Sleepless nights, endless feeds, and cries that spike your pulse. New guidance sheds light on what unsettles so many newborns.
Your baby feeds, fusses, and you’re left guessing. Is it milk coming back up or air trapped inside? The difference steers what you do next and when you ring for help.
Why newborns struggle after feeds
During the first year, the valve between the oesophagus and stomach still matures. Milk can ride back up. At the same time, tiny tummies swallow air during feeding and crying. That air stretches the gut and hurts until it escapes. Both issues peak after feeds and in the evening. The cues overlap, which confuses even seasoned parents.
What reflux looks like
Reflux means milk or stomach contents travel upwards into the throat or mouth. You may see small possets or full vomits. Babies may cough, hiccup, or gulp after a burp. Many wriggle or cry when you lay them flat. A few struggle to gain weight if feeds feel uncomfortable or too much milk returns.
What wind looks like
Wind means trapped air causes pressure pain. Babies clench fists, pull knees to the tummy, arch their back, and redden in the face. A solid burp brings relief. You may not see milk at all. Timing matters: wind discomfort tends to settle quickly once air escapes.
Think of it this way: wind hurts because air is stuck; reflux bothers because milk rises. The fix depends on which one you face.
At-a-glance differences that guide your next move
| Feature | Reflux | Wind |
|---|---|---|
| What you see | Milk in mouth, posseting, occasional vomit | Burp or gas only, little or no milk |
| Peak moments | During feeds, just after, or when laid flat | Mid-feed, at burp breaks, or soon after feeds |
| Baby’s posture | Grimaces when lying back, prefers upright | Arches back, pulls knees up, clenches fists |
| Sound cues | Gulping, wet swallowing, cough or hiccup | Loud burps, windy rumbles, then relief |
| Relief after burp | Partial or brief | Clear and fast |
| Weight gain | Usually fine; may stall in tricky cases | Usually fine |
Nine quick checks you can complete in a single day
- Timing: does fussing spike during feeds (wind) or after lying down (reflux)?
- What comes up: milk visible (reflux) or mostly air (wind)?
- Burp effect: instant calm after a good burp (wind) or only brief ease (reflux)?
- Positions: happier upright and unhappy flat (reflux), or squirmy in any position until burped (wind)?
- Sounds: wet swallows or coughs (reflux) versus rumbling belly and big burps (wind)?
- Feed pace: rapid sucking with big gulps points to air intake (wind risk).
- Teat or latch: a leaky seal lets air in, worsening wind.
- Volume: large spit-ups or repeated possets lean towards reflux.
- Pattern: a diary shows evening clusters with relief after gas (wind), or consistent feed‑related posseting (reflux).
If relief follows a burp, think wind. If milk keeps returning and lying flat upsets your baby, suspect reflux.
What you can try today
- Pause and burp: build in 2–3 burp breaks during each feed, not just at the end.
- Hold upright: keep baby upright on your chest for 20–30 minutes after feeds.
- Slow the flow: use paced bottle feeding or a slower teat to cut air gulping.
- Check the latch: a deep latch reduces air intake; ask a midwife or breastfeeding counsellor to watch a full feed.
- Smaller, more frequent feeds: reduce volume peaks that push milk upwards.
- Calm the room: dim lights and quiet sounds to reduce frantic sucking.
- Tummy relief: gentle bicycle legs and clockwise tummy circles ease gas.
- Wardrobe check: loosen waistbands; tight clothing can press on the tummy.
- Track patterns: note times, positions, and what helps; share this with your GP or health visitor if concerns persist.
When to seek medical advice
Most unsettled feeds improve with time and technique. Some signs call for a professional view. Phone your GP, health visitor, or NHS 111 if you see any of the following:
- Poor weight gain, faltering growth, or fewer wet nappies.
- Feeds cut short by distress or feed refusal.
- Repeated vomiting that soaks clothes or mattress.
- Green (bilious) or yellow vomit.
- Blood in vomit or stools.
- Swollen tummy, unusual lethargy, or piercing, persistent crying.
- Fever, shivers, or your baby seems unwell in themselves.
- Diarrhoea lasting longer than a week or clear signs of dehydration.
Green vomit, blood, dehydration, or faltering growth need prompt assessment. Trust your instincts and call for help.
What current guidance says
Health services advise simple steps first: feed in a calm setting, burp during and after feeds, and keep baby upright post‑feed. Many babies improve by 6–12 months as the valve at the top of the stomach strengthens. Some may benefit from reviewing feed volume, thickened feeds prescribed for reflux, or allergy assessment where symptoms strongly suggest it. Clinicians weigh up risks and benefits before suggesting medicines.
Real-life scenarios that mirror what parents see
The mid‑feed meltdown
Halfway through a bottle, your baby stiffens, turns red, and kicks hard. A deep burp erupts and they settle to finish. That pattern points to wind from fast flow or a shallow latch.
The post‑feed possetter
Ten minutes after every feed, milk dribbles back with a cough. Baby prefers your shoulder and cries when you lay them flat. That picture suggests reflux, with gravity and upright cuddles helping.
The evening cluster
From 6–9 pm, crying peaks, legs scrunch up, and wind pops out in bursts. Daytime feels calmer. This often reflects wind and fatigue working together; paced feeding and structured burp breaks help.
Hands-on burping positions that work
- Over‑shoulder: chest to your collarbone, tummy pressed gently in, firm back pats and rubs.
- Sitting on lap: support chin, tilt baby slightly forward, rub up the back in circles.
- Tummy over forearm: lay baby across your forearm, head higher than chest, bounce lightly while rubbing the back.
Could it be something else?
Allergy can mimic reflux. Cow’s milk protein allergy may bring eczema flares, mucus or blood in stools, and distress after feeds. Speak with your GP before changing formula or your diet if you breastfeed. Silent reflux, where little milk appears yet discomfort persists, also exists. A feed and sleep diary helps your clinician see patterns and choose the next step.
A practical 60‑minute post‑feed plan
| Time after feed | What to watch | What to try |
|---|---|---|
| 0–5 minutes | Gulps, leaks at mouth corners, fast breathing | Paced feeding, adjust teat, correct latch, pause for a burp |
| 5–20 minutes | Back arching, clenched fists, squirming | Burp again, tummy massage, shoulder hold |
| 20–60 minutes | Dribbled milk, coughs when laid flat | Keep upright, angle the cot safely for awake time only, avoid tight waistbands |
Small tweaks—slower flow, smarter burps, and upright cuddles—often turn chaotic feeds into calm ones within days.
Extra context parents ask for
Gastro‑oesophageal reflux (GOR) differs from gastro‑oesophageal reflux disease (GORD). GOR describes milk coming up in a thriving baby. GORD adds complications such as poor growth, pain that disrupts feeding, or breathing symptoms. Your clinician looks at the whole picture, not a single spit‑up.
Think longer term as well. A consistent routine, measured changes, and a simple diary give you control. Note start and end times, positions, burps, and any vomit. Share that record during appointments. You remove guesswork and speed decisions that keep your baby comfortable.
Honestly the cleerest breakdown I’ve read on reflux vs wind. The at‑a‑glance table and 60‑minute plan make it feel doable—printing this for the fridge. Thank you!
Do we really need to keep a baby upright for 20–30 minutes after every feed? With twins and a toddler, that sounds… unrealistic. Any triage tips for busy evenings?