Reflux, put simply, is the movement of fluid through a vessel or valve in the opposite direction to normal. In the case of the reflux we associate with babies, this is milk moving back up (definitely the wrong direction!) from the stomach to the oesophagus (the food pipe that takes food from our mouth to our tummy) and, often, out and all over the outfit you just changed them into. 

In a grown-up, healthy body, the clever valve that divides these 2 sections of our digestive system, closes once the food has gone down and has entered the stomach to avoid the unpleasantness of regurgitating what we eat. In the immature, undeveloped digestive system of a baby though, this valve is pretty floppy and doesn't close readily after a feed. Add to this open door system: being laid on your back for most of the day (sleeping in a safe sleep space, playing on the floor, in a car seat, in a pram...etc.)...and it's even easier for whatever your baby has just eaten to be brought back up! 

Research has found that around 40-50% of babies under 3 months will regurgitate part of their feed at least once a day (Craig, 2004), that this is even more likely in younger babies or those born prematurely, and that, peaking at around 4 months old, it should be significantly less of a problem by, and beyond, 6 months old and definitely by a year (NICE, 2015). 

As well as regurgitating their feeds regularly, signs of reflux in your baby can include irritability and crying (you would be irritated too if your food kept trying to exit the wrong way!), hiccups, frequent night waking (as mentioned, just because being put to sleep on their back is done for their safety, it doesn't mean it's the comfiest after a full feed!) and even frequent coughing can be a sign - if you think about it, they're trying to clear something that's in the wrong place. 

Sometimes, these symptoms are present without the regurgitation...this could be silent reflux. The food has still come up the wrong way, but your baby has swallowed it back down before it has had a chance to exit the body entirely. 

In most cases, it shouldn't be necessary to seek medical support as it is simply a condition that will improve with time and can be managed to minimise discomfort - as I'll go into below - in the meantime. However, if those mentioned above are accompanied by more than one other concern around feeding, faltering growth, particularly distressed behaviour, an episode of pneumonia, do seek some support.

Otherwise, there are some general approaches you can take to try and alleviate the causes and ease your little one's discomfort

Alleviate causes:

• Have a feeding assessment - to identify any potential issues with latch, fast let-down, feeding volume, air intake, tongue-tie, identifying early feeding cues and this may even identify any possible allergens or intolerances causing pain. This isn't just for breastfeeding parents either. If you bottle-feed you can get support too! If you see someone who is able to assess for tongue-tie, this is great as this may be impacting on latch and air intake too and is something that can be resolved if needed.

• Feed little and often - this is easier said than done, I know. If breastfeeding, it may mean you feel you're rarely off the sofa or able to put your little one down. If bottle-feeding, it may mean offering smaller quantities than those suggested by the formula companies...just more often and always trying to use paced feeding. It may feel endless, but it will be a great help at putting less pressure on your littlest one's tiny digestive system.

• Identify early feeding cues - what doesn't help an uncomfortable baby is trying to feed while crying. It can often just lead to more gulping and taking in even more air which just adds to all the discomfort and the likelihood of bringing their feed back up. So, if you can identify the signs your little one needs feeding before they reach the point of crying, you can avoid that extra cause of gulps!

• Keep baby upright - after feeds, for around 30 minutes, hold baby upright, avoiding lots of jiggling around, and then lay them flat as opposed to in the slumped positions encouraged by bouncers or car seats. Babywearing might be a great solution to achieving this while also achieving...making a cup of tea. This upright period should also help to bring up wind without too much back-slapping or jiggling. As grown-ups we tend to avoid rollercoasters or trampolines after a big meal for a reason....

• Raise their sleep space - since we've established that lying on our backs with a full tummy isn't so fun for our babies, making their position that little bit more inclined can help but laying them to sleep on a flat surface remains important so the trick is to angle the entire sleep space as opposed to just their head - place a big book or similar under one end of the cot so their head is higher and body on an angle but still flat.

• Note any changes in your diet that may correlate with baby's symptoms - There isn't any evidence for foods a breastfeeding mother eats influencing her baby's wind but if you do think there's a chance something in your diet is lining up with your baby's discomfort, perhaps start a food diary and then seek support from a feeding specialist. For example, reflux can be a symptom of cows milk allergy. If this is confirmed, there are lots of options to help you keep feeding your baby, from specially designed formulas to adaptations in your diet if needed.

• Alginate therapy - something like Gaviscon - might be recommended if other strategies have been tried and not worked (I mean, if adjusting how and when baby is fed eases your baby's distress, then there isn't a need to try medications). These are dissolved in breastmilk or water and work by thickening the stomach contents and making it harder for it to move back the wrong way....however, it can create the conflicting problem of constipation (hence the importance of trying other strategies first).

Reflux in this form, this pretty common, all-be-it painful experience our littlest humans can go through, is a symptom. And the the thing about symptoms is things can be done to try and reduce them, causes can be explored and alleviated...and you can reach out for help if, in the meantime, it's all getting too much.

Note: in some cases, this reflux goes beyond the basic discomforts and alleviations mentioned above. If the symptoms discussed above are associated with respiratory disorders (like multiple cases of pneumonia) or other, more severe, gastric symptoms e.g. frequent and forceful vomiting, spitting up green or yellow fluid, spitting up liquid coffee grounds, refusing to feed, blood in their poo...these are signs of what could be Gastro-Oesophageal Reflux Disease which a doctor can diagnose and treat.