Few things worry parents more than a baby who spits up, arches, cries, or seems uncomfortable after feeds.
In clinic, I often hear:
“Is this reflux…?” “…do we need medication?”
What is reflux in babies?
Reflux means milk flowing back from the stomach into the oesophagus.
In infants, this happens easily because:
The muscle at the top of the stomach is still immature
Babies spend much of their time lying flat
They drink only liquid feeds
This type of reflux is called GER – Gastro-Oesophageal Reflux.
It is:
Very common
Developmental
Usually harmless
Often improves with time
GER vs GERD – what’s the difference?
GER (normal reflux)
Frequent spit-ups
Milk coming up without distress
A baby who feeds, grows, and develops well
Symptoms peak around 3 – 4 months
Gradually improve by 6 – 12 months
Many parents apologise for “overreacting” – but reflux looks dramatic, even when it’s normal.
GERD (reflux disease)
GERD is reflux that causes problems.
This may include:
Poor weight gain
Refusal to feed
Persistent distress linked to feeds
Recurrent choking or coughing
Feeding becoming a daily struggle
GERD is much less common than GER.
What reflux does NOT usually cause
Normal reflux does not usually cause:
Severe, constant crying all day
Blood in stool (this suggests other causes)
Eczema or breathing problems
Failure to thrive
If these are present, reflux may not be the main explanation.
Why reflux can still look uncomfortable
Some babies:
Arch their back
Cry briefly after feeds
Seem unsettled when lying flat
This doesn’t always mean pain – sometimes it reflects:
Immature digestion
Gas
Normal sensory sensitivity
Tiredness rather than hunger
A baby can be uncomfortable without being ill
– and that’s a hard distinction when you’re exhausted.
This is one of the most important things I say to parents in clinic. Exhaustion changes how we interpret our baby’s symptoms. Getting support – for the baby and for yourself – matters as much as any medical answer.
What usually helps (without medication)
For most babies with GER, simple measures are enough:
Smaller, more frequent feeds
Keeping baby upright briefly after feeds
Avoiding overfeeding
Time and reassurance
Importantly:
Thickened feeds may help some babies
Positioning should always be safe (on the back for sleep)
What about reflux medication?
Acid-suppressing medication:
Does not stop milk coming up
Is rarely needed for simple reflux
Is reserved for clear GERD with complications
International guidelines recommend caution, especially in young infants.
Studies consistently show that acid-suppressing medication in infants with normal reflux does not reduce crying, does not improve feeding, and carries real risks including altered gut microbiome and increased infection susceptibility. If medication has been suggested for your baby, it is always reasonable to ask what specific complication it is treating.
When to see a doctor
Please seek medical advice if your baby has:
Poor weight gain
Persistent feeding refusal
Blood in vomit or stool
Recurrent breathing symptoms
Extreme or worsening distress
These signs don’t mean something serious is happening – but they deserve assessment.
A reassuring closing thought
Reflux is one of the most common reasons parents worry in the first months of life.
In the vast majority of babies, it reflects a gut that is still learning – not something broken or dangerous.
With time, support, and clear information, reflux usually becomes a phase parents look back on and say:
“This was hard – but it passed.”
Clear information can make worrying feel lighter.
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This article reflects guidance used by paediatricians in daily clinical practice.
Sources & medical guidance:
- ESPGHAN/NASPGHAN Paediatric Gastroesophageal Reflux Clinical Practice Guidelines – Rosen R, Vandenplas Y et al. (2018)
- NICE Guideline NG1: Gastro-oesophageal Reflux Disease in Children and Young People (2015, updated 2019)
- Rome IV Criteria for Infant Functional Gastrointestinal Disorders – Benninga et al. (2016)
- Rome V Criteria for Paediatric Disorders of Gut-Brain Interaction – Hyams et al. (2026)