The valve at the top of baby’s stomach is still developing, and milk sometimes comes back up if the valve doesn’t close properly. Reflux without visible spilling is uncommon, although symptoms of unsettledness are often attributed to this. Reflux usually stops between 6 and 12 months. Most of the time these babies do not need medicine for the spilling as it is usually harmless.
Sometimes milk spills out of the mouth, and sometimes milk only partly comes up the tube between the stomach and mouth, then goes back down into the stomach. The only signs might be that they’re unsettled, not sleeping well, and are fussy feeders. They may also arch their back and extend their legs.
Many babies don’t seem distressed by spilling and grow normally. Then the only problem is the extra washing to clean up the spills. Spilling and reflux are different from vomiting, where the baby empties their stomach forcefully.
Dress or change your baby before feeds, when their stomach isn’t full.
Wind your baby several times during feeds, and use large bibs.
Use a towel after feeds to catch the milk and protect your clothes.
Have a towel with you to put under your baby where they’re 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 with a book under each leg at the head end.
Make up the bed with your baby’s feet at the bottom so there’s no space for them to slip down under the blankets.
Talk to your Plunket nurse or doctor about feed thickeners and other medication to reduce the spilling if it is accompanied by unsettled times. Often you’re doing everything right, but your baby with reflux is still unsettled. It can be helpful to get support for yourself and talk to others about managing your baby’s reflux from day to day.
See your doctor if you are worried, or your baby:
is not gaining weight or has only small weight gains
appears to be in pain
is difficult to settle or becomes more unsettled
spilling large amounts or more often
vomits violently (projectile vomiting)
has green vomit.
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 mothers who are breastfeeding believe that wind may be caused by food they have eaten.
Many babies have hiccups after feeds and winding. This is normal.