Baby's reflux or normal behaviour?

Your baby cries after a bottle feed, squirms when you put them down, spits up (or doesn't), makes noises while sleeping (you can hear the milk coming back up, they grunt)? 

On social media, one answer is everywhere: "it's reflux," or "silent reflux." Ebooks, programmes, and specialist consultations promise you a solution.

Here is a summary on this topic.

What is normal in a newborn

Many behaviours that worry parents are in fact completely normal:

• Up to 70% of babies at 4 months spit up, without it being pathological. These regurgitations resolve spontaneously by 1 year of age (HAS, 2024).

• A baby who settles in your arms but cries when put down is not in pain: they are expressing a normal need for contact and closeness (Douglas, 2013).

• Back arching, breast refusal, and crying are normal neurobehavioural signals, not signs of oesophageal pain (Douglas, 2013). (Back arching during a feed and breast refusal can be caused by positional instability, and negative conditioning following repeated unsettled feeding experiences.)

• Regurgitation affects 40% of babies, peaking at 4 months (Douglas, 2013).

• When a baby activates their nervous system (e.g. in a stressful situation such as being put down) or transitions into light sleep, they grunt, move, and pass gas: the digestive system kicks in and milk can travel back up into the oesophagus. Within 2 hours of a feed, the milk is not yet acidic. (I discuss this in this article.)

  
  

Pathological baby's reflux is rare

Pathological Gastrooesophageal reflux (GORD), the kind that requires medical treatment, has a genuinely low prevalence. Pathological reflux is defined by the presence of symptoms associated with reflux.

The symptoms are non-specific; the main suggestive signs are:

• Persistent or excessive regurgitation associated with feeding refusal

• Persistent, unusual crying

• Irritability during feeding

• Poor weight gain or sleep disturbances

The HAS states: "Irritability or excessive crying, when isolated, should not lead to a diagnosis of pathological GOR in children under one year of age, particularly when development is otherwise normal."

The diagnosis is a medical one, and your doctor will decide whether or not medication is appropriate.

Crying, even when accompanied by visible regurgitation, does not justify medication. Proton Pump Inhibitors (PPIs, such as omeprazole) have limited efficacy and can cause adverse effects; their prescription is therefore subject to specific conditions (HAS, 2024)

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Why do methods promoted online seem to work?

Paid "anti-reflux" programmes largely repackage freely available official recommendations, adding unproven explanations (muscle tension, tongue-tie, sucking difficulties) that steer families towards further consultations. Manual therapies such as osteopathy and chiropractic care have not demonstrated efficacy in reducing infant crying (Cabanillas-Barea et al., 2023).

If you feel these methods have helped, it may be due to the placebo effect, the sense of being heard during a consultation, or simply the fact that crying naturally improves between 3 and 4 months. It has also been shown that parental beliefs and reassurance directly influence infant behaviour (Czerniak et al., 2020).

Furthermore, simply labelling a baby's symptoms as "reflux" can increase parental anxiety — at a time when hypervigilance in the postpartum period is already common.

Colic: a reality, but not a disease

Colic affects many babies between 1 and 4 months of age. It is defined by inconsolable crying for more than 3 hours a day, more than 3 days a week, for at least 3 weeks (Wessel, 1954; Ong et al., 2019). Its exact cause remains unknown. Colic falls under the umbrella of functional gastrointestinal disorders (even though a digestive origin has not been proven and several theories exist on this topic), which means there is no identifiable underlying disease (Zeevenhooven et al., 2017).

What genuinely helps: carrying, rocking, lullabies, whole-body massage, physical closeness (Mrljak et al., 2022; Hunziker & Barr, 1986). And above all: being supported, informed, and reassured (Sarasu et al., 2018).

What you can do in practice

• Carry your baby: babywearing significantly reduces crying.

• Feeding:

  • If your baby spits up a lot, try smaller, more frequent feeds and avoid overfeeding. Use paced bottle feeding — hold the bottle horizontally and take regular breaks.

  • Change the teat flow rate or shape if needed.

  • A side-lying position can also help your baby feed more calmly.

  • If you are breastfeeding and your baby is unsettled at the breast, several causes are possible — including positional instability (see this article for stable positioning) or oversupply. Consulting an IBCLC lactation consultant can help.

• Keep your baby upright for a few minutes after feeds to reduce regurgitation.

• Massage your baby: gentle whole-body massage has shown benefits for crying.

• Talk to your doctor or midwife: their role is to reassure you, check that all is well, and support you.

  
  

Key takeaways

Social media posts are often anxiety-provoking, and the information shared does not always reflect evidence-based guidance.

A baby who cries, spits up, makes noise, grimaces in their sleep, or squirms is, in most cases, a baby behaving normally: one who needs a great deal of closeness. Some babies simply cry more than others, with a natural reduction in crying observed after 4 months.

The best treatment is your presence, your reassurance, and the support of trusted healthcare professionals.

Healthcare professional? Read the more detailed article at www.lactasource.com

References

• Cabanillas-Barea S et al. Systematic review and meta-analysis: complementary and alternative medicines were not effective for infantile colic. Acta Paediatr. 2023;112(7):1378–1388.

• Czerniak E et al. "Placebo by Proxy" and "Nocebo by Proxy" in Children. Front Psychiatry. 2020;11:169.

• Douglas PS. Diagnosing gastro-oesophageal reflux disease or lactose intolerance in babies who cry a lot in the first few months overlooks feeding problems. J Paediatr Child Health. 2013;49(4):E252-6.

• HAS. Reflux gastro-œsophagien chez l'enfant de moins d'un an. Mars 2024.

• Hunziker UA, Barr RG. Increased carrying reduces infant crying: a randomized controlled trial. Pediatrics. 1986;77(5):641-8.

• Mrljak R et al. Effects of Infant Massage: A Systematic Review. Int J Environ Res Public Health. 2022;19:6378.

• Ong TG et al. Probiotics to prevent infantile colic. Cochrane Database of Systematic Reviews. 2019, Issue 3.

• Sarasu JM, Narang M, Shah D. Infantile Colic: An Update. Indian Pediatr. 2018;55(11):979-987.

• Zeevenhooven J et al. The New Rome IV Criteria for Functional Gastrointestinal Disorders in Infants and Toddlers. Pediatr Gastroenterol Hepatol Nutr. 2017;20(1):1-13.

  
  

Disclaimer: This article is intended for general information purposes only and does not in any way substitute for medical advice. It is essential to consult a healthcare professional regarding your individual situation.

You can contact me for advice or questions: "My Baby Moon" by Elise Armoiry, IBCLC Lactation Consultant & founder of My Baby Moon. Over 2,000 families supported since 2014. Doctor of Pharmacy by training, specialised in breastfeeding and infant sleep. Email: info@mybabymoonibclc.com | Tel: 07.49.50.67.82 | Website: mybabymoonibclc.com