Reflux in children 👶🏻

Reflux, Retching, and Really Tired Parents: Surviving Reflux in Children

Ah, reflux. That glamorous rite of passage that transforms your adorable bundle of joy into a tiny, milk-scented volcano. If you’ve ever found yourself catching vomit mid-air or Googling “Is baby spitting up normal or should I panic?”, you’re not alone.

In my clinic I often get a parade of very tired, slightly milky-smelling parents asking, “Is this reflux? Is it serious? Is it going to end? God when will it stop??”

Let’s break it down (without breaking down ourselves, ideally).

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What Even Is Reflux?

Reflux—more formally known as gastro-oesophageal reflux (GER)—is when stomach contents travel up into the oesophagus. In non-doctor speak: food goes down, and then some of it comes back up, like a boomerang with bad manners.

This happens because the little valve between the stomach and oesophagus—the lower oesophageal sphincter—is still a bit floppy in babies.

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So… Is It Normal? Or Not?

Short answer: It can be perfectly normal. And very common

Many babies have reflux to some degree—especially in the first few months of life. They eat liquid food, lie down a lot, and have a digestive system that’s basically still in beta testing.

But when should you be concerned and seek medical advise? Well the below is when it goes from “okay this a bit annoying” to “I should really get this seen to”

🚩 Poor Weight Gain or Weight Loss
If your baby isn’t gaining weight well, or even losing weight, despite feeding regularly, this may be a sign the reflux is affecting their nutrition.

🚩 Refusing Feeds or Feeding Aversion
If your baby starts arching their back, crying, or turning their head away from the bottle or breast, reflux pain may be making mealtime miserable.

🚩 Frequent Forceful Vomiting (Not Just Spit-Up)
Regular, forceful vomiting aka as projectile vomit (think The Exorcist – vomit literally flying to the one side of the bed to the other) is different from mild spit-up. It could indicate something more serious like pyloric stenosis—especially if it starts around 2-8 weeks of age.

🚩 Blood in Vomit or Stool
If you notice red or coffee-ground-like material in vomit, or black/tarry stools, call your doctor. These can be signs of bleeding in the gut.

🚩 Persistent Cough, Wheezing, or Breathing Issues
Reflux that causes frequent coughing, wheezing, or pauses in breathing (apnea) may be entering the airway—this is definitely worth a medical check.

🚩 Extreme Irritability or Discomfort
All babies cry, but if your baby seems in constant distress, especially during or after feeds, it’s time to rule out more severe reflux or another issue.

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Symptoms of Reflux: The Good, the Bad, and the Burpy

Reflux can look like:

• Frequent spit-ups (the kind that soak you through your fourth shirt of the day)
• Crying or fussiness during or after feeds
• Arching of the back (not ballet aspirations—just discomfort)
• Coughing, gagging, or hiccupping a lot
• Poor weight gain (in some cases)
• Frequent night waking (though let’s be honest—all babies seem to have this symptom)

Now, most babies with reflux are what we call “happy spitters.” They chuck, they smile, they carry on. But sometimes, it can be more distressing—for baby and for the person doing 45 loads of laundry per week.

When reflux leads to feeding aversion, growth issues, or just generally turns every mealtime into an operatic tragedy, it’s time to talk to your doctor.

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The Emotional Toll: A Parent’s Journey Through the Land of Laundry

Reflux doesn’t just affect the child—it affects the entire household. It’s hard to see your baby in discomfort, and harder still to feel like nothing you’re doing is helping. Many parents come in concerned, confused, and sleep-deprived enough to mistake a onesie for a hat.

So, first off: you’re not failing. You’re just in the splash zone.

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How to Manage Reflux: The (Evidence-Based) Game Plan

While your grandmother may suggest everything from goat’s milk to hanging the baby upside down after feeds (please don’t), here’s what the evidence actually says:

Feed Smart

• Offer smaller, more frequent feeds.
• Avoid overfeeding (here’s a rough guide¹):
  • Children Day 1-4, 30-60 mls/kg/day and increase over the next few days as tolerated
  • Day 5 – 3 months, 150 mls/kg/day
  • 3 – 6 months, 120 mls/kg/day
  • 6 – 12 months, 100 mls/kg/day
• Burp the baby during and after feeding.
• Keep them upright for 20-30 minutes post-feed. Think “milk bar with a view.”

 Positioning

• While awake, tummy time helps with gas and core strength.
• But remember: babies should sleep flat on their backs on a firm surface, even with reflux. No wedges or elevated sleeping unless specifically directed by a healthcare provider.

Formula Tweaks

• If formula-fed, some babies may benefit from a thickened formula.
• For some, cow’s milk protein intolerance can mimic reflux, and trying a hypoallergenic formula (with medical guidance) may help.

 Medication? Maybe.

• For most babies, meds aren’t needed.
• But in some cases they are and your doctor can advise and prescribe certain medications like gaviscon infant or omeprazole provided they think its appropriate

So: medicine is a maybe, not a must.

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Final Thoughts: It Won’t Last Forever (Even If It Feels Like It Will)

Reflux usually improves with time—often by 12 months, as babies start eating solids, sitting up, and developing a better-functioning digestive system. Hang in there. The spit-up days will pass. One day you’ll wear white again and eat a meal without being interrupted by burps—not all of them yours.

Until then, you’ve got this. Wipes in one hand, burp cloth in the other, and hopefully—one day soon—a hot cup of coffee that doesn’t have a splash of regurgitated milk in it.

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References:

1. Source: National Health and Medical Research Council (2012) Infant Feeding Guidelines. Canberra: National Health and Medical Research Council ↩︎