What is reflux?

Reflux is the regurgitation of most commonly liquid back up the oesophagus/food pipe/gullet, from the stomach. There are two types of reflux, ‘physiological’ and ‘non-physiological’.

Physiological reflux

Most babies have a degree of physiological reflux, because they spend most of their time lying on their backs, and have an under-developed muscle ring (sphincter) at the top of their stomach, which fails to prevent regurgitation. This type of reflux is very common, the baby is well, putting on weight appropriately and will naturally improve by their first birthday, as the sphincter muscle develops and the baby becomes more upright.

Non-physiological reflux

This refers to reflux which is impacting on the health of the baby and is frequently called Gastro-Oesphageal Reflux Disease (GORD). Recent evidence suggests that allergy, in particular to Cows’ Milk Protein, is the most likely cause. Rarely, a blockage in the oesophagus can also cause this reflux. Babies with this type of reflux may have a number of additional symptoms such as:

  1. being difficult to settle
  2. arching after feeds and drawing their legs up
  3. explosive poos
  4. blood in their poo
  5. making rattling noises
  6. poor weight gain
  7. coughing or gagging during and after feeds
  8. frequent vomiting after and between feeds

Since the regurgitated milk is also mixed with stomach acid, this can create discomfort for the baby. Some babies respond to this discomfort by being put of feeding (termed oral aversion), or want to feed all the time, in an attempt to keep down the acidic milk, and soothe their oesophagus/food pipe.

Most babies will vomit the regurgitated milk, but a minority do not, and this is termed ‘silent’ reflux. These babies often have milk in their mouth between feeds, from regurgitation even if they don’t vomit.

The most common allergy that underpins reflux is due to a reaction to a protein in cows’ milk called Cows’ Milk Protein Allergy (CMPA). Babies with CMPA need to be assessed by a qualified medical practitioner. If your baby has CMPA then all items with cows’ milk protein need to be avoided.

Read more about reflux on the National institute of Clinical Excellence Gastro-oesophageal reflux disease in children and young people: diagnosis and management | Guidance and guidelines | NICE and NHS choices.

There are a number of ways to help with the symptoms of reflux, read more in Simple ways to improve reflux.


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