, more frequent feeds rather than large ones, and do not overfeed. Follow your baby's hunger signs.
- If bottle feeding, check that the teat size lets milk flow at a comfortable pace and keep the teat full of milk to reduce swallowed air.
- Never thicken feeds or change formula on your own. Thickened or anti-reflux formulas are used only when your doctor advises.
- If you suspect a milk allergy, talk to your doctor before removing any food from your own diet or changing formula.
Medications
Most babies do not need any medicine for reflux.
- Acid-reducing medicines are not recommended for happy babies who simply spit up.
- Your doctor may try a short course of treatment only if there is confirmed reflux disease with feeding problems, poor growth or complications.
- Do not give your baby any medicine, herbal drink, or home remedy unless a doctor has advised it.
- The doctor decides the medicine, dose, and how long to use it, and will review whether it is still needed.
Procedures & Surgery
Procedures are rarely needed.
- Tests such as an upper GI contrast study, ultrasound, or endoscopy are only used when red flags or poor growth suggest another cause or a complication.
- Surgery is considered only in very rare cases of severe reflux that does not respond to other treatment.
Living with the condition
- Spitting up can be messy and tiring. Keep spare clothes and muslin cloths handy.
- Keep a short diary of feeds, vomits and wet nappies to share with the doctor.
- Ask for help and rest when you can. Caring for an unsettled baby is hard, and support matters.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Is my baby's spitting up normal for their age?
- Is my baby gaining weight as expected?
- Could a milk allergy be causing these symptoms?
- Does my baby need any tests or medicine, and for how long?
- Which signs mean I should come straight to the emergency department?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide