What is reflux?

Reflux occurs when milk or food flows back up into the throat. In babies, the muscle at the top of the stomach is still developing, which means small amounts of milk can easily move upward again. Reflux is very common in babies under six months of age, in those who feed quickly, and in babies who drink large volumes at a time. Most children naturally outgrow reflux between 12 and 18 months of age.

What are the most common symptoms of reflux in babies and children?

Common symptoms of reflux in babies and children include bringing up milk after feeds, coughing or gagging, hiccups, arching the back during or after feeds, irritability when lying flat, a sour smell on the breath, and frequent swallowing. In older children, reflux may present differently, with symptoms such as heartburn, chest discomfort, tummy pain after meals, or the sensation of food coming back up.

There are several first-line measures parents can try at home. Adjusting feeding patterns can help by offering smaller, more frequent feeds, ensuring good winding during and after feeds, keeping the baby upright for 20 to 30 minutes after feeding, and avoiding overfeeding. Babies should always be placed on their backs to sleep for safety reasons, but holding them upright during the day after feeds may reduce symptoms.

For formula-fed babies, using a slower-flow teat or trialling a thickened anti-reflux formula under clinical guidance may be helpful. For breastfed babies, adjusting the mother’s diet, such as reducing dairy if a sensitivity is suspected, can sometimes improve symptoms, although this should only be done with professional advice.

Sometimes, reflux may be more than just a normal developmental phase. Medical review is recommended if a baby or child shows poor weight gain, feeding refusal, severe irritability or pain, vomiting blood or green bile, persistent cough or wheeze, apnoeas or breathing difficulties, marked back arching with crying, or ongoing reflux symptoms after one year of age. These signs may suggest more significant gastro-oesophageal reflux disease (GORD) or a possible food allergy.

Most babies do not require investigations. However, in certain cases, a specialist may consider tests such as a pH or impedance study, blood tests to check for allergies or anaemia, an ultrasound scan if pyloric stenosis is suspected in younger infants, or a monitored trial of treatment to assess response.

How is reflux in babies and children treated?

Treatment depends on the severity of symptoms. Thickened feeds can reduce visible regurgitation. Medication is reserved for more significant cases and may include alginates such as Gaviscon Infant or acid-suppressing medicines like omeprazole when GORD is confirmed or strongly suspected. Medication is not necessary for simple, uncomplicated reflux. If cow’s milk protein allergy is suspected, a trial of hypoallergenic formula or maternal dairy exclusion may be advised.

Referral to a paediatric specialist is appropriate if symptoms persist beyond 12 months, if the baby appears to be in pain with every feed, if growth is affected, if symptoms are severe or unusual, if there are concerns about allergy or feeding difficulties, or if standard measures have not been effective. A paediatrician can assess for reflux, allergy, infections, structural causes, or feeding problems and develop an individualised management plan.

For parents, it is reassuring to know that most reflux in babies is normal and improves with time. However, if feeding becomes stressful, the baby appears uncomfortable, or symptoms continue, seeking specialist advice can make a significant difference. With appropriate guidance and support, the vast majority of children outgrow reflux and go on to thrive.

Paediatric Gastroenterology in Chelmsford