Bringing up milk after feeds, often called spit-up or possetting, is one of the most common things babies do. NICE says it affects at least 40% of babies, usually starts before 8 weeks of age, and settles in 90% before their first birthday. If your baby brings milk up easily but is feeding well, content and growing, it usually needs no tests or treatment.
A few signs mean something else may be going on, and some need urgent help. This guide explains normal reflux, reflux disease, what helps, safe sleep, and when to act.
Is it normal for my baby to spit up after feeds?
Yes. NICE calls effortless regurgitation of feeds a normal process in infancy. It says spit-up can be frequent: 5% of affected babies have 6 or more episodes each day. It usually becomes less frequent with time.
The Royal Children's Hospital Melbourne (RCH) explains that reflux happens when stomach contents come back up. Most is swallowed again, but some babies bring it out of their mouth. The RCH says reflux will most likely get better on its own by the time your child is one year old. The NHS also says reflux usually starts before 8 weeks and gets better by the time a baby is 1.
What's the difference between reflux and GORD?
Reflux becomes gastro-oesophageal reflux disease (GORD) when it causes problems that need medical care. The RCH lists these signs of GORD:
- Pain or discomfort in the chest or upper tummy, with irritability, crying or back arching.
- Disrupted sleep, or being hard to settle.
- Poor weight gain.
- Breathing and swallowing problems, such as gagging, choking, wheezing or coughing a lot.
| Pattern | What it usually means | What to do |
|---|---|---|
| Effortless spit-up; content, feeding and growing | Normal reflux | Feeding tips below |
| Pain, arching, feed refusal, poor weight gain | Possible GORD | See your GP or child-health nurse |
| Projectile, green, bloody, or a very unwell baby | Possibly not reflux | Urgent tiers below |
The NHS adds that some babies have silent reflux, without bringing up milk. They may cough or hiccup during feeds, gulp, or be unsettled while feeding.
What helps reduce spit-up?
These steps are simple and safe to try. They help some babies, but reflux often continues until the gut matures:
- Keep your baby upright during feeds. The NHS suggests feeding upright and keeping your baby upright for as long as possible afterwards. The RCH suggests about 20 minutes.
- Burp regularly during feeds. The NHS recommends this. See burping and wind for positions.
- Get help with feeding technique. The NHS suggests checking breastfeeding positions or bottle-feeding technique. For bottle-fed babies, paced bottle feeding slows the flow.
- Try smaller, more frequent feeds if feeds are large. NICE suggests this for formula-fed babies with frequent spit-up and marked distress, keeping the daily total the same.
- Play upright or on the tummy while awake. The RCH says this is fine only when your baby is awake and an adult is with them, and it won't make reflux end sooner.
What about thickened feeds and medicines?
The RCH says changing formula or feeding method won't affect reflux and isn't recommended. It says thickened feeds should only be used if a GP or child-health nurse advises them, and that pre-thickened formula is better than thickening at home. Thickened feeds can cause constipation. NICE suggests a trial of thickened formula only for formula-fed babies with marked distress, after checking volumes and trying smaller feeds.
Most babies with reflux need no medicine. If one is needed, your doctor will prescribe it. Don't start reflux medicines, or add thickener to bottles, without advice.
How should a baby with reflux sleep?
On their back, on a firm, flat mattress, every sleep. Red Nose says tilting the sleep surface doesn't reduce reflux and isn't recommended. A baby in a tilted cot can slip down and be covered by bedding. A pillow used to raise a baby is a suffocation hazard and can let the chin drop onto the chest, reducing airflow.
Red Nose says the risk of sudden death from tummy or side sleeping outweighs any benefit for reflux. NICE says not to use positioning to treat reflux in sleeping babies, and the NHS says not to raise the head of the cot.
The AAP agrees that even babies with reflux disease should sleep flat on their backs. It says any surface inclined more than 10 degrees isn't safe for sleep. If your baby falls asleep in a car seat, pram, swing or sling, move them to a firm, flat surface on their back as soon as you can.
See safe sleep for the full set of recommendations.
Could it be something other than reflux?
Some vomiting has other causes that need different care:
- Pyloric stenosis. The RCH pyloric stenosis fact sheet says it usually happens between 2 and 6 weeks of age. Vomiting gets more forceful and may be projectile, the baby is hungry soon after, and weight drops or doesn't increase. See a doctor immediately; it needs an operation.
- A blocked or twisted bowel. The Sydney Children's Hospitals Network says green or yellow vomit is usually caused by a blockage or twist in the bowel, and that babies can look healthy while the bowel is being damaged.
- Infection or other illness. NICE says spit-up that starts after 6 months, or keeps going after 1 year, suggests a cause other than reflux. It lists fever, a bulging soft spot, and unusual sleepiness or irritability among red flags.
- Cows' milk protein allergy. NICE lists blood in poo, long-lasting diarrhoea, and eczema or other allergies as possible clues. Your GP can assess this; don't change your baby's milk without advice.
When should I get help for reflux or vomiting?
These tiers match our when to call the doctor guide.
Call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) now if your baby:
- Has green or yellow vomit. The SCHN advises calling an ambulance or going to the nearest emergency department.
- Is vomiting blood, or has red, black or brown vomit. The NHS vomiting guide lists vomiting blood among reasons to call an ambulance or go to A&E. NICE notes a breastfed baby can sometimes bring up blood swallowed from a cracked nipple, but get it checked straight away rather than assume.
- Is vomiting and has a swollen, hard tummy.
- Pauses in their breathing, is struggling to breathe, or turns blue, grey or very pale.
- Is floppy, very sleepy or hard to wake.
- Has a bulging or tense soft spot.
- Has had no wet nappy for 12 hours, or has signs of severe dehydration such as sunken eyes or cold, mottled skin.
- Is under 3 months and has a temperature of 38°C or more.
These come from the NHS urgent-help guide, the SCHN and NICE. The NHS reflux page lists green or yellow vomit, and vomit with blood in it, as reasons for an urgent GP appointment, but we follow the stricter advice of the SCHN and the NHS vomiting guide because of the risk of a twisted bowel or bleeding.
Get medical help today if your baby:
- Has forceful or projectile vomiting, especially between 2 and 6 weeks of age.
- Has blood in their poo, or a swollen or tender tummy.
- Refuses feeds, or keeps vomiting and can't keep fluids down.
- Is losing weight.
- Is under 6 months and has any sign of dehydration, such as fewer wet nappies or a dry mouth, as the RCH dehydration fact sheet advises.
- Won't stop crying and seems very distressed.
Talk to your GP or child-health nurse if:
- Reflux isn't improving after trying the feeding tips.
- Spit-up starts after 6 months, or is still happening after 1 year.
- Your baby seems in pain with feeds, arches, or coughs and gags a lot during feeds.
- Weight gain is slow at a routine check.
What is worth noting about your baby's reflux?
A few days of notes can help your GP or child-health nurse. Record when spit-up happens in relation to feeds, roughly how much, whether your baby seems in pain, and any change in colour or force. Note feeds, wet nappies and weights from health checks. If you see green vomit, blood or a floppy baby, get help first and write things down later.
