Your baby has been told they have reflux. They are unsettled after feeds, pulling off the breast, gulping, arching or bringing milk back up. You may have been told that medication is the next step.
But before assuming reflux is the problem, it is worth asking:
Could something about breastfeeding be contributing to what you are seeing?
For many breastfed babies, reflux is a normal part of infancy. Small, practical changes to feeding frequency, positioning and milk flow may help make feeds more comfortable and reduce some reflux symptoms. Medication can be appropriate for babies with genuine reflux disease, but uncomplicated reflux does not automatically require treatment.
What is reflux in babies?
Reflux, also called gastro-oesophageal reflux, occurs when stomach contents flow back up into the oesophagus. In young babies, the muscle between the oesophagus and stomach is still developing, as a result, milk can travel back up more easily.
Reflux is particularly common during the early months of life. If your baby is feeding well, growing appropriately and generally comfortable, frequent spit-up is often considered physiological reflux. It usually improves as your baby matures, and begins eating solid foods.
Reflux does not automatically mean something is wrong. It also does not necessarily mean your baby is experiencing pain. In otherwise healthy, thriving infants, reflux has not been shown to be a reliable explanation for excessive crying or irritability.
Can breastfeeding strategies help reduce reflux?
Yes, especially in breastfed infants. The most useful starting point is to look at how your baby is feeding.
1. Keep their nervous system settled
When babies become overwhelmed, overtired, very hungry or overstimulated, their whole body responds. They may become more unsettled, feed less smoothly and find it harder to coordinate sucking, swallowing and breathing.
Their digestive system is also influenced by the nervous system. Stress and dysregulation can affect gut motility and may contribute to feeding discomfort or more frequent spit-up.
This does not mean your baby needs to be kept perfectly calm all day. Rather, look for ways to support a more settled feed:
- Offer the breast when your baby shows early feeding cues
- Consider sensory stimulation
- Give them time to connect, settle with skin-to-skin contact
- Respond to their need for closeness, comfort and rest
Sometimes, the most helpful reflux strategy is simply helping your baby feel safe and settled before, during and after breastfeeds.
2. Follow your baby’s feeding cues
Cue-based breastfeeding means offering the breast when your baby shows early feeding cues, rather than waiting until they are extremely hungry or distressed.
A very hungry baby may attach quickly, or find it hard to attach, and they may also struggle to coordinate their feeding. Offering the breast earlier may help create a calmer, more organised feed.
There is no need to impose a rigid feeding schedule. Instead, aim to respond to your baby’s cues and offer the breast frequently.
3. Find a position that supports a stable attachment
Your baby’s position at the breast can influence how comfortably they feed.
If your baby is slipping off, repeatedly pulling away or struggling to remain attached, they may be finding it difficult to manage the milk flow or coordinate their feeding.
A breastfeeding assessment can help you explore:
- Your baby’s body alignment
- The depth and stability of attachment
- Whether your baby is maintaining a comfortable position at the breast
- Whether they are swallowing effectively
- Whether small positioning changes may improve comfort
- Whether your baby is receiving an effective balance of the milk available throughout the feed
The goal is to find your baby’s most comfortable and effective breastfeeding position, rather than forcing you into one particular hold. A stable attachment can help your baby coordinate sucking, swallowing and breathing while feeding.
4. Consider whether milk flow and composition of breastfeed is contributing
Some babies become unsettled when milk flows quickly. They may gulp, cough, pull off, repeatedly reattach or appear uncomfortable during the feed.
Frequent switching between breasts may also make it harder for some babies to settle into a feed, and may cause fermentation of milk in their gut, leading to more gas and tummy discomfort.
This does not automatically mean you have an oversupply or that your milk supply needs to be reduced. It may simply mean your baby needs help managing the feed more comfortably.
A feeding assessment can help identify whether milk flow, attachment or feeding coordination may be contributing to the symptoms, and whether adjusting how you offer the breast could help.
5. Consider whether cow’s milk protein intolerance or another allergy may be contributing
Reflux-like symptoms can sometimes overlap with cow’s milk protein allergy or other food allergies. However, not every unsettled or spitting-up baby has an allergy.
An assessment may be worthwhile if your baby’s symptoms occur alongside:
- Blood or mucus in their stool
- Persistent diarrhoea
- Eczema or other allergic symptoms
- Ongoing feeding difficulties
- Breast aversion
- Poor weight gain
- A strong personal or family history of allergies
A breastfeeding and nutrition assessment can help determine whether allergy concerns may be contributing, or whether the symptoms are more likely related to feeding patterns, positioning or milk flow.
If cow’s milk protein allergy is suspected, a supervised elimination followed by reintroduction may be recommended to establish whether it is genuinely contributing. Dietetic guidance is recommended to ensure the mothers nutritional needs are met throughout the elimination diet.
Does reflux medication help breastfed babies?
Reflux medication is not routinely recommended for otherwise healthy, irritable infants without evidence of reflux disease.
Acid-suppressing medication may reduce stomach acidity, but it does not necessarily stop milk from coming back up. It is also not a reliable treatment for ordinary spit-up or unexplained crying.
Potential adverse effects include infections, changes to the gut microbiome and concerns relating to bone health. Associations with respiratory conditions have also been reported, although the evidence is not definitive.
This does not mean medication is never appropriate. Some babies with confirmed reflux disease or complications may benefit from medical treatment.
If your baby has already been prescribed medication, do not stop it without speaking with your doctor. Instead, ask whether their symptoms are consistent with uncomplicated reflux and whether a breastfeeding assessment could help identify contributing factors.
When should your baby be medically assessed?
Seek medical advice if your baby has:
- Poor weight gain or difficulty maintaining growth
- Persistent feeding difficulties
- Significant distress during or after feeds
- Refusal to feed
- Blood in vomit or stool
- Green or bilious vomit
- Repeated projectile vomiting
- Signs of dehydration
- Breathing difficulties
These symptoms should not simply be attributed to reflux.
How I can help
I support mothers and their babies with practical, breastfeeding-focused strategies for managing reflux concerns.
Together, we can look at your baby’s feeding patterns, positioning, attachment, milk flow and milk transfer. We can also consider whether allergy concerns may need further investigation and whether your current feeding approach could be adjusted.
The aim is to help you understand what may be contributing to your baby’s symptoms and what you can practically do during breastfeeding, rather than simply being told that your baby has reflux.
For a deeper understanding of breastfeeding positioning, attachment and milk transfer, my ebook, Breastfeeding: A Guide for Mothers, explores the mechanics of an effective feed in greater detail, and covers reflux in breastfed infants in more detail.
Need personalised support?
If you’re still navigating unsettled feeds, reflux concerns, allergy-like symptoms, growth concerns, digestive discomfort, nipple pain, positioning or attachment difficulties, or uncertainty about milk transfer, a 1:1 Breastfeeding Consultation can help.
We’ll look at the bigger picture of your baby’s feeding, identify what may be contributing to their symptoms, and work through practical, personalised strategies for you and your baby.