Infant Reflux: Feeding, Self-Help and when to Seek Support

A baby who brings milk back up may look uncomfortable, particularly when feeds already feel hard work. Searching for the best feeding positions for reflux is a sensible practical step, but position is only one part of the picture.

The safest and most helpful approach depends on whether a baby is feeding, being held after a feed or sleeping — and on their feeding function, growth and overall wellbeing.

Reflux is very common during infancy. The mechanisms that normally help keep stomach contents in the stomach are still developing, and most babies with uncomplicated gastro-oesophageal reflux (GOR) improve as they mature (NICE, 2015; NHS, 2025).

Not all reflux is the same

Normal infant reflux — GOR

Gastro-oesophageal reflux (GOR) is when stomach contents pass back into the oesophagus. It is very common in babies and is often a normal physiological process rather than a disease.

NICE describes GOR as a common physiological event in infants and notes that around 90% of affected infants have resolution by their first birthday (NICE, 2015).

A baby may bring milk back up during or after a feed but otherwise be comfortable, feed effectively and continue to grow normally.

Reflux-like symptoms and feeding factors

Not every baby who appears to have reflux necessarily has GOR as the primary problem.

Swallowed air, feeding too quickly, taking more milk than is comfortable, difficulties coordinating sucking, swallowing and breathing, or difficulties maintaining an effective seal can all contribute to abdominal distension and discomfort.

A baby who has swallowed a significant amount of air may appear unsettled, pull away from the feed, arch or cry and then bring milk back up. In some babies, what looks like reflux may therefore be partly related to feeding mechanics and aerophagia — swallowing air.

This is one reason it is useful to look at the whole feeding picture rather than assuming that every unsettled or regurgitating baby has GORD.

What about “silent reflux”?

“Silent reflux” is commonly used to describe reflux where stomach contents pass back into the oesophagus and are then swallowed again rather than being visibly spat out.

It is therefore not a separate disease from reflux. The term describes how the reflux presents rather than identifying a different underlying condition (NHS, 2025).

GORD

Gastro-oesophageal reflux disease (GORD) is different from uncomplicated physiological reflux.

GORD refers to reflux that is associated with troublesome symptoms or complications significant enough to require assessment and, in some cases, treatment (NICE, 2015).

This distinction is important because the presence of regurgitation alone does not mean that a baby has GORD or needs medication.

Feeding positions

There is no single “best” reflux position for every baby.

The aim during feeding is to support comfortable, coordinated feeding while avoiding unnecessary pressure on the abdomen.

Breast or chest feeding

Some babies are more comfortable feeding in a semi-reclined or laid-back position, with the baby well supported against the caregiver.

This can allow the baby to have greater control over the pace of the feed and may be particularly helpful where milk flow is fast.

A baby should still have a clear airway, with the head and neck able to move freely and the nose and mouth unobstructed.

Side-lying breastfeeding can also be comfortable for some feeding dyads, but this is a feeding position rather than a sleep position. If the baby falls asleep, they should be moved to their separate, flat sleep space and placed on their back.

For breastfed babies with frequent regurgitation accompanied by marked distress, NICE recommends a breastfeeding assessment before moving on to other interventions (NICE, 2015).

An IBCLC can be particularly helpful when feeding mechanics, milk transfer, positioning or possible aerophagia need closer assessment.

Bottle feeding

A semi-upright position can help some babies coordinate sucking, swallowing and breathing more comfortably.

Holding the bottle relatively horizontal rather than tipped steeply downwards can support responsive, paced bottle feeding and allow the baby greater control over milk flow.

A slow-flow teat may also be appropriate for some babies, although teat flow needs to be considered alongside the individual baby's feeding skills and the manufacturer's instructions.

Avoid propping a bottle or leaving a baby to feed without active support. Responsive bottle feeding allows the caregiver to observe the baby's cues and pause when needed (NHS, 2025; NHS Dumfries and Galloway, 2025).

Anti-reflux formula

For some formula-fed babies, a healthcare professional may recommend a thickened or anti-reflux formula.

These products are not simply another version of standard first-stage infant formula. Some are marketed as foods for special medical purposes and are subject to a different regulatory framework from standard infant formula. Some are available directly from pharmacies or supermarkets rather than requiring a prescription, but this does not mean that they are intended for unsupervised use (NHS, 2025; CMA, 2024).

NHS guidance recommends that anti-reflux formula is used only under medical supervision.

Preparation instructions can also differ from those for standard formula. Some anti-reflux products have specific instructions about the temperature of the water used for preparation and may require a different teat because the feed is thicker. Always follow the instructions for the individual product.

Do not cut or enlarge a teat to make a thickened feed flow more quickly.

It is also important not to add additional thickening agents or medicines such as Gaviscon Infant to an already thickened anti-reflux formula unless specifically advised by a healthcare professional. Combining different thickening products can result in excessive thickening (Alder Hey Children's NHS Foundation Trust, 2025; EMC, 2025).

NICE recommends a stepped approach to managing frequent regurgitation in formula-fed infants, which may include reviewing feeding volumes and frequency before considering thickened feeds (NICE, 2015).

Winding and trapped air

Winding is not about producing a burp at all costs.

The aim of winding is comfort. Some babies need very little winding, while others appear much more comfortable after bringing up trapped air.

There is no single winding position that works for every baby. A caregiver may find that holding the baby upright against the chest, supporting them over the shoulder or using another comfortable supported position works best.

And compressing the tummy is not automatically wrong.

During winding, gentle abdominal support or pressure may help some babies move trapped air. The important distinction is between brief, purposeful support while trying to help a baby wind and prolonged abdominal compression or a tightly curled, slumped position that may increase pressure on the stomach.

If trapped air appears to be contributing to discomfort or regurgitation, allowing time for the baby to wind before immediately offering more milk may sometimes be helpful.

If a baby repeatedly swallows large amounts of air during feeds, however, it is worth looking beyond winding and considering why the air is being swallowed in the first place.

Could a high palate or tongue-tie contribute to reflux symptoms?

Tongue-tie and reflux symptoms can occur together, but it is important to be precise about the relationship.

A restrictive lingual frenulum can affect tongue posture and function during early oral development. In some babies, this may contribute to the development of a higher or narrower palate.

A high palate can alter how the tongue, breast or teat and oral cavity work together during feeding and may make it harder for a baby to maintain an effective seal.

One possible consequence is increased aerophagia — swallowing more air during feeds. When swallowed air accumulates in the stomach, gastric distension can contribute to discomfort, winding difficulties and increased regurgitation in some babies.

For an individual baby, the relationship may therefore be understood as:

restricted tongue function → altered tongue posture and oral development → high palate → altered feeding mechanics → increased swallowed air → gastric distension → increased regurgitation or reflux symptoms.

This does not mean that every baby with a tongue-tie will develop reflux, or that every baby with reflux has a tongue-tie or high palate.

Reflux is common in infancy for many reasons, and feeding history, feeding mechanics and the individual baby's anatomy all need to be considered.

It is also important to understand what frenotomy can and cannot change.

Dividing a restrictive lingual frenulum may remove the restriction and allow greater tongue movement, but it does not reshape an established high palate. If palatal shape has contributed to the baby's feeding mechanics, that factor may therefore remain after frenulum division.

For this reason, frenotomy should not be presented as a treatment for reflux itself. Where tongue restriction, palatal shape, feeding mechanics and reflux symptoms appear to interact, the whole feeding picture needs to be assessed rather than assuming that releasing the frenulum will resolve the reflux.

Research has reported improvements in reflux-related symptom scores following frenotomy in some infants, but this does not establish that tongue-tie is the cause of reflux or that frenotomy is a treatment for GORD (Slagter et al., 2021).

Maternal diet and breastfeeding

It is understandable to wonder whether something eaten or taken by a breastfeeding caregiver could be contributing to a baby's symptoms.

There is not good evidence that routinely removing foods from the maternal diet prevents or treats uncomplicated infant reflux.

Cow's milk protein allergy can sometimes present with symptoms that overlap with reflux, but this is different from assuming that dairy is responsible for every baby's regurgitation or unsettled behaviour. Where cow's milk protein allergy is suspected, dietary elimination should be considered in a structured way with appropriate professional guidance rather than through multiple unnecessary dietary restrictions.

Caffeine

Caffeine passes into breast milk and is absorbed relatively quickly.

Research into maternal caffeine intake and symptoms such as infant colic, sleep disturbance or fussiness remains limited and inconsistent. A systematic review found insufficient evidence to establish a clear causal relationship between maternal caffeine consumption and adverse effects in breastfed infants (McCreedy et al., 2018).

Younger and premature babies may metabolise caffeine more slowly.

European guidance considers maternal intake of up to around 200 mg of caffeine per day unlikely to cause harm to a breastfed infant (EFSA, 2015). This can represent several cups of tea or coffee depending on how they are prepared and their caffeine content, so counting “cups” alone is not particularly precise.

Very high caffeine consumption may be more relevant, particularly if a baby appears unusually unsettled, jittery or has disrupted sleep. If there appears to be a consistent relationship, reducing caffeine intake and observing whether symptoms change may be reasonable.

Herbal products and galactagogues

“Natural” does not automatically mean risk-free.

Herbal products and galactagogues such as fenugreek can cause digestive effects in the person taking them, including diarrhoea, nausea, abdominal discomfort and flatulence.

If a baby's symptoms change after a breastfeeding caregiver starts taking a supplement, the timing is worth considering rather than automatically assuming that the symptoms are caused by reflux.

Any supplement being used regularly during breastfeeding is worth discussing with an appropriately qualified healthcare professional, particularly where a baby is premature, unwell or medically complex.

Probiotics

Research into probiotics for infant reflux remains limited, and different probiotic products contain different strains and doses.

Some studies have suggested possible benefits for gastrointestinal symptoms, crying or feeding discomfort, but probiotics are not established as a treatment for infant reflux or GORD.

If probiotics are being considered, the individual product and the reason for using it should be discussed with a healthcare professional, particularly for premature or medically complex babies.

Simple things you can try at home

Small changes can sometimes make feeds more comfortable.

• Keep feeds as calm and unhurried as possible.

• Watch the baby's feeding cues and allow pauses where needed.

• With bottle feeding, consider responsive, paced feeding rather than encouraging the baby to finish a set volume.

• Consider whether the teat flow is appropriate for the baby's feeding skills.

• Allow time for winding if the baby appears uncomfortable with swallowed air.

• Hold the baby upright while they are awake after a feed if this appears comfortable.

• Avoid prolonged periods in a car seat, bouncer or other semi-reclined equipment after feeds where possible.

• Avoid vigorous bouncing or jiggling after feeds if this appears to increase discomfort or regurgitation.

• Avoid unnecessary prolonged pressure on the abdomen.

• If using formula, prepare it exactly according to the manufacturer's instructions.

• If using an anti-reflux formula, follow that product's specific preparation instructions rather than applying standard formula preparation assumptions.

• Check whether the particular anti-reflux formula is suitable for the preparation machine being used. Some manufacturers specifically advise against using their anti-reflux products in certain preparation machines.

• If a feed becomes very frothy, consider how it is being prepared. Vigorous shaking can introduce additional air bubbles into a feed. If a baby is already swallowing significant amounts of air, this may increase the amount of air available to swallow and potentially contribute to gastric distension, discomfort or regurgitation (Derbyshire Family Health Service, 2025).

Keep a simple record if symptoms are difficult to understand. Recording feeds, regurgitation, winding, stools, wet nappies, periods of distress and what appears to help can sometimes make patterns easier to identify.

Positions to avoid for routine reflux management

A baby should not routinely be positioned face-down or on their side for sleep as a way of managing reflux.

It can be tempting to think that a baby will be less likely to bring milk back up if they are sleeping on their front or side, but this is not considered safer sleep practice.

Similarly, wedges, sleep positioners and inclined surfaces should not be used as a routine reflux treatment.

A sleep surface should be firm, flat and clear, with the baby placed on their back for every sleep (The Lullaby Trust, 2025; BASIS, 2025).

Reflux and sleep

Back sleeping remains the safest position for babies, including babies who have reflux.

The Lullaby Trust recommends placing babies on their back for every sleep and specifically states that this applies to babies with reflux too (The Lullaby Trust, 2025).

Research and guidance from the Baby Sleep Information Source (BASIS) also support a flat, clear sleep surface. Inclined or sloping products can result in a baby's body becoming slumped, which may affect airway positioning. Car seats and other sitting devices are not designed to provide a safe prolonged sleep environment (BASIS, 2025).

If a baby falls asleep while being held upright after a feed, they should be moved to their separate, flat sleep space and placed on their back.

Do not raise the head of the cot or use wedges or other positioning products unless specifically advised as part of a medical plan.

When feeding position is not enough

If changing feeding position is not making a meaningful difference, it is worth stepping back and considering the whole feeding picture.

An IBCLC can help assess breastfeeding or bottle-feeding mechanics, milk transfer, positioning, feeding cues, oral function and possible aerophagia.

A health visitor can help assess feeding, growth, wet nappies, stools, settling and general wellbeing, and can help identify when further assessment is needed.

A GP should be involved when symptoms are persistent, particularly where there is significant distress, ongoing feeding difficulty, poor weight gain, faltering growth or weight loss.

Weight loss should not simply be attributed to reflux without assessment.

Medicines and reflux

Medication is not automatically appropriate simply because a baby regurgitates milk.

NICE specifically recommends not offering acid-suppressing medication to infants with overt regurgitation when there are no other concerning symptoms (NICE, 2015).

Where medication is prescribed, it is important to understand what it is intended to do and what side effects may occur.

Some preparations used in reflux management can affect bowel habit. Alginate-containing preparations such as Gaviscon Infant can cause changes in stool consistency, and constipation is listed as a very rare adverse effect in the product information. Persistent or significant changes in bowel habit should be discussed with a healthcare professional (EMC, 2025).

Gaviscon Infant and other thickening preparations also need to be used carefully. Gaviscon Infant should not be combined with another thickener or with an infant milk preparation that already contains a thickening agent because excessive thickening can occur (EMC, 2025).

If a baby is prescribed or advised to use a reflux medicine, follow the instructions provided rather than adding or changing products independently.

When to seek help from an IBCLC, health visitor or GP

You do not have to wait until reflux becomes severe before asking for help.

An IBCLC may be appropriate when:

• feeds are difficult, painful or very prolonged

• a baby repeatedly comes off the breast or teat

• there is clicking, coughing or significant swallowing of air during feeds

• milk transfer appears poor

• the baby struggles to coordinate sucking, swallowing and breathing

• bottle feeding is stressful or difficult to pace

• you would like an individual feeding assessment.

A health visitor may be appropriate when you are concerned about:

• feeding generally

• weight or growth

• wet nappies

• stools

• settling and comfort

• whether your baby's overall pattern of feeding and behaviour is within the expected range.

A GP should assess persistent or worsening symptoms, particularly where there is:

• poor weight gain or weight loss

• ongoing feeding difficulty

• significant or persistent distress

• repeated vomiting

• symptoms that are not improving

• concerns about an underlying medical condition.

When urgent medical assessment is needed

Seek urgent medical advice if your baby has:

• green or yellow-green vomit

• blood in the vomit

• blood in the poo

• persistent or forceful/projectile vomiting

• a swollen or tender abdomen

• signs of dehydration

• a high temperature or appears feverish and unwell

• refuses feeds

• cannot keep feeds down

• becomes unusually sleepy or difficult to wake

• breathing difficulties

• a sudden deterioration or appears seriously unwell.

If a baby is having difficulty breathing, is unusually difficult to wake or appears seriously unwell, seek emergency medical help.

A calm, individual plan

Reflux can be frustrating because the same symptom can have very different contributing factors in different babies.

For one baby, adjusting feeding position may make a significant difference. For another, the main issue may be fast milk flow, swallowed air, feeding volume, teat flow, oral function or another underlying problem.

A baby who is regurgitating but feeding well, remaining comfortable and growing normally may need reassurance and time rather than treatment.

For a baby who is distressed, struggling with feeds, swallowing significant amounts of air or not gaining weight appropriately, looking beyond the reflux itself can be much more useful.

The aim is not simply to stop a baby bringing milk back up. It is to understand what is happening during feeding, identify anything that may be contributing to discomfort, and make sure the baby is feeding safely, comfortably and growing appropriately.

References

Alder Hey Children's NHS Foundation Trust (2025) ‘Gastro-oesophageal reflux in babies’. Available at: https://www.alderhey.nhs.uk/conditions/patient-information/gastro-oesophageal-reflux-in-babies/ (Accessed: 10 September 2026).

Baby Sleep Information Source (BASIS) (2025) ‘Where babies sleep’. University of Durham. Available at: https://www.basisonline.org.uk/where-babies-sleep/ (Accessed: 10 September 2026).

Competition and Markets Authority (CMA) (2024) ‘Infant formula and follow-on formula market study’. London: CMA.

Derbyshire Family Health Service (2025) ‘Bottle feeding and making up formula milk’. Derbyshire Family Health Service (Accessed: 10 September 2026).

Electronic Medicines Compendium (EMC) (2025) ‘Gaviscon Infant Powder for Oral Suspension: Summary of Product Characteristics’. Available at: https://www.medicines.org.uk/ (Accessed: 10 September 2026).

European Food Safety Authority (EFSA) (2015) ‘Scientific Opinion on the safety of caffeine’, EFSA Journal, 13(5), 4102.

Lullaby Trust (2025) ‘Safer sleep and reflux’. Available at: https://www.lullabytrust.org.uk/safer-sleep-advice/safer-sleep-and-reflux/ (Accessed: 10 September 2026).

McCreedy, A., Bird, S., Brown, L.J. et al. (2018) ‘Effects of maternal caffeine consumption on the breastfed child: a systematic review’, Journal of Human Lactation, 34(3), pp. 546–556.

National Institute for Health and Care Excellence (NICE) (2015, updated) ‘Gastro-oesophageal reflux disease in children and young people: diagnosis and management (NG1)’. Available at: https://www.nice.org.uk/guidance/ng1 (Accessed: 10 September 2026).

NHS (2025) ‘Reflux in babies’. Available at: https://www.nhs.uk/conditions/reflux-in-babies/ (Accessed: 10 September 2026).

NHS (2025) ‘Types of formula milk’. Available at: https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/types-of-infant-formula/ (Accessed: 10 September 2026).

NHS Dumfries and Galloway (2025) ‘Gastro-oesophageal reflux in infants’. Available via Right Decisions (Accessed: 10 September 2026).

Slagter, K.W., Raghoebar, G.M., Hovinga, J. et al. (2021) ‘Effect of frenotomy on breastfeeding and reflux in infants with ankyloglossia’, International Journal of Pediatric Otorhinolaryngology, 150, 110891.