Reflux in babies

Reflux is where some of the contents in your baby’s tummy leak back up into their mouth. This is different from vomiting, where your baby’s muscles forcefully contract.

Reflux is common and can affect up to 40% of babies.

It usually occurs because a baby’s food pipe (oesophagus) is still developing.

It generally begins around 8 weeks old and improves as they get older because the ring of muscle at the bottom of their oesophagus fully develops. This stops stomach contents leaking out.

Signs and symptoms of reflux

Your baby may not show any signs of reflux or they may show the following signs:

• Spitting up milk during or after feeds.
• Refusing feeds, gagging or choking.
• Persistent hiccups or coughing.
• Excessive crying or crying while feeding.
• Frequent ear infections.

You do not need to be concerned about reflux if your baby is feeding well, happy and gaining weight as normal.

When to get medical advice

Non-urgent advice: Contact your public health nurse, GP or midwife if reflux starts after 6 months of age, continues beyond 1 year, or your baby has any of the following problems:

• Spitting up feeds frequently or refusing feeds.
• Coughing or gagging while feeding.
• Frequent projectile vomiting.
• Excessive crying or irritability.
• Green or yellow vomit, or vomiting blood.
• Blood in their poo or persistent diarrhoea.
• A swollen or tender tummy.
• A high temperature (fever) of 38C (degrees Celsius) or above.
• Not gaining much weight, or losing weight.
• Arching their back during or after a feed, or drawing their legs up to their tummy after feeding.

Breastfeeding and reflux

If you are breastfeeding and you are concerned that your baby may have reflux, you should speak with your public health nurse.

Your lactation consultant and the HSE’s breastfeeding online guide can also give you support and advice.

It is worthwhile having your feeding technique, positioning and attachment checked.

Positioning and attachment of baby to the breast

Formula feeding and reflux

If your baby is on infant formula, speak to your public health nurse to make sure that they are taking the correct amount of formula for their age.

To help their symptoms, try:

• offering smaller but more frequent feeds instead of a large volume in one go
• feeding in a more upright position
• winding regularly during a feed
• holding your baby upright for a while after feeding.

Avoid chopping and changing your baby’s infant formula. If you are considering changing your baby’s infant formula milk, discuss it with your public health nurse first.

Important

If reflux is causing your baby a lot of discomfort or distress, speak with your public health nurse or GP. There are some treatments available that can help

• Do not elevate the head while sleeping
• Do not elevate your baby’s head when asleep to treat reflux. This is sometimes called positional management.
• Positional management is elevating the head of their cot or using pillows under the baby’s mattress, sleep positioners and baby pillows.
• Place your baby on their back to sleep. Follow advice on safe sleep to reduce the risk of cot death.

Reference: HSE.ie (our health service) April 2022