Posseting, Reflux or Vomiting? What's Normal After a Newborn's Feed, and What to Note Before the GP

Posseting is when a baby brings up a little milk, without effort, during or after a feed. It is also called spilling, spitting up or simple reflux. Most newborns do it, breastfed or formula-fed. A baby who possets but is happy, feeding well and gaining weight needs no treatment. Forceful, green or bloody vomit is different and needs a doctor.

Australian health services use several names for the same normal thing. Pregnancy, Birth and Baby lists posseting, regurgitation, reflux and gastro-oesophageal reflux (GOR) as other names for spitting up, and American sites mostly say "spit-up". The two words that change the picture are GORD, which is reflux causing problems, and vomiting.

This guide draws on the Royal Children's Hospital Melbourne (RCH), the Sydney Children's Hospitals Network (SCHN), Raising Children Network, Pregnancy, Birth and Baby (PBB) and the Australian Breastfeeding Association (ABA).

Is it normal for a newborn to bring up milk after feeds?

Yes. Bringing up small amounts of milk after feeds is common and normal in newborns, and it happens in breastfed and formula-fed babies alike. Pregnancy, Birth and Baby(opens in a new window) calls a baby who spills often but stays content a "happy chucker". That baby is otherwise happy, putting on weight and developing well.

It happens because a newborn's stomach doesn't close tightly. The Australian Breastfeeding Association(opens in a new window) compares the muscle at the top of the stomach to a drawstring bag that doesn't close all the way. Add a liquid diet, a short food pipe and a lot of time lying down, and milk comes back up easily.

Pregnancy, Birth and Baby and the ABA list the times a baby is more likely to spill:

• lying down, or being picked up quickly after lying down
• a very full tummy
• pressure on the tummy from a tight nappy, clothes or a seat belt
• sitting slumped or curled in a capsule, carrier or sling
• nappy changes and baths
• being born premature

The ABA says reflux is as common in formula-fed babies, whose episodes are more frequent and last longer.

Normal, see your GP, or go to emergency?

A baby who spills but is happy, feeding and growing is normal. See your GP for signs of pain, slow weight gain or feeding trouble. Green, yellow or bloody vomit, or signs of severe dehydration, need 000 or the emergency department. The list below puts the Australian guidance for each level in one place.

• Normal at home: Milk comes up without effort during or after feeds, even several times a day. Your baby is otherwise happy, feeding, gaining weight and breathing normally (PBB, ABA, RCH).
• See your GP: Crying, fussing or arching during or after feeds; hard to settle much of the time; slow weight gain; gagging, choking, coughing or wheezing during feeds; vomiting a lot; spilling that starts suddenly when it never happened before; treatment that isn't helping (RCH, Raising Children, PBB).
• GP today: Forceful or projectile vomiting, or any true vomiting in a baby under 6 months; refusing feeds; a fever in a baby 3 months or older; fewer wet nappies, dark wee or a dry mouth; blood or mucus in poo, or black poo; a swollen or painful tummy (PBB, SCHN, RCH).
• 000 or emergency: Green or yellow vomit; blood in vomit, whether red, black or dark like coffee grounds; a baby under 3 months with a fever above 38°C; no wet nappy for 4 to 6 hours; a sunken soft spot, sunken eyes, pale skin or cold hands and feet; difficulty breathing or unusual drowsiness (SCHN, PBB, Raising Children, healthdirect).

One condition is worth knowing in the newborn weeks. Pyloric stenosis narrows the outlet of the stomach and usually appears between 2 and 6 weeks of age, says the Royal Children's Hospital Melbourne(opens in a new window).

The vomiting gets more forceful over time and may be projectile. The baby is often hungry straight after vomiting and loses weight or gains slowly. The RCH says to see your GP immediately if your baby has persistent vomiting.

Pregnancy, Birth and Baby(opens in a new window) advises a doctor's visit for any vomiting baby under 6 months. If you're unsure whether you're seeing spilling or vomiting, treat it as vomiting and get it checked.

You know your baby best. If something seems off and isn't urgent, call your child health nurse or GP. The Pregnancy, Birth and Baby nurse line is 1800 882 436 (7am to midnight AET, every day), and healthdirect is 1800 022 222 at any hour.

Posseting vs reflux vs GORD vs silent reflux

Posseting is the reflux you can see: milk that comes back up and out. Both are normal. GORD is reflux that causes problems such as pain, poor weight gain or feeding refusal, and it needs a doctor's diagnosis. "Silent reflux" is not a medical diagnosis, according to the RCH. Here is how the words line up.

• Posseting: Milk spills out of the mouth without effort, during or after a feed. It is also called spilling, spitting up or simple reflux. It needs no doctor if your baby is happy and gaining weight.
• Reflux (GOR): The medical name for the same thing: stomach contents coming back up the food pipe. Most reflux is swallowed again; some comes out as posseting. It usually needs no doctor, and most babies grow out of it.
• GORD: Reflux that causes complications: pain, arching, poor weight gain, feeding refusal, or breathing and swallowing problems. It needs a doctor, who diagnoses and manages it.
• Silent reflux: A term for an unsettled baby who doesn't bring milk up. The RCH says it is not a medical diagnosis. See your GP or nurse to check other causes.
• Vomiting: Milk or food coming out forcefully, not spilling. A baby under 6 months who is vomiting needs a doctor.

Posseting and reflux

In babies, reflux is often called posseting, says the Sydney Children's Hospitals Network(opens in a new window). The RCH(opens in a new window) explains that most reflux is swallowed back into the stomach, and only some comes out of the mouth.

Most babies with reflux are otherwise well, show no discomfort and grow well. The RCH says reflux will most likely get better on its own by one year.

GORD (reflux disease)

GORD is reflux that causes complications. The ABA(opens in a new window) describes stomach acid burning and damaging the food pipe, and calls it fairly rare.

Babies with GORD tend to vomit a lot, usually in the first hour after a feed. The RCH and SCHN list the signs as pain that makes a baby irritable or arch their back, disrupted sleep, poor weight gain, and gagging, choking, coughing or wheezing during feeds.

Silent reflux

"Silent reflux" is a common search, and UK sources such as the NHS(opens in a new window) (supporting evidence) use the term for babies with reflux signs who don't bring milk up. Australian guidance is more cautious. The RCH says the term is controversial and not a medical diagnosis, because there is no scientific evidence to support it.

That doesn't mean an unsettled baby should be ignored. Raising Children Network(opens in a new window) says vomiting is a key symptom of reflux. If your baby isn't vomiting but cries a lot, pulls up their legs or arches their back, see your GP, paediatrician or child and family health nurse to rule out other causes.

Crying and arching have many causes. The RCH(opens in a new window) notes that some babies who cry a lot pull up their legs and arch their back, and that most of the time there is no medical reason.

The ABA names lactose overload and cow's milk protein allergy as two things often mistaken for reflux. See your doctor before changing your diet or your baby's formula.

How much spilling is normal?

No Australian guideline sets a normal amount of spilled milk. What matters is your baby: happy, feeding well, gaining weight and filling enough wet nappies. The ABA notes that spilled milk looks like a lot once it spreads, and that your baby is unlikely to have lost the whole feed.

Even when spilling happens several times a day, most babies gain weight well, says the ABA. After a big spill, it's fine to offer another breastfeed straight away, or to wait a while before the next feed. Our newborn feeding schedule covers how often a newborn usually feeds.

To check intake at home, count wet nappies: from day five, a breastfed baby should have at least five heavy wet nappies a day. Our guide to how many wet nappies a newborn should have has the full count. For bottle feeding, see the signs a formula-fed baby is getting enough.

Spilling usually eases with time. Red Nose Australia says most reflux stops after six months, and has stopped completely by 12 months for 95% of babies. SCHN and Pregnancy, Birth and Baby say most babies stop by 12 to 18 months.

What helps a baby spill less

Pregnancy, Birth and Baby, the ABA, the RCH and SCHN suggest these steps:

• Feed upright. Hold your baby upright during feeds, not lying down.
• Stay upright after. Keep your baby upright for 20 to 30 minutes after a feed, for example on your shoulder.
• Burp gently. If you burp your baby, do it gently with their back kept straight. Our guide on how to wind a baby has the positions.
• Change the feed size. Some babies do better with smaller, more frequent feeds. The ABA notes that others prefer larger feeds less often, so try what suits your baby. If you try smaller feeds, make sure your baby still gets their usual total over the day.
• One breast per feed if you make a lot of milk. The ABA suggests offering the same breast again if your baby wants another feed soon after.
• Roll, don't lift. At nappy changes after a feed, keep your baby's head higher than their body and roll their bottom sideways.
• No smoke or vapes. Keep your baby away from tobacco smoke, which can contribute to reflux, and don't smoke or vape near them or in the car or house.

The RCH says changing formulas, or moving from breastfeeding to bottles, will not change reflux and is not recommended. Don't thicken feeds unless your doctor or child health nurse has advised it. If your baby is diagnosed with GORD, any treatment is a decision for your GP.

Safe sleep with reflux

Babies with reflux still sleep on their back. Red Nose Australia is clear that a tilted mattress does not reduce reflux:

Red Nose Australia · My baby has reflux

Babies with reflux should be placed to sleep on their back from birth, on a firm, flat mattress that is not elevated at one end. Tilting the sleeping surface does not reduce reflux and is not recommended.

Red Nose adds that a pillow used to raise a baby can be a suffocation hazard. The RCH says upright holding or tummy time between feeds is only for when your baby is awake and an adult is with them.

What to note before the GP appointment

Write down when the spills or vomits happen, how forceful they are, what colour they are, how feeds are going, the wet and dirty nappy count, and any weights you have.

SCHN and Pregnancy, Birth and Baby say a doctor or child health nurse usually diagnoses reflux by asking about feeding and health history, examining your baby and watching a feed. The RCH adds that the doctor will check your baby's growth.

Bring notes on these:

• Timing. How long after a feed milk comes up, and how many times a day.
• Force and amount. A spill down the chin, a gush, or a forceful vomit that lands away from your baby.
• Colour. Milky or curdled, or any green, yellow, red, brown or black.
• Feeds. Times, which breast and for how long, or mL from the bottle, plus any coughing, pulling off or arching during feeds.
• Nappies. Wet nappies in 24 hours, and any blood, mucus or black in the poo. Our baby poo colour chart shows which colours need a check.
• Weights. The weights recorded in your baby's health record book.
• Anything else. Temperature readings, and what you've already tried.

A short phone video of a typical spill or an arching episode can also show what is hard to describe in a busy appointment.

A paper list on the fridge does this job well. If you'd rather keep it on your phone, BabyLog logs feeds, nappies and symptoms such as vomiting for free, shared with everyone who cares for your baby, and you can start free in your phone's browser.

Common questions