The Real Reason So Many South African Babies Have Reflux and What You Can Do About It
- Samantha Pieterse
- Oct 22
- 12 min read
You’ve Just Fed Your Baby… and Now There’s Milk Everywhere (Or Maybe Not)
You’ve barely put the bottle down, and there it is. Milk down the chin, on the bib, on your shirt (and probably in your hair). You sigh, reach for the burp cloth, and wonder if this much spit-up can possibly be normal.
Reflux is when milk (and a bit of stomach acid) flows back up from the stomach into the tube connecting the mouth and tummy. It happens because the tiny valve at the top of your baby’s stomach, which should stay closed after feeding, is still soft and learning to work properly. This sometimes causes milk to sneak back up after a feed, especially when your baby’s lying down or their tummy is full.
But not all reflux looks like this. Some babies never spit up at all, but they still grimace, swallow hard, or cry after feeds. That’s what we call silent reflux, and it can be every bit as uncomfortable (and confusing).
Before you spiral, take a breath. Reflux is one of the most common (and misunderstood) baby issues I see in South African clinics. Most of the time, it’s harmless and short-lived. But sometimes, it’s a signal that your baby may need a little extra help.
In this guide, we’ll unpack what’s really happening in those tiny tummies, how to tell normal reflux from the kind that needs attention, and what really helps if your little one has this common problem.
Baby Reflux vs Silent Reflux: What’s the Difference?
You’ve probably heard the term “colic.” I’ll be honest. I don’t really believe in it. “Colic” is what we say when a baby cries and we can’t quite explain why. In reality, it’s usually a symptom of something else, and reflux (silent or not) is often the real reason. When you figure out the root cause, the so-called “colic” usually improves.
Now, let’s make sense of the reflux side of things.
Regular Baby Reflux
This is the classic, messy kind. Milk comes up and often out. It might look dramatic, but most babies are perfectly happy afterwards. A quick burp, a change of clothes, and they’re smiling again.
Silent Baby Reflux
This is the sneaky version. The milk (and stomach acid) travels up the oesophagus, burns a little, and then goes back down, so there’s no visible spit-up. Instead, these babies swallow, grimace, or cry after feeds because it hurts on the way down.
How Regular and Silent Baby Reflux Compare
Silent reflux is one of the big reasons I rarely use the word “colic.” Babies with “colic” are often babies with silent reflux, mild tummy cramps, or feeding sensitivities, and once we address those, the endless crying usually settles.
Both kinds of reflux are common in young babies and, in most cases, not dangerous. They simply mean the digestive system is still finding its rhythm.
😭 If your baby’s cries seem endless, don’t blame yourself or a vague label like colic. There’s almost always a reason, and that reason can be helped.
What Causes Baby Reflux and Why It’s So Common in South Africa
Most parents don’t hear this often enough, but reflux isn’t a disease. It’s usually just baby anatomy doing baby things. Nothing you did caused it. It’s not about the “wrong” formula, poor burping technique, or feeding too soon. It’s just baby physiology.
Why We See So Much Reflux in South Africa
You’re not imagining it, reflux does seem more common here, and there are a few reasons why:
Warm climate = more frequent feeds. Babies drink more often to stay hydrated, which means their little tummies are constantly full and more likely to spill.
Fast let-down during breastfeeding. South African moms often have strong let-down reflexes, which can cause gulping and extra air intake.
Formula thickened with maize starch. Many local brands are “AR” (anti-regurgitation) or “comfort” formulas that use maize starch to thicken milk. Sometimes this helps, but other times it makes babies even gassier or constipated.
Lying flat too soon after feeding. Common in our hot afternoons when babies fall asleep right after a feed. A gentle upright hold helps more than wedges or gadgets.
Most of this settles as your baby grows. That little valve strengthens, digestion matures, and the feeds become calmer and cleaner.
👻 If your baby spits up after every feed, don’t panic. It’s usually just a sign of a full tummy, not a failing one.
How to Tell When Baby Reflux Is Normal, and When to Worry
Some babies spit up and still sleep peacefully afterwards. Others hardly bring up a drop but seem uncomfortable after every feed. So how do you know when it’s just reflux and when it’s a signal of another minor baby illness?
The thing is, most reflux is completely normal. Your baby’s digestive system is still maturing, and reflux is generally messy, not dangerous. However, there are moments when reflux begins to affect comfort, sleep, or growth, and that’s when it warrants a closer examination.
When Baby Reflux Is Normal
Spitting up small amounts (or none) but staying happy and alert.
Feeding eagerly and gaining weight.
No coughing, choking, or signs of pain.
Happier upright, but not constantly crying.
Occasional night fussing, not every feed.
Normal reflux often looks worse than it feels. As long as your baby is thriving, there’s no need for medication or worry, just a few extra bibs and patience while their digestive system strengthens.
When Baby Reflux Might Need Attention
Call or visit us at Mums & Bums if you notice any of these:
Persistent crying during or after feeds.
Back arching, gagging, or choking.
Coughing fits or noisy breathing during sleep.
Refusal to feed or poor weight gain.
Green, yellow, or blood-stained spit-up.
Projectile vomiting or worsening symptoms at night. If this happens, keep an eye out for dehydration (see here how to spot dehydration in babies).
Even silent reflux, where you don’t see any milk come up, can become “problem reflux” if it’s causing pain, sleep disruption, or weight concerns.
💯 If you’ve been told it’s “just colic,” but your gut says otherwise, trust yourself. Babies don’t cry without reason, and reflux is one of the most common ones we can actually help with.
💉 Sometimes, fussiness from routine vaccines is mistakenly linked to reflux. Read our post on baby vaccine side effects and what’s normal, here.
Baby Reflux Treatment & Remedies That Actually Help (From a Nurse Who Sees This Every Day)
If you’ve Googled baby reflux, you’ve probably seen hundreds of “miracle cures,” most of which don’t work, or worse, aren’t safe. There’s no magic formula or instant fix. But there are simple, practical things that genuinely make a difference.
These are the same steps I share with parents every day in the clinic. Just tweaks that help your baby feel more comfortable (with or without visible spit-up).
Feeding Tips That Ease Reflux and Silent Reflux
Offer smaller, more frequent feeds. Big feeds overfill small tummies. Think of it as giving the stomach a chance to “keep up.”
Pause halfway to burp. Gentle burping reduces air buildup and pressure. Try upright burping instead of bouncing or patting.
Keep your baby upright for 20–30 minutes after feeding to prevent reflux. Gentle rocking in your arms or a snug upright hold works best.
Check your nipple flow. If milk gushes too fast, babies gulp air, which can worsen reflux. Try a slower teat if bottle-feeding.
Don’t stretch out feeds too long. Hungry, frantic babies swallow more air. Sometimes, “feeding on demand” reduces reflux more effectively than rigid schedules.
🍼 Remember, “less and slower” usually beats “more and faster.” Small changes in feeding rhythm can make big differences over a few days.
Everyday Habits That Help With Baby Reflux
Avoid car seats or swings right after feeds. They squeeze the tummy and push milk upward. If you’re driving, feed a little earlier and keep them upright first.
Keep the sleep surface flat. Wedges and pillows might seem logical, but they’re not safe and don’t stop reflux.
Create a calm feeding space. Turn down the noise and movement. Overstimulation can worsen swallowing air.
Try tummy time (not straight after feeds). Strengthens muscles that help digestion.
Dress comfortably. Tight nappies or waistbands can increase pressure on that little tummy.
Silent reflux in particular often improves with these exact changes. No medication, no special formula. Just smart feeding and posture tweaks. Think of it as helping your baby’s tummy learn the rhythm of eating and resting, the same way they’ll learn to crawl and walk.
Baby Reflux Medication in South Africa: What Parents Should Know Before Using Anything
If you’ve reached the point where you’re considering medication, join the club. Many South African parents start searching for “baby reflux medicine” after weeks of spit-ups, crying, or sleepless nights. But before you reach for a bottle, it’s important to know that most reflux doesn’t need medication, and in many cases, it won’t help.
The goal isn’t to “stop” reflux completely (that’s impossible until the digestive system matures). It’s to make sure your baby is comfortable. Medication is only considered when there’s genuine reflux disease, meaning the reflux is causing pain, feeding refusal, or poor weight gain.
When Medication Might Be Considered for Baby Reflux
Persistent distress despite feeding and posture adjustments.
Poor weight gain or feeding refusal.
Suspected oesophagitis (throat inflammation from acid).
Confirmed reflux disease diagnosed by your healthcare provider.
Even then, it’s a short-term plan, closely monitored by a nurse or paediatrician.
Medications You Can Use for Baby Reflux
If feeding and positioning changes aren’t enough, a few safe, doctor-approved medicines can help ease discomfort, but only when they're truly needed.
Infant Gaviscon Products in South Africa
You may have heard about Gaviscon Infant®, but that version isn’t currently available in South Africa. Some healthcare professionals occasionally recommend a small, carefully measured amount of the regular (adult) Gaviscon liquid for older infants, but only under direct medical guidance.
Because adult Gaviscon is formulated differently, doses must be prescribed on a case-by-case basis by a professional based on your baby’s weight and feed volume.
⚠️ Never guess the dose or use spoon estimates. Even minor miscalculations can cause constipation or an electrolyte imbalance.
Milk of Magnesia for Babies
This old-school remedy is still used in South African clinics. It can help alleviate constipation that often worsens reflux, but it’s not a first-line treatment for reflux. Like Gaviscon, it’s used off-label and only in select cases, for short-term relief under supervision.
The same safety rule applies: dosing must be determined individually by a registered professional.
Acid-Blocking Medications for Babies (Nexium®)
Medications like Esomeprazole (Nexium®) and Omeprazole work by reducing acid production in the stomach. While they sound helpful, they’re rarely the first step, and definitely not a long-term solution.
Here’s why:
Most baby reflux isn’t acidic. It’s milk, not stomach acid.
Over-suppression of acid can interfere with digestion and nutrient absorption.
Long-term use has been associated with an increased risk of gut infections and food intolerances.
These medications should be reserved for babies with diagnosed reflux disease or oesophagitis, confirmed by a paediatrician. They should always be used at the lowest effective dose and tapered off once symptoms improve.
🖊️ If your doctor has prescribed Nexium®, ask about the review plan. These medications are intended for short-term use only, not for prolonged periods.
What Usually Works Better Than Medication
Positioning, smaller feeds, and calm feeding environments often help far more than medicine. Medications don’t strengthen the valve or stop milk from coming up. They only change what that milk feels like.
In short: fix the cause before reaching for the cupboard.
Baby Reflux Myths: What Parents Keep Hearing (and What’s Actually True)
If you’ve spent five minutes in a mom’s group, you’ve probably seen it all: reflux equals allergy, prop them up to sleep, try this “miracle” formula.
Let’s clear the noise. Here are the myths that keep South African parents awake long after their babies have drifted off, and what the science (and daily clinic life) really says.
Myth 1: “Reflux means my baby is allergic.”
Reality: Sometimes, yes, but usually, no.
True cow's milk protein allergy can cause reflux-like symptoms (blood in stools, rash, constant pain, or poor weight gain). But for most babies, reflux happens because that little stomach valve isn’t mature yet, not because of an allergy. Don’t rush to switch formulas or eliminate dairy unless your healthcare provider recommends it.
✨ Tip: If your baby is happy, gaining weight, and only spitting up, it’s reflux, not an allergy.
Myth 2: “All reflux needs medicine.”
Reality: Most reflux doesn’t need any medication.
Medicines can reduce stomach acid, but they don’t stop milk from coming up. For mild or silent reflux, adjusting feeding positions and volumes works far better (and with zero side effects). Save medicine for true reflux disease diagnosed by a doctor.
Myth 3: “Babies will choke if they lie flat.”
Reality: Safe-sleep guidelines still recommend babies sleep flat on their backs.
It feels counterintuitive, but research shows healthy babies naturally protect their airways. Propping up the mattress or using wedges increases the risk of suffocation and doesn’t prevent reflux.
💡Flat, firm, and face-up is always safest.
Myth 4: “Only vomiting means reflux.”
Reality: Some of the worst reflux is completely silent.
In silent reflux, milk travels up and down without ever reaching the mouth. Babies may gulp, cough, or cry during feeds but never spit up. If your baby seems in pain after eating yet never vomits, it could still be reflux, just the quiet kind.
Myth 5: “Silent reflux is always severe.”
Reality: Not necessarily.
Silent reflux can be uncomfortable, but it’s rarely dangerous and often improves with simple tweaks to feeding and posture. The word “silent” sounds scary, but it mostly describes how it looks, not how serious it is.
🩵 If you remember one thing, reflux is common, temporary, and fixable. The internet makes it sound terrifying, but your baby’s tummy just needs time. Also, not every drooly, crying baby has reflux. Sometimes, it’s just teething symptoms.
The Emotional Side of Baby Reflux: You’re Not Doing Anything Wrong
Reflux doesn’t just affect babies. It drains parents, too. When you’ve changed your shirt for the fifth time, your baby’s crying again, and you haven’t had a full night’s sleep in weeks, it’s hard not to wonder if you’re doing something wrong.
You’re not.
Reflux can feel relentless, especially when no one else sees what your nights look like. The endless feeding, the mental checklist (“Is it the milk? The burping? The bottle? Me?”). But reflux isn’t your fault, and it’s not a reflection of how good a parent you are.
The Mental Load of Baby Reflux
Caring for a reflux baby is emotionally heavy. It chips away at your confidence and your energy. Studies show that parents of reflux babies are more likely to feel anxious or down because exhaustion changes everything: your hormones, your patience, even how you see yourself.
If you’ve ever found yourself crying quietly after yet another feed, please know you’re not alone. Every week, I meet moms (and dads) who say, “I love my baby, but I’m just so tired.”
You can’t always fix reflux, but you can comfort through it, and that’s powerful. Babies need closeness, calm, and a caregiver who’s there for them, even when it’s hard.
A Nurse’s Note on Reflux
In the clinic, I often see the shift happen. A parent walks in exhausted and leaves lighter because they finally understand it. That moment of “It’s not me, it’s just reflux” changes everything.
If you’re in Centurion or Pretoria and you’d like support, whether it’s guidance, feeding tweaks, or just a space to breathe, we offer gentle, practical help at Mums & Bums Clinic. You don’t have to figure this out alone.
💕 At our trusted baby clinic in Centurion, we see reflux all the time, and we know how to handle it. If you’re worried, book a baby reflux consultation online or contact our nurse for personalised baby reflux advice.
FAQs About Regular & Silent Baby Reflux
How do I know if my baby has silent reflux?
Silent reflux means milk travels up and down without visible spit-up. Babies may gulp, swallow, grimace, arch, or cry after feeds. If your baby seems uncomfortable but rarely vomits, it could be silent reflux.
Is baby reflux normal or dangerous?
Most reflux is normal and harmless. It happens because the valve between the stomach and oesophagus is still developing. It becomes a concern only if your baby has pain, feeding refusal, or poor weight gain.
How can I help reflux without medication?
Feed smaller, more frequent amounts, burp often, and keep your baby upright for 20–30 minutes after feeds. Avoid car seats straight after feeding and keep your baby’s sleep surface flat and firm.
Does Gaviscon Infant help?
The UK’s Gaviscon Infant® isn’t available in South Africa. Some healthcare providers may recommend a very small, individualized dose of regular Gaviscon Liquid, but only under professional supervision. Always confirm with your nurse or pediatrician first.
What if my baby vomits after every feed?
Frequent spit-up is common, but if vomiting is forceful, projectile, green/yellow, or your baby isn’t gaining weight, book a check-up. Continuous vomiting after every feed may signal reflux disease or another issue.
What’s the safest sleep position for reflux?
Always place your baby flat on their back on a firm mattress. Propping or wedges aren’t safe and don’t prevent reflux. Healthy babies protect their own airways while lying flat on their backs.
When does baby reflux go away?
For most babies, reflux typically peaks around 2–4 months and improves by 6–12 months as the digestive system matures and they spend more time in an upright position.
🍎 If you're wondering about starting solids after reflux settles, read our blog on when the right time is to start solids here.
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