Reflux in babies (posseting and GORD) explained

What reflux is

Reflux is when the milk a baby has swallowed comes back up from the stomach. It happens because the ring of muscle at the top of the stomach, which keeps food down, is still developing in young babies. Add to this that babies have small stomachs, take a large amount of milk for their size, and spend a lot of time lying down, and it is easy to see why bringing up milk is so common. Bringing up small amounts of milk, often called posseting, is normal and usually causes the baby no distress at all. Reflux typically starts in the first weeks of life, is often at its peak around three to four months, and usually improves as the baby grows, with most having settled by around their first birthday.

Normal posseting versus GORD

The key question is whether reflux is simply messy or is actually bothering the baby. In normal reflux or posseting, the baby brings up milk but is otherwise well — feeding fine, content between feeds, and growing and gaining weight as expected. This is sometimes called a "happy spitter" and needs no treatment. GORD is diagnosed when reflux causes troublesome symptoms or complications, for example a baby who is distressed, cries a lot and seems in pain during or after feeds, feeds poorly or refuses feeds, is not gaining weight well, or has frequent coughing or chest problems linked to the reflux. Most babies who bring up milk do not have GORD. Telling the two apart matters because normal reflux just needs reassurance and time, while GORD may need a doctor's help.

Simple things that can help

For everyday reflux, simple measures often help and no medicine is needed. Try feeding your baby in a more upright position and keeping them fairly upright for a short while after feeds. Winding your baby regularly during and after feeds can help bring up trapped air. Offering smaller, more frequent feeds rather than large ones can reduce how much comes back up. For bottle-fed babies, making sure the teat is the right size and the baby is not gulping air helps. Avoid tight nappies or clothing pressing on the tummy. Always place your baby on their back to sleep, as this is safest — do not prop up the cot or use pillows, as raising a baby's sleeping position is not recommended for safety reasons. If in doubt, your health visitor can advise.

When reflux needs a doctor

See your GP or health visitor if reflux is troubling your baby or you are worried. Signs that need medical advice include your baby being very distressed and in pain with feeds, refusing feeds or feeding very poorly, not gaining weight or losing weight, or frequently coughing or gagging with feeds. If simple measures have not helped and your baby seems genuinely unwell or unhappy, it is worth being seen. Depending on the situation, a doctor may suggest changes to feeding, and in some cases treatments are considered under medical guidance. Reflux that starts after six months of age, or that continues past the first birthday, should also be checked, as this is less typical and may need looking into further. Do not start special formulas or medicines without professional advice.

Red flags that need urgent help

Certain symptoms are not simple reflux and need prompt or urgent attention. Seek advice urgently, and consider NHS 111 or your GP the same day, if your baby has green or yellow (bile-stained) vomit, blood in the vomit, or forceful, projectile vomiting after feeds, as these can point to a blockage or other problem. Also seek help if your baby has a swollen or tender tummy, is not feeding, has far fewer wet nappies, or seems unwell. Follow the usual baby red-flag advice: a baby who is very floppy, hard to wake, struggling to breathe, has a fever (especially under three months), or a rash that does not fade under a glass needs urgent help — call 999. Never assume serious symptoms are just reflux; when in doubt, get your baby checked.