Reflux happens when some stomach contents (eg breastmilk) pass from the stomach back up into a baby’s oesophagus (muscular tube that leads from the mouth to the stomach), and sometimes spills out of their mouth.
This spilling, which can be called spitting up, posseting or bringing milk up, is common in babies, especially after a feed.
Reflux occurs in adults too, but we’re mostly not aware of it. Babies spend a lot of time lying down, have a liquid diet and a short oesophagus. These factors make reflux more noticeable.
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 is a disease which requires medical diagnosis and advice. With reflux disease, the acid in the stomach burns and causes damage to the oesophagus. This is fairly rare. Only a small number of babies have vomiting which is linked with pain and crying.1
Babies with reflux disease usually need medical treatment. They often show more than one of the following:
refusal to feed
vomiting up a large amount of milk after most feeds, so they have problems gaining weight
blood (bright or very dark red) or bile (green or yellow) in the vomit
being in pain after breastfeeds and fussy and unhappy between feeds
coughing a lot or wheezing 2,3
In some cases, babies may breathe in what has come 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 tell you that your baby has 'reflux'. However, if your baby doesn’t have the symptoms listed above, they are unlikely to have reflux disease.
How often to feed
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.
However, reflux episodes are worse in the first hour or so after feeds so your baby may prefer a larger feed less often. These babies may feed from both breasts at each feed and go longer between feeds. You may like to try a few of these to see what works best.
For more practical tips on coping with your baby’s reflux, see Bringing up milk (Posseting)
Should I keep breastfeeding?
People may suggest you change to formula. You might even wonder if giving your baby formula instead of breastmilk could be better for them. However, breastmilk is the normal food for all babies and is even more important for a baby with symptoms of reflux.
It’s easy to digest and contains everything they need for normal development.
If your baby breathes in their vomit, breastmilk is less harmful than formula.
Breastmilk has immune factors that help to heal sore or damaged areas in your baby’s gut. Formulas that claim to help with reflux lack these factors. They only differ from standard formula because they have thickener added.
Reflux is about as common in formula-fed babies as in breastfed babies. However, reflux episodes in formula-fed babies tend to happen more often and last longer.7,8
The smell of the vomit and poos of babies fed formula is much stronger than those of breastfed babies.
Formula is harder for a baby to digest. It cannot protect your baby from infection.
Support and information
Although babies usually ‘grow out’ of reflux, it can be a very difficult and tiring time for parents.
ABA's booklet Breastfeeding: and reflux combines the experiences of many families with the latest research into reflux. It includes practical suggestions for:
helping your baby with different holds and feeding positions
ways to improve sleep
gentle ideas for playtime
how to change your baby’s nappy without causing reflux.
The booklet has a section on strategies that have helped parents cope with reflux and includes parents' own stories.
ABA breastfeeding counsellors on the National Breastfeeding Helpline, can discuss ideas to help you manage the reflux while breastfeeding your baby.
You may also find support through the Reflux Infants Support Association (RISA).
The information on this website does not replace advice from your health care provider.
© Australian Breastfeeding Association April 2022
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