Baby Reflux and Silent Reflux: Signs, Causes and How to Help

Quick answer: Reflux is stomach contents flowing back up the oesophagus, and it usually settles on its own by around 12 months. Visible reflux brings milk up as a posset or vomit; silent reflux is swallowed back down, so the clue is distress without spit-up. Upright feeding, smaller feeds, thorough winding and safe-sleep-friendly measures help. See your GP if weight gain, feeding or pain is affected.

What parents need to know

If your baby spits up frequently, arches their back during or after feeds, or seems uncomfortable despite being fed, reflux could be the explanation. It's one of the most common infant conditions — affecting around half of all babies under three months to some degree — and for most babies, it's temporary and manageable.

What is baby reflux?

Reflux occurs when stomach contents flow back up into the oesophagus (food pipe). In babies, this happens because the lower oesophageal sphincter — the muscle that keeps food in the stomach — is immature and doesn't always close effectively. As it matures (usually by 12 months), reflux resolves on its own for the vast majority of babies.

Reflux is often called gastro-oesophageal reflux (GOR) when it's the normal, developmental kind. When it causes significant distress or other symptoms, it becomes gastro-oesophageal reflux disease (GORD).

Reflux vs silent reflux

In regular reflux, milk comes all the way back up and is visible as a posset or vomit. In silent reflux, the milk travels up the oesophagus but is swallowed back down before reaching the mouth — so there's no visible spit-up. This can make it harder to identify, because the visible clue is missing.

Signs of reflux in babies

• Frequent spitting up or vomiting after feeds
• Arching the back during or after feeding
• Crying and apparent discomfort during or after feeds
• Feeding difficulties — pulling off the breast or bottle, refusing to feed, or wanting to feed constantly for comfort
• Hiccupping frequently
• Wet or "gurgly" breathing sounds
• Disturbed sleep (discomfort tends to worsen when lying flat)

Signs that may indicate silent reflux

• Distress during and after feeds without visible vomiting
• Swallowing or gulping frequently
• Hoarse or "raspy" voice
• Back-arching and apparent pain
• Refusing feeds despite apparent hunger
• Poor sleep and frequent waking

What helps with reflux

Feeding position

Keep your baby as upright as possible during feeds — ideally at a 45-degree angle. After feeding, hold them upright for at least 20–30 minutes before laying them down. Gravity is your friend.

Smaller, more frequent feeds

For formula-fed babies, smaller amounts more often reduces the volume in the stomach at any one time. For breastfed babies, shorter feeds or more frequent feeds may help. Avoid overfeeding.

Winding well

Ensure you wind thoroughly during and after feeds. Trapped wind can make reflux worse.

Thickened feeds (formula)

Anti-reflux or "comfort" formulas contain thickeners that make the milk harder to bring back up. Speak to your GP or health visitor before switching — these aren't suitable for all babies.

Elevated sleep surface

Slightly elevating the head end of the cot mattress (by placing a firm rolled towel under the mattress — not under the sheet) can help some babies. However, always follow safe sleep guidelines; never prop your baby on pillows or inclined devices.

Medication

If lifestyle measures aren't enough and your baby's reflux is causing significant distress or affecting weight gain, your GP may prescribe antacids (Gaviscon) or acid-suppressing medication (omeprazole or ranitidine). These are safe and effective when used appropriately.

Frequently asked questions

How can I tell if my baby has silent reflux?

Silent reflux has no visible spit-up because the milk is swallowed back down. Look instead for distress during and after feeds, frequent swallowing or gulping, a hoarse or raspy voice, back-arching, refusing feeds despite hunger, and poor sleep.

When does baby reflux go away?

Reflux happens because the muscle keeping food in the stomach is still immature. As it matures, usually by 12 months, reflux resolves on its own for the vast majority of babies.

How long should I hold my baby upright after a feed?

Keep your baby as upright as possible during feeds, ideally at a 45-degree angle, then hold them upright for at least 20–30 minutes before laying them down.

When should I see my GP about baby reflux?

See your GP if your baby is not gaining weight adequately, consistently refuses feeds, seems to be in significant pain, has blood in vomit or stool, or has projectile vomiting.