Is your baby having trouble with reflux and regurgitation?

Key takeaways

• Reflux and regurgitation are common in babies.
• Reflux occurs when milk, food and stomach acid flow from the stomach into the oesophagus.
• Regurgitation happens when milk, food and/or stomach acid flow into the oesophagus and out the mouth.
• Spitting up more than twice a day for 3 or more weeks is a sign of regurgitation.
• Reflux and regurgitation peak around 4-6 months.
• Most babies grow out of reflux between 12-18 months.
• Reflux and regurgitation can be symptoms of Cow’s Milk Protein Allergy (CMPA).

Reflux and regurgitation in an otherwise healthy baby is common, and often completely normal, in the first year of life as their digestive system develops. In fact, most babies bring up small amounts of milk after feeding. But in some cases, reflux and regurgitation can cause distress for both babies and parents. Let’s take a closer look at why reflux and regurgitation occur, the symptoms to watch for, and what you can do to help make your baby more comfortable.

Reflux or regurgitation – what’s the difference?

Experts think reflux or regurgitation are usually caused by an immature digestive tract: the muscle at the top of the stomach (the sphincter) in babies is still developing, causing it to be loose. Gastroesophageal Reflux or GER occurs when milk, food and stomach acid flow from the stomach into the oesophagus. Regurgitation (also known as spitting up or ‘posseting’) occurs when milk, food and stomach acid flows from the stomach, into the oesophagus and out the mouth. Unlike vomiting, regurgitation involves no straining – it’s almost effortless, more like a hiccup.

What is gastro-oesophageal reflux disease (GORD)?

Reflux in babies is often just an occasional nuisance. But in severe cases, the acidic stomach contents can cause complications – like inflammation of the oesophagus – that can lead to feeding problems or poor growth. Reflux that results in complications is called gastro-oesophageal reflux disease (or GORD). Reflux and regurgitation can also be symptoms of Cow’s Milk Protein Allergy (CMPA). If you have any questions or concerns about this, speak to a healthcare professional. You can also find more information in our article How to tell if your child has cows’ milk allergy.

Signs of reflux and regurgitation

Your baby is considered to have regurgitation if they spit up 2 or more times a day for 3 or more weeks but have no other obvious signs of illness (such as retching, vomiting, poor growth or feeding difficulties). As well as regurgitated milk, reflux can have other unpleasant symptoms such as:

• ‘Wet’ burps
• Frequent hiccups
• Irritability, excessive crying or screaming
• Appearing to be in pain
• Arched back during or after feeding.

Most babies grow out of reflux

Reflux and regurgitation in babies peak around 4-6 months. Symptoms usually resolve spontaneously between 12-18 months. Approximately 95% of infants outgrow the gastroesophageal reflux by 12 months of age, with the greatest improvement at about 8–10 months of age when the infant starts to sit upright.¹ If you’re concerned about your baby’s symptoms, speak to a healthcare professional, like a Pharmacist, GP or Maternal Child Health Nurse.

Tips to manage reflux and regurgitation

Here are some practical things you can try to help your baby feel more comfortable until their digestive system develops, and they outgrow their reflux and regurgitation:

• Avoid overfeeding – feed smaller amounts more frequently
• Burp your baby, before, during and after feeding
• If your baby is formula-fed, check the hole in the teat is not too large (this can cause babies to gulp their feed too quickly)
• Keep your baby upright during, and for about 30 minutes after feeding
• Avoid tight-fitting clothing for your baby
• For formula fed babies, consider asking your healthcare professional about suitable specialist formulas for the dietary management of reflux and regurgitation. Ingredients such as carob bean gum are designed to thicken further in the stomach to help reduce reflux and regurgitation episodes in babies.

REMEMBER:

Reflux and regurgitation in otherwise healthy babies is common, particularly in the first year. If you have any concerns, please speak to a healthcare professional. References

1. Campanozzi A, Boccia G, Pensabene L, et al. Prevalence and natural history of gastroesophageal reflux: pediatric prospective survey. Pediatrics. 2009;123(3):779–783.
2. The Sydney Children’s Hospitals Network. Fact Sheets Reflux. https://www.schn.health.nsw.gov.au/fact-sheets/reflux. Accessed Oct 15, 2021.
3. The Royal Children’s Hospital Melbourne. Gastrooesophageal reflux disease in infants. https://www.rch.org.au/clinicalguide/guideline_index/Gastrooesophageal_reflux_disease_in_infants/. Accessed Oct 15, 2021.
4. Pregnancy, Birth and Baby. Reflux. https://www.pregnancybirthbaby.org.au/reflux. Accessed Oct 15, 2021.
5. Reflux Infants Support Association Inc. Management Tips. https://www.reflux.org.au/management-tips/. Accessed Oct 15, 2021.
6. Zeevenhooven et al. The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers. Peadiatr Gastroenterol Heptaol Nutr. 2017; 20:1-13.
7. Vandenplas Y, Abkari A, Bellaiche M, et al. Prevalence and Health Outcomes of Functional Gastrointestinal Symptoms in Infants From Birth to 12 Months of Age. J Pediatr Gastroenterol Nutr. 2015 Nov;61(5):531-7. doi: 10.1097/MPG.0000000000000949. Erratum in: J Pediatr Gastroenterol Nutr. 2016 Mar;62(3):516. PMID: 26308317; PMCID: PMC4631121.
8. Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018 Mar;66(3):516-554. doi: 10.1097/MPG.0000000000001889. PMID: 29470322; PMCID: PMC5958910.