Breastfeeding and reflux

Reflux is common in babies, especially after feeding. It happens when milk moves back up into your baby’s oesophagus (the tube from mouth to stomach) and sometimes spills out. You might hear this called spitting up, posseting, or bringing up milk. 

Some adults experience reflux too but it’s more noticeable in babies because of their liquid diet and time spent lying down.

It’s important to know that not all reflux is the same. Most babies experience simple reflux, which is harmless and usually resolves as they grow. Reflux disease (also called GORD) is less common and needs a medical diagnosis and advice.

If your baby brings up milk but is otherwise happy and putting on weight well, they have what is called ‘simple reflux’. It doesn’t hurt your baby and it usually stops by itself as your baby grows. 

Gastroesophageal reflux disease (sometimes known as GORD) requires medical diagnosis and advice. With reflux disease, the acid in the stomach burns and causes damage to the oesophagus (the tube between the mouth and stomach). This is fairly rare. Only a small number of babies have vomiting which is linked with pain and crying.¹  

Babies with reflux disease tend to vomit a lot, usually in the first hour after feeding.² The vomit may contain blood from damage to the oesophagus which can look fresh and bright red or very dark, like coffee grounds. 

Other symptoms may include:

• Refusing to feed
• Poor weight gain or weight loss
• Being fussy or upset during and/or after breastfeeds
• Coughing or wheezing during feeds^3,4
• Sleep problems
• Breathing (respiratory) symptoms
• Crying and irritability

In some cases, babies may breathe in vomit that has come up from their stomach. This can be serious, especially if the baby is fed anything other than breastmilk.

If your baby fusses, cries a lot, and arches their back, people might say your baby has “reflux.” However, if your baby doesn’t have the symptoms listed above, they are unlikely to have reflux disease.

If you notice these symptoms in your baby, it’s important to see your healthcare provider for advice and support.

Before looking at medical treatments, check that there isn’t another reason for your baby’s crying. 

Lactose overload: Babies gain weight but have lots of wind, don’t settle after feeds and may cry a lot. This is often mistaken for reflux.

Cow’s milk protein allergy/intolerance: Some babies react to proteins in cow’s milk and research has shown the symptoms can look similar to reflux disease.^5,6 If you want to find out if your diet may be causing your baby’s reflux, first see your doctor to rule out any other causes of symptoms. You could then see an accredited dietitian who has a special interest in this area. 

Here are some gentle ways to help your baby with either type of reflux:

• Try different feeding positions: Upright holds often help. You might sit your baby facing your breast, cradle them down your body, or lie back with your baby on top.
• Keep baby upright after feeds: Holding your baby on your shoulder can help them feel comfortable.
• Adjust feeding frequency: Some babies do better with smaller, more frequent feeds. This causes less pressure on the sphincter muscle between the oesophagus and the stomach. Your baby may not want both breasts at each feed or may do better if you offer only one side, but more often. 
  Other babies prefer larger feeds less often because reflux episodes are worse in the first hour or so after feeds. 
  Try different approaches to see what works for you and your baby.

People may suggest you change to formula. You might even wonder if it would be better for your baby. However, breastmilk is even more important for a baby with symptoms of reflux. 

• Breastmilk is easy for babies to digest and provides everything they need to grow and develop.
• If your baby breathes in their vomit, breastmilk is gentler on their body than formula.
• Breastmilk contains immune factors that help heal and protect your baby’s gut. Formulas marketed for reflux don’t have these benefits. They’re just regular formula with added thickener.
• Reflux happens just as often in formula-fed babies as in breastfed babies, but episodes tend to be more frequent and last longer with formula.^7,8
• Vomit and poos from formula-fed babies usually have a much stronger smell than those from breastfed babies.
• Formula is harder for babies to digest and doesn’t protect against infections like breastmilk does.

Although babies usually ‘grow out’ of reflux, it can be a very difficult and tiring time for parents. 

ABA's booklet Breastfeeding: and reflux offers practical suggestions and real stories from families. 

ABA breastfeeding counsellors on the National Breastfeeding Helpline can discuss ideas to help you manage the reflux while breastfeeding your baby. 

Your health care provider may also be able to recommend local services that can provide you with support during this challenging time. 

The information on this website does not replace advice from your health care provider.

© Australian Breastfeeding Association January 2026