Sleepless nights blur into anxious feeds. New guidance sheds light on that familiar cry that follows the bottle or breast.
Across the country, parents are asking the same question at 3am: is this reflux or just trapped wind? The answer changes what you do in the next five minutes, and how soon your baby settles. Here’s how to tell the difference, fast, and what actions make the next feed calmer.
What parents often see after feeds
Both reflux and wind tend to appear right after a feed. Both can trigger crying, scrunched fists and a back that arches. Yet they come from different mechanics. Trapped wind comes from swallowed air that needs to come up. Reflux happens when milk washes back into the oesophagus because the valve at the top of the stomach is still maturing.
- Wind: discomfort peaks around burping, then eases once the air is out.
- Reflux: milk or sour fluid comes up into the mouth, sometimes with coughing or a wet burp.
- Timing clue: wind often settles within minutes of winding; reflux can grumble on, especially when lying down.
Think air versus acid: wind is trapped air causing pressure; reflux is milk moving upwards and stinging the throat.
Quick checks you can run in 60 seconds
- Look: do you see milk in the mouth or on the bib, or is the mouth dry after the cry?
- Listen: are there gulps and swallows after the feed that suggest fluid rising, or small burps of air?
- Feel: does a gentle pat on the back release a burp quickly, or does the baby stay unsettled?
- Position: does discomfort ease upright, or persist when you lay them flat?
- Pattern: is the upset clustered at feeds, or happening between feeds too?
Body language clues
Wind often brings knees pulled to the tummy and an immediate red face. Reflux can cause wincing during or after swallowing, back arching when you lower the baby, and hiccups after feeds.
Side‑by‑side signs and first steps
| Sign | More likely reflux | More likely wind | What to try first |
|---|---|---|---|
| Milk in mouth or on bib | Yes, frequent wet burps or spit‑up | Rare | Hold upright 20–30 minutes after feeds |
| Crying during burping | Sometimes | Common | Pause mid‑feed for a burp; switch positions |
| Hiccups and coughing | Often during/after feeds | Occasional | Slow the feed; check teat flow or latch |
| Back arching | When laid down post‑feed | With trapped air pressure | Keep upright; try gentle tummy‑to‑chest hold |
| Settles after a big burp | Less likely | More likely | Wind during and after each feed |
If your baby calms after two good burps and no milk appears, you’re probably dealing with wind rather than reflux.
Practical fixes you can try tonight
- Wind more often: pause every 5–10 minutes for breastfeeds, or every 30–60 ml for bottles. Aim for two burps per feed.
- Hold upright: keep your baby on your shoulder for 20–30 minutes after feeding. Avoid bouncing.
- Check flow: a teat that’s too fast floods the mouth; too slow invites gulped air. Adjust one size at a time.
- Slow the pace: tilt the bottle so the teat stays full, or use paced bottle feeding so baby leads the rhythm.
- Review latch: a deep, comfortable latch reduces air swallowing. If nipples feel sore, seek feeding support.
- Tummy relief: bicycle the legs and massage clockwise around the tummy to move air along the gut.
- Safe sleep: place baby on their back for sleep on a flat, firm surface. Elevating cots is not recommended.
Skip thickeners and medications unless a clinician has advised them after assessing feeding, growth and symptoms.
When to contact your GP or health visitor
Most unsettled feeds improve with time and technique. Seek advice promptly if you notice any of the following:
- Poor weight gain or weight loss across checks.
- Refusing feeds or taking much less than usual.
- Frequent vomiting that soaks clothes or no fluids kept down.
- Green or yellow vomit, or blood in sick or stools.
- A swollen tummy, persistent hard crying, or unusual lethargy.
- A very high temperature, or shivers and mottled skin.
- Watery stools for over seven days, fewer wet nappies, a dry mouth or a sunken soft spot.
The timeline: when things usually ease
Trapped wind peaks in the early weeks, when feeding volumes rise and gut coordination is still developing. Many parents see clear improvement by 8–12 weeks as burping becomes easier. Reflux tends to settle as the valve at the top of the stomach strengthens; most babies improve steadily and feel far better by around 12 months.
Feeding style and small kit tweaks
Breastfed babies take in less air with an effective latch, but wind can still build during fast let‑down. Try a brief break when the flow surges. Bottle‑fed babies benefit from a teat that matches their suck: too slow and they gulp; too fast and they splutter. Cup the bottle so the teat stays filled, and angle the baby at roughly 30–45 degrees during the feed. If you switch brands or teat sizes, change one variable at a time and watch the next three feeds.
Real‑world examples you can use
- After‑feed cry, dry bib, big burp, settles in two minutes: think wind. Keep burping during the next feed and add gentle tummy massage.
- After‑feed cough, sour‑smelling wet burp, unsettled when flat: think reflux. Keep upright longer and trial slower flow or paced feeding.
- Multiple spit‑ups plus fewer wet nappies and strong crying: call your GP for advice the same day.
Simple tracking that helps clinicians help you
Keep a 48‑hour diary with times, volumes or sides fed, positions used, burps achieved, spit‑ups seen, and nappies. Add sleep windows and any temperature readings. Patterns jump out quickly: a faster teat at the 11am feed, a missed mid‑feed burp at night, or discomfort only when the baby goes flat straight after feeding. Bring the diary to your next check.
Beyond the feed: small habits that ease both problems
Skin‑to‑skin before a feed steadies breathing and reduces frantic gulping. Aim for calm starts. Offer frequent, smaller feeds during windy phases rather than stretching long gaps. Build in daily tummy time when baby is awake and supervised; stronger core muscles make burping and digestion smoother. If your baby uses a dummy, make sure the shield sits flush and the suck stays rhythmic rather than frantic.
You don’t need to solve everything at once. Change one thing, watch three feeds, and keep what clearly makes your baby more comfortable.
This is the clearest breakdown I’ve read—“think air versus acid” finaly clicked for me. The 60‑second checks are gold. Thank you!
Are we over-pathologizing normal spit‑up? Babies spit up, like, a lot. How do we avoid turning every wet burp into “reflux” and stressing parents more?