Spilling & reflux

A baby with reflux can be very difficult to manage. Often you are doing everything ‘right’ but baby is still unsettled. Talk to others about how you feel and get support for yourself.

Some babies spill (bring up milk) after each feed, while some hardly ever do so. Spilling/reflux occur because the valve at the top of the stomach is still developing and sometimes does not close, allowing milk to come back up. This usually stops between 6 and 12 months.

The milk can be spilled out of the mouth. Some babies can have reflux without spilling, where milk only partly comes up the tube between the stomach and mouth, then goes back down into the stomach. Reflux when there is no visible spilling is uncommon, although it is common for symptoms of unsettledness to be attributed to this.

Many babies do not seem distressed and grow normally, with the only problem being the extra washing to clean up the spills.

Some babies become unsettled with reflux. They may cry, be a fussy feeder and not sleep well. They may arch their back and extend their legs out. Spilling and reflux are different from vomiting, where the baby empties their stomach forcefully.

Ways to cope when your baby spills milk

• Dress or change your baby before feeds when their stomach is not full.
• Wind your baby several times during feeds (see below for wind).
• Use a towel to cover yourself after feeds, to catch the milk.
• Have lots of large bibs.
• Have a towel with you to put under your baby where they are sitting or lying during feeds.
• After feeds, sit your baby up on your lap or in a bouncinette for a short period.
• Raise the head end of the cot or bassinette by putting a book under each of the legs at the head end. To stop your baby slipping under the blankets, make up the bed with your baby’s feet at the bottom so that there is no space for them to slip down under the blankets.

Using feed thickeners and other medications can also help reduce the spilling and unsettledness. Talk with your Plunket nurse, well child health provider or doctor about these options.

See a doctor if you are worried or your baby:

• has poor weight gain
• appears to be in pain
• is difficult to settle or becomes more unsettled
• is spilling more
• is spilling large amounts
• vomits violently (projectile vomiting)
• has green vomit

Wind

Some babies don't need to be winded (burped) after feeds, while others become unsettled with wind and need winding at every feed. When winding it helps to keep your baby upright to your shoulder or sitting on your knee with their back straight. Some people believe that the food you eat can cause wind for baby.