Reflux in babies and children: what is normal and when to worry

Bringing up milk after feeds is very common in healthy babies and is usually nothing to worry about. Doctors call this gastro-oesophageal reflux; it is GERD only when it causes troublesome symptoms or complications.

Normal reflux in babies

A baby's oesophageal valve is still developing and their diet is all liquid, so milk comes back up easily. Reflux often starts before eight weeks of age, can happen many times a day, and usually gets better on its own. NICE notes that it resolves in about 90% of babies before their first birthday, typically as they start solid food and spend more time upright.

A baby with normal reflux is generally happy, feeding well and gaining weight, even if they bring up milk often.

What can help

• hold your baby upright during feeds and for a while afterwards
• wind (burp) your baby regularly during feeds
• if bottle-feeding, ask your health visitor or doctor whether smaller, more frequent feeds might help, without reducing the total amount
• avoid tight nappies and clothing around the tummy
• always put your baby to sleep on their back on a flat, firm mattress. Do not raise the cot or use wedges or pillows; safe-sleep guidance applies to babies with reflux too

Medicines are not usually needed. If they are, a doctor will advise; acid-reducing medicines are not recommended for babies who just bring up milk or cry.

See a doctor urgently if your baby

• brings up green or yellow-green fluid (bile)
• has projectile vomiting, especially in the first two months
• has blood in their vomit or poo
• is not feeding or is losing weight
• has a high temperature, seems floppy, very sleepy or unwell
• has breathing difficulties, or pauses in breathing
• starts vomiting for the first time after six months old
• has a swollen or tender tummy

Also see a doctor if your baby is very distressed during or after feeds, keeps refusing feeds, or you are worried for any reason. Some of these signs point to other conditions, such as a blockage, infection or cow's milk allergy, which need treatment.

Older children and teenagers

In older children, reflux causes the same symptoms as in adults: heartburn, chest or upper tummy pain, regurgitation, a sour taste or a cough. Lifestyle measures such as avoiding late meals, fizzy drinks and trigger foods help, along with a healthy weight. A doctor should assess children with ongoing symptoms before medicine is started.