Baby Reflux and Silent Reflux: Signs, Causes & What Helps

Most babies spit up. It's a normal, if frequently inconvenient, part of early life. But for some babies, stomach contents coming back up the oesophagus causes real pain and distress — and that's reflux. Here's how to tell what's normal, what's not, and what your GP can do.

Three types: posseting, reflux, and GORD

Posseting: Small amounts of milk brought up after feeds. Normal, painless, not distressing to baby. The famous "happy spitter" — soaks through muslin cloths at an alarming rate but is completely unbothered.

Gastro-oesophageal reflux (GOR): Stomach contents coming back up more frequently and/or in larger quantities. May or may not cause discomfort. Very common — affects around 50% of babies under 3 months to some degree.

Gastro-oesophageal reflux disease (GORD): When reflux causes significant pain, feeding difficulties, or other complications. This is the category that requires medical treatment.

What causes reflux in babies?

The lower oesophageal sphincter — the muscle valve between the oesophagus and stomach — is immature in newborns. It doesn't close efficiently after swallowing, allowing stomach contents (milk + acid) to wash back up.

Add to this: babies spend a lot of time lying flat, have small stomachs that fill quickly, and feed frequently — all of which increase reflux opportunity.

The good news: as the sphincter matures and babies spend more time upright, reflux almost always resolves on its own — typically by 12–18 months, and significantly better by 6 months in most babies.

Signs of reflux

• Frequent, large possets (more than a small mouthful after most feeds)
• Crying or arching back during or after feeds
• Feeding reluctance — pulling off during feeds, seeming scared of feeding
• Poor weight gain (if reflux is causing pain that interrupts feeding)
• Frequent hiccups
• Coughing or making throat-clearing sounds after feeds
• Wet-sounding breathing or gurgling

Silent reflux: the harder diagnosis

Silent reflux is when stomach contents come back up but are swallowed rather than spit out. Because there's no visible vomit, it's often missed — but the acid still burns the oesophagus.

Signs of silent reflux:

• Significant distress during and after feeds with no visible sick
• Arching back sharply, particularly during feeding
• Constant swallowing or gulping motions
• Excessive drooling
• Very disrupted sleep — seems to wake in pain after 20–30 minutes
• Persistent cough or hoarse cry

Silent reflux can be harder to diagnose and is sometimes dismissed. Trust your instincts — if your baby is clearly in distress around feeding, push for a GP review.

When to see a GP

See your GP if:

• Baby is in clear pain or distress around feeds
• Baby is refusing feeds or has significant weight loss/poor gain
• Reflux seems to be worsening rather than improving
• There is blood in the sick
• Baby has difficulty breathing, wheezing, or a persistent cough

Urgent: Blood in vomit, green vomit, significant weight loss, or baby is lethargic — see a GP or go to A&E same day.

Treatments your GP can offer

Step 1: Feed and positioning changes

Before medication, GPs will usually recommend:

• Smaller, more frequent feeds — less volume per feed reduces overflow
• Upright during feeding — angle bottle or feeding position
• Upright for 20–30 minutes after feeds
• Raising the head of the cot (for safety, use a cot wedge under the mattress — never pillow inside the cot)

Step 2: Thickened formula

For formula-fed babies, thickened anti-reflux formulas (Aptamil Anti-Reflux, SMA Anti-Reflux) or adding a thickener like Carobel can reduce the frequency of posseting.

Step 3: Infant Gaviscon

A thickening agent that forms a gel in the stomach to reduce reflux. Available on prescription. Works better for posseting than for pain. Can cause constipation.

Step 4: Ranitidine / Omeprazole

Acid suppressants that reduce the acidity of stomach contents — so even if reflux occurs, it burns less. More effective for silent reflux and GORD than Gaviscon. Your GP may prescribe after trying the above.

Breastfeeding and reflux

Breastfed babies with reflux can benefit from:

• More frequent, shorter feeds to reduce volume per session
• Feeding in a more upright position (biological nurturing / laid-back feeding)
• Block feeding (staying on one breast per feed period) to reduce foremilk/hindmilk imbalance, which can worsen reflux

Some lactation consultants suggest a maternal dairy elimination trial if all else fails — cow's milk protein sensitivity can mimic and worsen reflux in breastfed babies.

What actually helps day to day

Beyond medical treatment, parents find these practical measures reduce discomfort:

• Burp thoroughly and often during feeds
• Keep baby upright after feeds — a sling is brilliant for this
• Avoid car seats and bouncers immediately after feeding (the position increases reflux pressure)
• Loose nappy at the waist — tight waistbands increase abdominal pressure
• Calm, slow feeding — rushed or stressed feeding increases air swallowing

It does get better

Reflux is exhausting, and if your baby is in pain it's heart-breaking. But almost all cases resolve significantly by 6 months and fully by 12–18 months. Log feeds and symptoms in TinyYears so you have clear data for your GP and can track improvement over time.