Reflux

Reflux is when the contents of the stomach are brought back up (regurgitated) either into the oesophagus (food tube) or mouth. This is often called spitting up, posseting or bringing milk up, and is common in babies, especially after a feed.

Signs and symptoms

Posseting, spilling or regurgitation is when stomach contents come all the way up to the mouth. It usually appears effortless in comparison to vomiting, and can occur at any time. It is very common in babies up to 18 months of age. There is no specific treatment and it usually gets better on its own.

Gastro-oesophageal reflux is the effortless regurgitation of stomach contents into the oesophagus (food pipe). It happens spontaneously and the contents are generally swallowed back into the stomach. It tends to happen after feeding or meals and can cause discomfort. Reflux can affect babies as well as children and young people who have problems with their muscles and nervous system, such as children with cerebral palsy.

Gastro-oesophageal reflux disease (GORD) is when the reflux of stomach contents causes complications such as poor weight gain, feeding difficulties, irritability and unsettled behaviour before, during and after a feed. In older children it may cause heartburn or tummy pain after meals. More severe complications are oesophagitis (inflammation of the oesophagus from the refluxing of stomach acid) or breathing changes.

How is it diagnosed?

Reflux is usually diagnosed by a doctor or child health nurse. GORD requires a doctor’s assessment to confirm a diagnosis.

Treatment

Reflux and regurgitation can be very worrying for parents. While it is difficult, it is important to remember that in the majority of cases, reflux will resolve itself without treatment or medication. Ask your family and friends about some other ways to manage your baby’s reflux.

Some things to consider include:

Feeding

• Continue to feed in the way you have chosen (breast or bottle feed)
• You should not change from breastfeeding or change the formula unless advised by the doctor, child health nurse or dietician

Feed thickening

• Using a feed thickener or thickened formula (with ‘AR’ in the title) can be helpful in reducing the signs of reflux.
• Thickener can be used in formula and expressed breast milk or alternatively, it can be mixed and given as a gel during breastfeeding.
• Ask your doctor or child health nurse if a feed thickener will help your baby.

Positioning and sleeping

• During a bottle feed, try keeping your baby upright if possible. After either a breast or bottle feed, try keeping your baby upright over your shoulder or sitting on your knee for a short period of time. Try not to bounce them around or provide too much stimulation following a feed.
• Safe sleeping recommendations suggest that babies with reflux should be only placed on their back to sleep on a firm, flat mattress. There is no evidence to support:
  • elevating the head of the cot for babies with reflux.
  • the use of positioning wedges or pillows in the cot for babies with reflux.
  • placing your baby on their side or tummy to sleep for babies with reflux.

Medication

Some infants and children require medication to help manage reflux. Medication is used to treat gastro-oesophageal reflux disease rather than simple reflux. If your baby or child regurgitates feeds or meals and otherwise behaves as you would expect a normal baby to behave, then they don’t need medication. If your baby or child has pain, long periods of crying and unsettled behaviour, difficulty with feeding and poor weight gain, then your doctor may prescribe medication that helps to reduce acid production such as omeprazole.

Smoking

Environmental tobacco smoke may also contribute to reflux in babies. It is important that you don’t smoke around your baby and that you don’t allow other people to smoke around your baby.

Starting solids

There is currently little evidence to suggest that starting solid feeds early can help with reflux. It is important to follow the Australian recommendation as discussed in the current Australian Infant Feeding Guidelines which is to introduce solids at around six months of age and not before four months.

When your infant is ready, start to introduce a variety of solid foods, starting with iron rich foods, while continuing to breast or formula feed.

When to seek help

See your GP if your child has these common symptoms:

• sudden or forceful vomiting, in large amounts
• vomit that’s green, yellow or has blood in it
• trouble swallowing
• gagging or choking
• fever
• irritability or being constantly hard to settle
• refusing milk or food
• swollen or bloated tummy
• blood or mucus in poo
• weight loss or very slow weight gain.

You should also see your GP if your child is having treatment that isn’t working.

In an emergency, call Triple Zero (000) and ask for an ambulance.

If you're not sure whether to go to an emergency department, call 13 HEALTH (13 43 25 84) and speak to a registered nurse.

Developed by the Division of Medicine, Queensland Children’s Hospital. We acknowledge the input of consumers and carers.

Resource ID: FS137. Reviewed: June 2023.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.