Reflux in babies?

Gastroesophageal reflux (GER)

As with many other parts of a baby’s body, the stomach and oesophagus continue to mature during the early months. The muscle at the top of the stomach, the lower oesophageal sphincter (LES) – is not fully developed at birth. This means it opens more easily than in adults, allowing small amounts of milk or air to move back up. This is a normal part of development and often helps babies release swallowed air.

If milk has stayed in the stomach for longer before coming back up, it may appear thicker or smell slightly sour. This is still common and usually part of normal infant digestive patterns.

Gastroesophageal reflux (GER)  where small amounts of stomach contents flow back into the oesophagus, is a normal physiological process in babies from around three weeks of age up to their first year. It may happen many times a day and can look like:

• the baby swallowing milk back down
• small visible possets
• occasional larger regurgitation

Over half of healthy babies aged 0-3 months bring up milk regularly. By 10-12 months, this becomes far less common as the digestive system matures.

Lower oesophageal sphincter (LES)

The LES is a ring-shaped muscle at the base of the oesophagus that acts as a one-way valve, keeping stomach contents in the stomach. Its movement is involuntary and part of the digestive system’s normal function.

In older children or adults, irritation from stomach contents entering the oesophagus may contribute to discomfort such as heartburn. Babies, however, often show reflux without distress, and in most cases it improves naturally as the LES strengthens and the digestive system develops.

If a baby shows persistent discomfort, has difficulty feeding, or is not gaining weight as expected, parents should seek advice from a GP, midwife or health visitor for assessment and support.

Silent (or “hidden”) reflux in babies

The term silent reflux is sometimes used when milk flows back up into a baby’s oesophagus but is swallowed again rather than appearing as visible regurgitation. Because nothing comes out of the mouth, it can be harder for parents to spot. The idea behind the term is that some babies may appear unsettled during or after feeds without showing the more typical signs of posseting.

It is important to note that silent reflux is a concept largely based on clinical observation, and research in young infants is still limited. Not all professionals use the term, and experiences can vary greatly from baby to baby.

Parents may describe babies with this pattern as appearing uncomfortable, more fussy than usual or difficult to settle, especially around feeding times. However, these behaviours can have many different explanations, which is why it can be helpful to look at the baby’s overall wellbeing rather than focusing on regurgitation alone.

Some babies may show both visible regurgitation and behaviours associated with silent reflux at different times. If parents are unsure whether feeding patterns or regurgitation are contributing to their baby’s fussiness, they can seek guidance from a GP, midwife or health visitor for reassurance and assessment.

Gentle ideas that may help settle a baby after feeds

Because reflux-like behaviours are very common in young babies, many parents try small adjustments to help their baby feel more comfortable during and after feeds. These are not treatments for reflux, but everyday strategies that some families find soothing.

Here are a few general ideas parents often explore:

• Holding the baby upright for a short period after feeds, to give them time to settle
• Offering smaller, more frequent feeds, if this fits naturally into the baby’s rhythm
• Creating a calm feeding environment, with fewer distractions and gentle lighting
• Ensuring the baby has opportunities to burp during and after feeding
• Introducing supervised tummy time once the baby is over one month old
• Avoiding tobacco exposure, which is recommended for all infants

If parents have concerns about feeding, digestion, weight gain or unsettled behaviour, it is important to seek advice from a GP, midwife, health visitor or lactation consultant. They can offer feeding-specific guidance and, if needed, assess whether further support or referral is appropriate.

A tongue-tie release (frenotomy) may be discussed by clinicians in cases where tongue movement clearly affects breastfeeding, but current evidence does not show an effect on reflux itself.

Research into probiotics and infant reflux is limited and inconsistent. Parents should always speak with a healthcare professional before introducing supplements or making changes to feeding practices.

What may contribute to reflux-like behaviours in babies?

Reflux-like behaviours are extremely common in young babies and are often linked to the natural development of the digestive system. Several normal factors can make it easier for milk to flow back up in infancy:

• The stomach-oesophagus valve (LES) is still maturing.
  In early life, this valve opens more easily than in older children or adults. This is part of normal development and gradually improves over time.

• Babies digest milk more slowly than adults.
  Milk can remain in a baby’s stomach for longer, and because their digestive tract moves at a gentler pace, small amounts of milk may be more likely to come back up.

• Babies spend a lot of time lying down.
  As babies become more upright and start moving more independently during their first year, regurgitation often reduces naturally.

• Feeding patterns vary.
  Young babies often take in small amounts of air during feeds, and their stomachs fill quickly. This can contribute to more frequent posseting.

Some babies, such as those born prematurely or those with additional health considerations, may show reflux-like behaviours for longer simply because their digestive development follows a different timeline.

It’s also very common for parents to notice temporary changes in regurgitation around growth spurts, feeding transitions or changes in routine.

If a baby seems persistently uncomfortable, is very unsettled after feeds, or is not gaining weight as expected, it is important to speak with a GP, midwife or health visitor for reassurance and guidance.

Why do babies experience reflux?

Reflux-like behaviours are extremely common in infancy and are usually linked to the natural maturation of a baby’s digestive system. Several normal factors can make it easier for milk to flow back up during the first months of life:

• The digestive system is still developing.
  The muscle at the top of the stomach (the lower oesophageal sphincter, or LES) takes time to strengthen, so it may open more easily in young babies.

• Babies spend a lot of time lying down.
  In early life, babies are mostly horizontal, which can make regurgitation more frequent. As they grow, become more upright and start moving more independently, these behaviours often reduce naturally.

• Feeding patterns vary.
  Young babies may swallow small amounts of air during feeding, take in different amounts of milk at different times, or feed in shorter bursts – all of which can influence how often milk comes back up.

• Individual development varies.
  Babies born early, or babies with different developmental needs, may take a little longer for their digestive system to mature, which can affect how long reflux-like behaviours continue.

Parents may also notice temporary increases in regurgitation around growth spurts, changes in feeding routines or periods of increased fussiness. These fluctuations are common and usually settle over time.

If a baby seems persistently uncomfortable, very unsettled during feeds, or is not gaining weight as expected, it is important to speak with a GP, midwife or health visitor for assessment and reassurance.

Signs parents may notice with reflux-like behaviour

It is normal for young babies to cry for around 2-3 hours a day in the early weeks, with crying usually peaking around 6-8 weeks of age. Many babies also bring up milk frequently – this is one of the most common features of reflux-like behaviour.

Alongside regurgitation, some parents may notice behaviours such as:

• fussiness or restlessness around feeding
• pulling away from the breast or bottle
• short or unsettled sleep when lying flat
• wanting to be held upright more often
• frequent hiccups or sounding “wet” after feeds
• more drooling than usual
• seeming uncomfortable when burping
• appearing unsettled in car seats or when strapped in
• periods of increased crying that are hard to soothe

Some babies also have phases where they prefer not to lie on their back for long or seem more easily upset after feeding. These behaviours can have many different causes, and reflux-like patterns may appear with only a few, many, or none of these observations.

It is important to remember that behaviour varies widely between babies, and frequent regurgitation alone does not indicate a medical problem.

If parents are unsure about their baby’s feeding, comfort or weight gain, or if something doesn’t feel right, it is always best to seek guidance from a GP, midwife or health visitor for reassurance and support.

Reflux and sleep in babies

Many parents notice that babies who bring up milk frequently may find it harder to settle when lying flat. Some babies prefer to be held upright for longer periods or seem more restless when placed on their back. These behaviours can make sleep more challenging and may cause babies to wake more easily or take longer to fall asleep.

Some babies also adopt positions such as tilting their head back slightly, which may feel more comfortable for them during periods of frequent regurgitation. Sleep patterns vary widely between babies, and changes in feeding, growth or development can all influence how easily a baby settles.

If parents are concerned about sleep, feeding patterns or overall comfort, speaking with a GP, midwife, health visitor or lactation consultant can provide reassurance and practical guidance.

Supporting a baby with reflux-like behaviours

For most healthy infants, bringing up milk is part of normal development and improves naturally as the digestive system matures. Many families try simple, everyday strategies to help their baby feel more comfortable, such as holding the baby upright after feeds, offering calm feeding environments and giving time for gentle burping.

If concerns persist, for example, if the baby seems very unsettled, struggles with feeding, or weight gain is not as expected, parents should seek advice from a healthcare professional. They can assess whether further support, investigation or referral is appropriate.

While some babies are prescribed medication by their doctor, this is a clinical decision made on an individual basis. Osteopaths do not diagnose or treat medical conditions, nor do they offer guidance on medication. Their role is instead focused on gently supporting a baby’s overall comfort, posture and ease of movement, and helping parents understand soothing strategies and handling positions during everyday care.