The muslin on your shoulder is damp again, and the washing pile is mostly bibs. If your baby brings up milk after most feeds, here's the comforting truth: this is one of the most common things babies do, and for the vast majority it is a laundry problem, not a medical one.
Why it happens
The ring of muscle at the top of a baby's tummy is still soft and immature. When the stomach is full or baby is lying down, a little milk slips back up. The clinical word is gastro-oesophageal reflux (GOR), but everyday parents call it posseting or spit-up.
It is genuinely common. Around 40 to 50% of healthy babies spit up at least once a day in the early months, and it usually peaks around 4 months. Most babies grow out of it by 12 months as they sit, eat solids and the muscle tightens.
Happy spitter, or reflux to watch?
The key question is not how much comes up, but how your baby is. A happy spitter brings milk up but is otherwise content, feeding well and gaining weight. Reflux only needs attention when it bothers your baby or affects their growth.
| Happy spitter (reassuring) | Worth a chat with your GP | |
|---|---|---|
| Mood | Settles after, generally content | Frequent pain, arching, crying with feeds |
| Feeding | Feeds willingly | Refuses feeds or pulls off distressed |
| Weight | Growing along their curve | Poor or no weight gain |
| The bring-up | Effortless dribble of milk | Forceful, projectile, green or bloodstained |
Simple things that can help
These are gentle, no-cost adjustments. They reduce spit-up for some babies and do no harm if they don't.
- Feed upright and unhurried. A calmer, more upright feeding angle means less air and less back-flow. Paced bottle-feeding can help bottle-fed babies.
- Burp partway through and after. Trapped wind pushes milk back up.
- Keep baby upright for 20 to 30 minutes after a feed before lying them down.
- Smaller, more frequent feeds can settle an over-full tummy.
- Loosen tight nappies and waistbands that press on the belly.
A note on positioners: never use wedges, pillows or props to tilt the cot, and don't leave baby upright in a car seat or bouncer to sleep.
When to call your GP or child-health nurse
Most reflux needs reassurance, not medicine. But please get medical advice promptly if your baby has any of these:
- Poor weight gain, or losing weight
- Forceful or projectile vomiting (especially in the early weeks)
- Green or yellow vomit, or vomit with blood
- Refusing feeds, persistent distress or arching with feeds
- Blood in the nappy, fewer wet nappies or other signs of dehydration
- A persistent cough, breathing pauses or chest infections
- Spit-up that is new or worsening after 6 months, or hasn't settled by 12 months
A small number of babies have vomiting from other causes, such as cow's milk protein allergy or, in the early weeks, pyloric stenosis (a tight stomach valve causing projectile vomiting). Your doctor can tell these apart. Reflux medicines are only occasionally needed and should always be prescribed and dosed by your doctor, never started on your own.
Regional notes
Guidance is reassuringly consistent. Raising Children Network (Australia), the AAP (US) and NICE (UK) all agree that uncomplicated reflux in a thriving baby needs no treatment. On safe sleep, follow your national authority — Red Nose in Australia and the AAP in the US — and both firmly recommend back-to-sleep with no cot elevation, even for babies with reflux. Thickened feeds or formula changes are sometimes suggested, and if a cow's milk protein allergy is suspected, ASCIA has Australian guidance. The specifics vary, so check with your local child-health nurse or GP before changing how you feed.
The bottom line: if your baby is feeding, growing and generally happy, spit-up is a stage to ride out, not a problem to fix. When in doubt, your GP or child-health nurse is the right person to ask. This guide is general information, not a substitute for medical advice.