Reflux or Feeding Difficulty? How to Tell the Difference

Reflux is one of the most common diagnoses given to unsettled babies - but it's also one of the most over-diagnosed. Many babies who are labelled as having reflux are actually experiencing a feeding difficulty, and the distinction matters because the support they need is very different.

What is reflux?

Gastro-oesophageal reflux (GOR) happens when stomach contents come back up into the oesophagus. In babies, the valve between the oesophagus and stomach is immature, which makes reflux very common - affecting around 40% of babies to some degree.

For many babies, reflux resolves on its own as the valve matures. But when reflux is causing significant symptoms - persistent discomfort, poor weight gain, or breathing problems - it is classified as gastro-oesophageal reflux disease (GORD) and requires medical assessment.

When it might be more than reflux

The difficulty is that many of the signs associated with reflux - feeding refusal, arching during feeds, distress at mealtimes, frequent waking - can also be caused by a feeding difficulty that has nothing to do with reflux at all.

Babies who have experienced painful reflux can also develop feeding aversion - where they associate feeding with discomfort and begin to refuse or resist feeds even after the reflux has been treated. This is a separate issue that requires different support.

Signs that might suggest a feeding difficulty rather than reflux include:

• Difficulty latching or sustaining a latch during feeds
• Clicking or gulping sounds
• Coughing, choking or colour changes during feeds
• Very slow feeds or frequent breaks
• Milk coming out of the nose
• Distress that starts during the feed, not just after

What an SLT can offer

If your baby has been treated for reflux but is still struggling with feeds, or if you're not sure whether reflux is the right explanation, a specialist feeding assessment can help clarify what's happening.

An assessment will look at how your baby feeds from the beginning to the end of a feed - their latch, suck pattern, swallowing coordination and any signs of discomfort or difficulty. This gives a much clearer picture than a diagnosis based on symptoms alone.

If you're concerned about your baby's feeding, a paediatric feeding assessment can be arranged without a referral.