What we see in clinic

At The Children's Naturopath, we frequently see babies and young children experiencing reflux, silent reflux and ongoing discomfort associated with feeding.

Drawing on over 28 years of clinical experience, we pay particular attention to feeding patterns, food intolerances, digestive development, bowel movements, and the quantity of food and fluids consumed at mealtimes.

One of the first questions we ask parents is: "Did your child's reflux begin shortly after birth, or did it develop following a change in feeding or diet?"

This can help us understand whether reflux may be associated with digestive immaturity, feeding patterns or possible food intolerances.

Some symptoms point away from ordinary reflux and need prompt medical assessment. The Royal Children's Hospital guideline asks clinicians to reconsider the diagnosis where there is green or bloodstained vomit, forceful vomiting, weight loss or faltering growth, blood or mucus in the stools, chronic diarrhoea, lethargy or fever, breathing symptoms, or vomiting at night. If you are seeing any of those, see your doctor rather than waiting.

Why reflux is common in babies

An important consideration is that a baby's digestive system is still developing. The lower oesophageal sphincter, which helps prevent stomach contents from moving back into the oesophagus, is less mature in young babies.

This can allow milk to flow back up after feeding, particularly when the stomach is full. As babies grow and the digestive system matures, reflux often improves on its own.

We also consider whether feeding patterns, food reactions or other digestive concerns may be contributing to persistent symptoms.

Could dairy or other food intolerances be contributing?

One area we frequently investigate is whether particular foods may be contributing to reflux symptoms.

Cow's milk protein allergy can produce symptoms that overlap with reflux, including vomiting, feeding discomfort and changes in bowel movements. It is more likely where there is blood or mucus in the stools, chronic diarrhoea, or a family history of allergy, eczema or asthma.

For breastfed babies, we consider the mother's diet when the history suggests a possible food-related reaction. For formula-fed babies, we review feeding history, formula changes, and whether symptoms developed after introducing a particular formula.

In older children, we may explore whether dairy, wheat or other frequently consumed foods appear to be associated with digestive discomfort, paying particular attention to whether symptoms change with the amount or frequency of a food consumed.

Removing cow's milk protein is not a step to take alone. The RCH guideline sets a trial at two to four weeks with paediatrician referral, strict maternal avoidance for breastfed babies, and a specialised formula where one is needed — so this belongs with your doctor, and a breastfeeding mother cutting out dairy needs her own nutrition looked after while she does.

Feeding quantities and stomach capacity

Another observation we explore is whether the quantity of milk or food consumed at one time may be contributing to reflux.

A baby's stomach has a limited capacity, and larger feeds can increase stomach distension and the likelihood of milk coming back up. We therefore ask parents about feeding frequency, approximate volumes, and whether symptoms are more noticeable after larger feeds.

In older children, large meals may also increase reflux symptoms, particularly when followed by lying down. Understanding feeding quantities can help identify whether meal size is contributing to discomfort.

Fluid at mealtimes

In older children, we also consider how much water or other fluid is being consumed alongside meals.

Large volumes of fluid consumed with a meal can increase stomach fullness and distension, which may aggravate reflux in some children.

We ask whether children drink large quantities of water immediately before, during or after eating. Rather than restricting normal hydration, we focus on whether fluid intake at mealtimes appears to coincide with symptoms.

Constipation and reflux

Another digestive pattern we investigate is whether constipation is occurring alongside reflux.

Children experiencing constipation may have abdominal bloating, increased pressure and discomfort that can affect their appetite and digestion.

We therefore ask about bowel movement frequency, stool consistency, and whether the child is passing stools comfortably. For some children, improving bowel regularity may also help reduce associated digestive discomfort.

What we encourage parents to observe

A feeding and symptom diary can provide valuable information when investigating persistent reflux. We encourage parents to record:

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  Whether reflux occurs during feeding, immediately afterwards, or several hours later.

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  The quantity and frequency of milk feeds or meals.

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  Whether symptoms are worse after larger feeds.

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  Foods consumed by the child or breastfeeding mother.

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  Any changes following the introduction of formula or solid foods.

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  Whether dairy, wheat or other foods appear to influence symptoms.

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  The amount of water or other fluids consumed with meals.

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  Bowel movement frequency and stool consistency.

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  Whether reflux is associated with bloating, constipation or abdominal discomfort.

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  Whether symptoms become more noticeable when lying down.

These observations can help identify patterns involving feeding, diet and digestive function.

Our clinical focus is on understanding the feeding, dietary and digestive factors that may be contributing to reflux, and helping families identify practical ways to improve their child's comfort.

References

Clinical insights by Fiona Stock — Paediatric Naturopath & Children's Nutritionist, founder of The Children's Naturopath, with 28 years of clinical experience.