Reflux that won’t quit? It could be an allergy

Written by Registered Dietitian Nishti

Many babies bring up milk after feeds. This is called reflux (or GOR), and it's very common in the first year of life. It often starts before your baby is 8 weeks old.

But if your baby is unsettled, feeding poorly, or seems in pain — it could be more than just reflux. When reflux starts to affect your baby's (and your!) daily life, we call it GORD (Gastro-Oesophageal Reflux Disease).

Could it be a milk allergy?

Cow’s milk protein allergy (CMPA) is the most common food allergy in babies. Research shows that up to 40% of babies with GORD may actually have a cow’s milk allergy — and removing cow’s milk often improves symptoms.

Signs it could be a milk allergy:

Your baby might have CMPA-related reflux if they also have:

• Repeated vomiting or spit-up

• Crying, discomfort or arching their back

• Refusing feeds or feeding poorly

• Eczema or rashes

• Loose or hard stools

• Wind, colic, or tummy pain

• Poor growth

If your baby has reflux and skin or tummy issues, it may well be due to cow’s milk.

What we do at our clinic:

Step 1: Full history

We start by looking at your baby’s full history — symptoms, feeding, growth, and more. Signs like tummy troubles or eczema can be linked to a milk allergy.

Step 2: Feeding check

• Breastfed babies: We’ll ask your health visitor to check positioning and latch.

• Formula-fed babies: We may suggest slower-flow teats and smaller, more frequent feeds.

Helpful tips:

• Keep baby upright for 30 minutes after feeds

• Avoid bouncing or laying flat straight after feeding

Step 3: Try thickened feeds

Some babies do better with thicker milk. Anti-reflux formulas already contain thickeners. Or, we may suggest adding one like Carobel to breast or formula milk.

Here’s a quick guide:

Step 4: Milk-free trial

If reflux continues, we may recommend cutting out cow’s milk for 2–6 weeks. This is called an elimination diet and is the gold standard way to diagnose CMPA.

If symptoms improve, we reintroduce milk slowly to confirm whether milk was the problem. Sometimes, we explore other food allergies too.

What about medication?

Medication for reflux should only be used after trying a milk-free diet. Sadly, many babies are prescribed reflux meds too soon — without trying the most effective (and natural) solution first.

Some reflux meds (like PPIs) may also affect your baby’s gut health, so it's best to try diet changes first.

In summary:

• Reflux is common — but if your baby is unsettled, it may be due to a cow’s milk allergy.

• A dietitian-led approach can help you figure it out safely.

• Trying a milk-free diet first may prevent the need for medication.

👶 If this was helpful, please share it with another parent who might need it.

References:

Omari, T. et al. (2020) ‘Characterization of Upper Gastrointestinal Motility in Infants With Persistent Distress and Non-IgE-mediated Cow’s Milk Protein Allergy’, Journal of pediatric gastroenterology and nutrition. J Pediatr Gastroenterol Nutr, 70(4), pp. 489–496. 

Salvatore, S. et al. (2018) ‘Thickened infant formula: What to know’, Nutrition. Elsevier, 49, pp. 51–56.

Meyer, R. et al. (2022) ‘Diagnosis and management of food allergy-associated gastroesophageal reflux disease in young children—EAACI position paper’, Pediatric Allergy and Immunology. John Wiley & Sons, Ltd, 33(10), p. e13856. 

Meyer, R. et al. (2018) ‘Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition’, JPGN, 66, pp. 516–554.

Levy, E. I., Hoang, D. M. and Vandenplas, Y. (2020) ‘The effects of proton pump inhibitors on the microbiome in young children’, Acta paediatrica (Oslo, Norway : 1992). Acta Paediatr, 109(8), pp. 1531–1538.