Almost all babies spit up to some degree — it is a normal part of infancy. But for some babies and children, reflux causes genuine distress or complications that require medical attention.

What Is Normal Infant Reflux?

Gastro-oesophageal reflux (GOR) simply means the backward flow of stomach contents into the oesophagus. In babies, this happens because the lower oesophageal sphincter (the muscle that keeps food down) is immature. By 12–18 months, it has usually strengthened and reflux resolves on its own.

Signs of normal reflux:

Frequent spitting up (especially after feeds)

Baby is otherwise well, growing, and gaining weight

No significant distress during or after feeding

This is sometimes called "happy spitter" reflux — messy but harmless.

What Is GERD?

Gastro-oesophageal reflux disease (GERD) refers to reflux that causes troublesome symptoms or complications. The key difference is the impact on the child.

Warning signs that suggest GERD rather than normal reflux:

Feeding refusal or severe distress during or after feeds

Arching of the back (Sandifer syndrome)

Poor weight gain or weight loss

Recurrent vomiting that is large in volume or projectile

Hoarse voice, chronic cough, or recurrent chest infections (suggesting aspiration)

Apnoea episodes in young infants

Heartburn in older children — described as chest or throat burning

When Should You See a Paediatric Gastroenterologist?

See your GP or paediatric gastroenterologist if:

Symptoms are causing significant distress or feeding problems

Your baby is not gaining weight appropriately

Vomiting is forceful or contains blood or bile

Symptoms persist beyond 12–18 months

Your child is older and describes heartburn or difficulty swallowing

Symptoms are not responding to simple measures

How Is GERD Managed?

Simple measures first:

Smaller, more frequent feeds

Keeping baby upright after feeds

Thickening feeds (under dietitian guidance for formula-fed infants)

If these don't help, your doctor may consider:

A trial of acid suppression medication (e.g. omeprazole)

Gastroscopy to look for complications such as oesophagitis

Most children do not need long-term medication, and many improve significantly as they grow.

Dr Harveen Singh FRACP assesses and treats infants and children with reflux at clinics across Sydney. A GP or paediatrician referral is required.

Last reviewed by Dr Harveen Singh FRACP, Paediatric Gastroenterologist & Hepatologist