Reflux | La Leche League SA

REFLUX RELIEF: SOOTHING REFLUX WITH LOVE AND PATIENCE

Article Update: June 2025

WHY IS MY BABY BRINGING UP MILK - AND IS THIS A PROBLEM?

It is natural to feel concerned when your baby brings up milk, especially when it is accompanied by burping and fussiness. It is comforting to remember these three truths:

1. reflux is very common in babies,

2. the amount/volume of what comes back up always looks more than it actually is and,

3. the vast majority of babies with reflux are growing well and gaining weight.

In this article we will discuss what reflux is, why it happens and what you can do to soothe your baby with confidence.

WHAT IS REFLUX?

Regurgitation is normal and can occur at any age. For example, if we, as adults, have a big festive meal and lie down straight afterwards, we feel the food coming back up. This is referred to as “reflux”. All humans can have some degree of reflux as it is mainly influenced by the size of the meal, the type of foods and the position of the body.

Reflux in babies peaks around 2-4 months, then tapers off at 6 months and symptoms decline in frequency by 12-15 months.

According to the late Dr. Gregory White, husband of the late LLLI Founder, Mary White, “In a healthy baby, spitting up is a laundry problem, not a medical problem.”

WHY IS IT HAPPENING?

Reflux symptoms can be influenced by a combination of factors:

Breastfeeding provides a liquid diet and liquids can come back up more easily than solid food.
Babies are busy growing. Their stomachs, and especially the little valve (gastro-oesophageal sphincter) at the entry to the stomach, are still developing. Maturity of this valve improves from 6 to 12 months of age. In a younger baby, however, it is easier for milk to leak past this valve. When they start solids, and start to sit more upright, there are fewer episodes of spit-up.
The length of the oesophagus also plays a role. The distance from the mouth to the stomach is much shorter in babies compared to adults, so the milk has a shorter distance to travel back up with reflux.
Sometimes the baby is not able to swallow quickly enough when milk ejects forcefully during a feeding. Laid-back positioning with a deep comfortable latch and breastfeeding responsively usually helps.
If a mother has an oversupply of milk, that can result in the baby taking too much, too fast for the stomach to handle. Please contact a La Leche League Leader for assistance if you’ve already tried laid-back positioning and need more help.
Excessive pumping, or using a silicone milk-catcher, may also exacerbate oversupply and reflux symptoms.
The frequency of feeds also plays a role. More frequent feeds allow milk to pass through and digest quickly and babies are less likely to overfeed. If you wait too long to breastfeed, your baby may be distressed and not latch on calmly. Overfeeding may also lead to an overfull stomach and more chance of spit up.
A calm baby = less reflux. Crying, stressed babies tend to kick their legs and bend their knees into their tummies and this will also increase regurgitation. Stress may also impair the digestive process.
Actively winding or burping a baby has been shown to increase the episodes of spit-up.
Any abdominal pressure will increase the spit-up.

You may notice that your baby spits-up after being in the curled-up position of a car seat, or after nappy changes when their legs are lifted up.

Older babies may spit-up more often after they start crawling as their legs move backwards and forwards into their abdomen.

Occasionally, some older babies will start to spit up when they hadn’t typically been spitting up before or a baby with reflux will have increased episodes of spit-up. If your baby doesn’t seem ill, other reasons might include:

Something new in the diet - perhaps solids; adding or changing vitamin supplements or medications for you or your baby.
Periods of developmental spurts, when babies may start feeding more frequently than usual and take in larger volumes of milk.
Teething can result in increased saliva production and swallowing, adding to the volume of fluid in the tummy.
Breastmilk is packed with anti-inflammatories and many infection-fighters. Because of this, breastfed babies often don’t show the usual sign of illness (like fever) even when they are fighting off germs. Instead you may notice subtle changes like increased fussiness, changes in poop colour and consistency, or more frequent spit-up to expel germs out of the body. Increased spit-ups in this instance may be protective.

MY BABY SEEMS UNCOMFORTABLE

It can look worrying to see so much milk coming back up and mothers naturally worry that the vomiting is uncomfortable for the baby.

Breastmilk protectively coats the surfaces on the way down from the mouth to the stomach and when it refluxes back up again.

Breastmilk has also been shown to neutralise stomach acid; when the pH of the vomitus was checked, it was found to not be acidic, in fact it was found to be neutral for 2 hours after feeds. Researchers therefore conclude that breastmilk reflux does not cause burning or pain. When endoscopic studies have been done, they have found that babies with reflux in the first year of life don't have oesophageal inflammation, even when they have symptoms of being very unsettled.

WHAT WILL HELP?

If your baby is generally healthy with good nappy output and normal growth patterns, be assured that they will likely outgrow this stage by 6-12 months, when the baby is able to sit upright on their own. In the meantime, here are some general tips to help keep spit-up episodes to a minimum:

Use feeding positions that keep the baby’s head higher than their tummy, such as a laid-back position or having the baby diagonally across your chest in a cradle hold. Avoid positions that have the baby bending at the waist, putting more pressure on their tummy. See Positioning

Try shorter, frequent feedings, if the baby is agreeable, to reduce the load in their tummy.
Keeping babies upright for most of the day in a sling or carrier can be very helpful for babies with reflux. All babies prefer closeness with their mothers or another adult. They feel safer and secure when they are close enough to smell you, feel your loving touch, hear your heartbeat through your chest and feel the rhythmic movement of your lungs breathing, and your body swaying as you continue through your day.
Young babies tend to fuss and show discomfort when they are separated from their mothers. They do not expect to be put down after feeds. Many babies sleep better after feeding when they are in contact with their mothers in a sling/wrap or carrier.
If your baby shows signs of wanting to release a wind, all you may need to do is lift them up so that they can release the gas on their own. Babies are so amazingly efficient at wiggling and squirming out those winds when simply held upright after feeds. If you’re lying down and breastfeeding, instead of getting up yourself, gently lift your baby into a more upright position and lean the baby against your own body till they release gas. If you’ve been actively “winding your baby” and nothing is coming, it is likely that there is no gas ready to be released at that time. Your baby may instead want to sleep or may need to drink again. There’s no reason to sit up at night trying to wind a baby who actually wants to sleep after the feed. All that essentially happens is that you disrupt your own and your baby’s sleep rhythms … and babies are quite capable of bringing up burps even while lying down.
Respond quickly to your baby if he/she is crying. (A calm baby = Less reflux)
Try avoiding nappy changes immediately after a feed. If possible, have your baby’s head higher than their bum, and change nappies with the baby on the side instead of on the back.
Minimise the time your baby spends in a car seat.

WHAT ABOUT MEDICATION?

Milk thickeners

Reflux is not a medical problem, but rather a developmental issue. Most mothers prefer not to start their young baby on medications. Occasionally, a paediatrician may recommend the use of milk thickeners. There are several risks to be aware of when considering the use of milk thickeners:

Adding a thickener requires mothers to interrupt breastfeeding in order to express or pump. Feeding breastmilk (or any milk) by bottle (even without a thickener) was shown to worsen reflux as compared to direct breastfeeding.
Thickeners are a starch or carbohydrate. This is a foreign substance to a young baby’s immature gut and changes the baby’s microbiome. They may also cause constipation which increases fussiness in babies.
Accidental aspiration of the thickener into the baby’s lungs is harmful.
Adding a thickener will not change the underlying cause (immaturity of the gut and sphincter, and poor core strength of the baby) and may simply disguise the reflux by raising the vomitus a little way into the oesophagus, instead of rising all the way up towards the mouth.

Antacid medications

There are several research studies proving that antacid medications (Proton Pump Inhibitors - PPI’s - such as omeprazole or esomeprazole) don’t make babies cry less, or sleep better. These medications, like all medications, also have possible side-effects. Some of the concerns that have been raised include:

- They change the gut microbiome.

- They prevent the absorption of essential minerals, vitamins and nutrients.

- They have been linked to fracture risk later in life.

- They have been linked to increased incidences of food allergy and asthma.

- They have been linked to increased incidences of gastroenteritis.

Should I try an anti-reflux formula?

Decades of research confirms that the use of infant formula is associated with multiple risks and worsens reflux.

Should I start solids earlier than 6 months?

Research has not found the addition of solids to be protective. The best practice and best results are seen in babies that are exclusively breastfed.

Is my baby reacting to something that I am eating?

Contrary to popular opinion, the mother’s diet does not affect infant reflux. Foods in the mother’s diet get digested in the mother’s gut, and gas is passed through her own gut. Gas does not enter breastmilk.

WHEN TO SEEK HELP

Please consult your doctor if your baby is vomiting to the extent that they are not gaining weight, or are constantly coughing and choking and/or possibly aspirating. These symptoms are extremely rare and may be a sign of more serious conditions.

CONCLUSIONS

One of the main functions of breastfeeding is protection; refluxing breastmilk may be a good thing, flushing out germs in the mouth and throat area (open areas where germs can enter).

Babies need loads more contact time and carrying time than we imagine; they are calmer, and fuss and cry less when carried.

Active burping is not necessary for breastfed babies and will make spit-up worse.

Seek medical help in the rare case of your baby vomiting excessively and losing weight.

Reflux is not an illness, rather a developmental issue. You may just need to carry an extra towel and extra sets of clothes around for a few months until your baby matures and life becomes drier.

Extra reading and resources

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Cuzzolin L, Locci C, Chicconi E, Antonucci R. Clinical use of gastric antisecretory drugs in pediatric patients with gastroesophageal reflux disease: a narrative review. Translational Pediatrics. 2023;12(2):260-270.

Drall KM, Hein MT, Kozyrskyj AL. Commentary: the influence of proton pump inhibitors on the fecal microbiome of infants with a gastroesophageal reflux – a prospective longitudinal intervention study. Frontiers in Cellular and Infection Microbiology. 2018:doi:10.3389/fcrimb.2018.00430.

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Douglas PS. Diagnosing gastro-oesophageal reflux disease or lactose intolerance in babies who cry alot in the first few months overlooks feeding problems. J Paediatr Child Health. 2013;49(4):e252-e256.

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Levy EI, Hoang DM, Vandenplas Y. The effects of proton pump inhibitors on the microbiome in young children. Acta Paediatrica. 2019;109:1531-1538.

Malchodi L, Wagner K, Susi A, Gorman GH, Hisle-Gorman E. Early antacid exposure increases fracture risk in young children. Pediatics. 2019;144(1):e20182625.

Mitchell DJ, McClure BG, Tubman TR. Simultaneous monitoring of gastric and oesophageal pH reveals limitations of conventional oesophageal pH monitoring in milk fed infants. Arch Dis Child. 2001 Mar;84(3):273-6. doi: 10.1136/adc.84.3.273. PMID: 11207184; PMCID: PMC1718697.

Mitre E, Susi A, Kropp LE, Schwartz DJ, Gorman GH, Nylund CM. Association between use of acid-suppressive medications and antibiotics during infancy and allergic diseases in early childhood. JAMA Pediatrics. 2018:doi:10.1001/jamapediatrics.2018.0315.

Smyth, C. Why Infant Reflux Matters. 2021 La Leche League International October 15–18, 2021

Tighe MP, Andrews E, Liddicoat I. Pharmacological treatment of gastro-oesophageal reflux in children (Review). Cochrane Database of Systematic Reviews. 2023(8):Art.No:CD008550.

Wang Y-H, Wintzell V, Ludvigsson JF, Svanstrom H, Pasternake B. Association between proton pump inhibitor use and risk of asthma in children. JAMA Pediatrics.2021;175(4):394-401.

Yourkavitch J, Zadrozny S, Flax VL. Reflux Incidence among Exclusively Breast Milk Fed Infants: Differences of Feeding at Breast versus Pumped Milk. Children (Basel). 2016 Oct 14;3(4):18. doi: 10.3390/children3040018. PMID: 27754430; PMCID: PMC5184793.

Zeevenhooven, J. et al. The New Rome IV Criteria for FGIDs in Infants and Toddlers. Pediatr Gastroenterol Hepatol Nutr 2017 March 20(1):1-13.  Benninga M.A. and Nurko S. et al. Childhood Functional Gastrointestinal Disorders:Neonate/Toddler. Gastroenterology 2016;150:1443–1455