Parents describe some of the behaviours and characteristics that may be displayed by babies and children who have gastro-oesophageal reflux.
Keep in mind that all children are different and the listed characteristics may not be indicative of your child’s condition.
See also How Reflux presents.
Babies and Children under the age of two years
Vomiting, Posseting or Regurgitation
- Babies and children who vomit can:
- regurgitate, posset down their chin and/or clothing or ‘spit up’
- projectile vomit with food literally being forced out, sometimes through their nostrils. Parents sometimes report projectile vomiting hitting a far wall (Beware- there are other reasons why a baby might projectile vomit. It is important they are seen by a doctor for a correct diagnosis).
- Vomit can appear to be:
- unchanged milk or undigested food
- curdled milk or partly digested food
- other stomach contents (such as stomach acid, mucous)
- blood (which can sometimes look like coffee-grounds in vomit, or it may appear black or red, with streaks or clots)
- bile (which can appear green or yellow)
- The number and amount of vomits vary but it often occurs after feeds.
- Babies and children may vomit without discretion – anytime, anywhere, over anybody or anything!
- Doctors may consider a milk protein sensitivity in a child who vomits
- The term ‘silent reflux’ can be confusing because there may be no obvious sign of reflux and they may not be ‘silent’. (Silent reflux does not refer to a baby who does not cry with their reflux as is sometimes believed)
- Vomiting is only one sign of reflux. Babies and children with ‘silent’ reflux may have any number of signs of reflux; however, they may not vomit. This can make it more difficult to diagnose.
- Parents may sometimes hear the baby reflux, but see no evidence of it.
- Medical intervention can still be necessary and the same complications can arise as in other forms of reflux.
- Babies and children may suddenly start crying while feeding or after the feed without any other obvious cause for the crying, or they may grimace or make a screwed up face like they tasted something bad.
Irritability and appearing to be in pain
- Irritability can cover such signs as screaming, whinging, crying, fussiness and inconsolable behaviour which can last for various periods of time (it can seem endless). Crying/screaming can be sudden.
- Signs can occur at any time of the day or night; however, they commonly occur during and after feeding and when the baby is laid down.
- Parents may have a gut feeling their child is in pain.
- Babies and children may:
- arch their back, stiffen, pull their feet up or squirm
- be distressed for the majority of the time; however, they can still be happy and settled at times
- be difficult to settle
- appear colicky or windy
- be happy sometimes when distracted e.g. they smile at the doctors, when visiting grandma or at the shopping centre
- be clingy, extremely sensitive, easily upset, overly sensitive to noise, and can be considered ‘high needs’ or demanding
- be unable to stop crying and may scream for hours (until they vomit or fall asleep from exhaustion)
- stick their hands, fingers or fist down their throat, or gag themselves
- salivate excessively and dribble
- Feeding issues are very common in babies and children of all ages with reflux.
- Babies and children with feeding issues may:
- fuss or show general distress or discomfort by fighting or pulling off the breast or bottle after a short time, pushing the breast or bottle away, pulling their feet up, stiffening up, squirming and or arching their back
- scream and refuse to feed (or only take small amounts despite being hungry)
- cry or scream during or after feeds (even an hour afterwards)
- be nervous or excitable; even people talking may interrupt their feed. They may need a darkened room, a routine of soft music or absolute quiet to feed
- display a fear of food, or an unwillingness to eat
- feed only when drowsy or asleep
- be a particularly fussy eater
- gag/splutter or have problems swallowing
- have difficulties with some textures
- be happy between feeds
- have allergies or intolerances to particular foods
- Babies and children who comfort feed may:
- feed or show signs they want to feed frequently
- be unhappy unless feeding
- suck vigorously
- have huge weight gains
- have a large number of wet nappies in a day due to their frequent feeding
- Reflux occurs in both breast and bottle-fed babies.
- Changing from breast to formula feeding will usually not solve the problem. Remember it is the act of putting something in the stomach – it may not matter whether it’s breast or bottle.
- Some babies can be inconsistent with weight gain. Most infants gain weight well, however a small percentage fail to thrive due to feeding difficulties (or excessive vomiting).
- There is a high incidence of sleep disturbance among babies and children with reflux, and they may have difficulty falling asleep or staying asleep.
- Babies and children may:
- be more comfortable in a fully upright position and may object to laying down, particularly after a feed. Even if they have settled, they may wake in a distressed state, and some will only sleep if held upright
- take short naps (sometimes called ‘catnaps’). They may only sleep for five or ten minutes before waking again in a distressed state.
- be easily disturbed from sleep or very restless
- have trouble self-settling
- wake frequently during the night. Note that some babies with reflux sleep through the night. They may simply be exhausted or they may not reflux much overnight.
- Weight issues may not necessarily reflect the severity of a child’s reflux. Babies and children can have normal weight and weight gains even with significant reflux.
- Most babies with reflux gain weight well; however, some babies do not gain weight at the expected rate and some may fail to thrive. This may be the result of feeding difficulties, frequent vomiting or other issues.
- Some reflux children have huge weight gains, particularly if they feed frequently for comfort.
- Reflux can be cyclic. Babies and children can also go through quite normal phases where the problem appears to be improving and then re-occurs quite suddenly, sometimes for no apparent reason.
- Parents often report a worsening of their child’s reflux with illnesses, teething, crawling, vaccinations, constipation, being overtired or out of routine. They may also report that hot humid weather can be a trigger as can laughing, jumping, running, playing games and other physical activities.
- Some parents notice that signs of reflux lessen when their babies are able to sit up or walk; however some notice their signs worsen when they crawl.
- Signs and symptoms may change as babies and children get older. It can look as though their reflux is improving because their signs go away, but their signs may have changed instead i.e. your child may no longer vomit but may still be refluxing significantly.
- Babies and children may:
- gag, splutter or swallow even when not feeding
- stop babbling or talking, perhaps in response to pain, or have a hoarse voice
- develop behavioural issues
- have teeth that show signs of erosion
- be quite intense. They may form strong attachments to you and protest loudly and quickly when things are not to their liking. They may not be easily distracted and may need lots of physical contact
- Responses may be unpredictable; what works one day may not work the next.
For more information on this topic, see the presentation at our 2013 conference by Professor Geoff Cleghorn, Paediatric Gastroenterologist on Diagnosis and medical management of infant GORD – introductory clip. Buy full version here.
© Written by RISA Inc; revised by Glenda Blanch, RISA Inc member and author of “Reflux Reality: A Guide for Families” 2010
Additional information on gastro-oesophageal reflux is provided in our book “Reflux Reality: A Guide for Families”.