Every page about baby reflux gives you one answer to “when does this stop?”. The published sources do not agree on one. They span six months to eighteen months, and the age band where spit-up typically resolves is the same age band two sources call a red flag when spit-up newly starts. The advice to hold your baby upright after a feed also collides with an absolute prohibition on the same idea at sleep — which is only a contradiction until you split the clock. This page quotes every red flag from the source that publishes it, reports the published disagreement instead of picking the tidiest answer, and names the two positions the same hospital publishes about whether reflux causes crying.
Every published red flag, from the source that publishes it.
These are not this page’s list. Each one is quoted from the source that publishes it, and the sources do not publish the same list — RCH’s clinical guideline, RCH’s parent fact sheet and Mayo each name a different set. This section is the first on the page on purpose: a page about how normal reflux is, is dangerous if it puts “normal” above a red flag.
RCH: “Reconsider diagnosis” features
RCH’s clinical practice guideline introduces these with “Reconsider diagnosis if any of the following red flag features are present”. That framing matters: these are not “signs of worse reflux”, they are reasons to question whether the diagnosis is reflux at all.
Spit-up or vomiting started at 6 months of age or olderRCH lists “Onset of vomiting <1 week or >6 months of age” under “Reconsider diagnosis”. Mayo separately lists “Begins spitting up at age 6 months or older” as a reason to contact your baby’s healthcare professional. A baby who has never spat up and then starts is a different question from a baby who has always spat up.Source: RCH Clinical Practice Guideline
Spit-up or vomiting started in the first week of lifeRCH lists “Onset of vomiting <1 week” under “Reconsider diagnosis”. Very early onset is a different question from the usual pattern, which RCH says “usually begins before 8 weeks of age”.Source: RCH Clinical Practice Guideline
Vomiting increasing or still going at 12 to 18 monthsRCH lists “Vomiting increasing or persisting beyond 12-18 months of age”. MedlinePlus states plainly: “Reflux that continues after 18 months is unusual.”Source: RCH Clinical Practice Guideline
Lethargy or feverRCH lists “Lethargy or fever”. A fever in a young baby is its own question with its own published thresholds — see the fever page for the cutoffs by age and measurement site.Source: RCH Clinical Practice Guideline
Excessive irritabilityRCH lists “Excessive irritability”. Note the tension on this page: the same hospital’s guideline says GOR “does not cause crying and irritability in healthy infants”, while its own parent fact sheet says reflux “is one potential cause” of colic. Both positions are quoted below.Source: RCH Clinical Practice Guideline
Weight loss or faltering growthRCH lists “Weight loss or faltering growth”. Mayo: “Most often spitting up doesn’t affect a baby’s growth. Does your baby seem well? Is your baby eating and gaining weight? Then there’s little cause for worry.” Growth is measured by your care team, not by how much appears on a bib.Source: RCH Clinical Practice Guideline
Feeding problems or oral aversionRCH lists “Feeding problems or oral aversion”. Mayo lists “Refuses to feed” and MedlinePlus lists “Poor eating or refusing to eat”.Source: RCH Clinical Practice Guideline
Respiratory symptoms: aspiration, chronic cough, wheezing, recurrent pneumoniaRCH lists these under “Respiratory symptoms” as red flags. This is the group where the published framing has shifted: the 2018 NASPGHAN-ESPGHAN guideline “shifts away from attributing respiratory and laryngeal symptoms to GER”, while RCH still treats them as a reason to reconsider the diagnosis.Source: RCH Clinical Practice Guideline
Seizures urgentRCH lists “Seizures” under neurological red flags. A seizure is on the published Call 911 list — contact emergency services.Source: RCH Clinical Practice Guideline
Vomiting at nightRCH lists “Nocturnal vomiting: may suggest increased ICP”. The source gives a possible interpretation, which is the reason it is on a red-flag list rather than a symptom list.Source: RCH Clinical Practice Guideline
Green or bile-stained vomit, or a rigid or distended abdomen urgentRCH: “Bilious vomiting and/or abdominal rigidity/distension: may indicate intestinal obstruction”. Mayo lists “Spits up green or yellow fluid” as a reason to contact your baby’s healthcare professional. This is the group to treat as urgent rather than routine.Source: RCH Clinical Practice Guideline
Forceful vomiting urgentRCH: “Forceful vomiting: may indicate pyloric stenosis”. Mayo draws the line by how it leaves the baby: spitting up is “the easy flow of food”, while vomiting “comes out with force. It shoots out of the mouth rather than oozing.” Mayo also lists “Spits up with force” as a reason to contact your baby’s healthcare professional.Source: RCH Clinical Practice Guideline
Blood in the vomit, or what looks like coffee grounds urgentRCH: “Haematemesis: may indicate potentially severe upper GI bleed”. Mayo: “Spits up blood or what looks like coffee grounds.” This one is on the published urgent list.Source: RCH Clinical Practice Guideline
Blood in the stool or chronic diarrhoea urgentRCH: “Chronic diarrhoea and rectal bleeding: can be seen in a variety of conditions, particularly bacterial infections, acute surgical causes, IBD, CMPA”. Mayo lists “Has blood in the stool”.Source: RCH Clinical Practice Guideline
Mayo and RCH parent guidance: contact your care team
A shorter list, published for parents rather than clinicians, and it is not identical to the one above.
Trouble breathing, or other signs of illness urgentMayo: “Has trouble breathing or other signs of illness.” Difficulty breathing is on the published Call 911 list. Contact emergency services rather than reading further.Source: Mayo Clinic
Crying more than usual, or more cranky than usualMayo: “Cries more than usual or is more cranky than usual.” A change in the baby is the signal here, not a number.Source: Mayo Clinic
Fewer wet diapers than usualMayo: “Has fewer wet diapers than usual.” Diaper output is the standard published feed-intake check; see the diaper output checker for the published counts by day of life.Source: Mayo Clinic
Something you cannot explain that is making you worriedRCH, on its parent fact sheet: you should see your GP if your baby “is making you worried for any other reason”. This is a published reason to call, on its own, with no other symptom required.Source: RCH Kids Health Info (parent fact sheet)
Reflux that looks normal can still carry a red flag — and one of them sits at the age spit-up usually stops. IFFGD: spit-up “typically resolves by 6 to 8 months of age”. Mayo, on its own red-flag list: “Begins spitting up at age 6 months or older.” RCH: “Onset of vomiting <1 week or >6 months of age”. So a baby of 6–8 months can be inside a published “typically resolving” band and inside two published “reconsider the diagnosis” bands at the same time. The sources are not contradicting each other — they are answering two different questions, when did it start and is it still happening. Ask both.
The part most pages leave out
When it starts, when it peaks, when it goes away.
Six sources, one table, as each of them publishes it. The onset and peak columns agree more than you would expect. The resolve column does not.
Source
When it starts
When it peaks
When it resolves
RCH Clinical Practice Guideline
begins before 8 weeks of age
peaks at 4 months
resolves by 1 year of age
AAFP / American Family Physician 2025
begin before 8 weeks of life
peak at approximately 4 months of age
usually resolve by 1 year
Mayo Clinic
during their first three months, about half of all babies do it
—
stop spitting up by age 12 months
MedlinePlus (NIDDK)
most babies spit up several times a day during their first 3 months
—
12 to 14 months
IFFGD / About Kids GI
usually start around 2 months of age
peak of this issue (which we call normal physiologic neonatal reflux) typically around 4 months of age
typically resolves by 6 to 8 months of age
JAMA Pediatrics practice-based survey
at least 1 episode a day was reported in half of 0- to 3-month-olds
Peak reported regurgitation was 67% at 4 months
5% at 10 to 12 months of age
Every published answer to “when does it stop”, side by side.
“Typically resolves by 6 to 8 months” and “usually resolves within 1 to 2 years” are both published by the same organisation, on the same page. One source says the ordinary version of this is over by 12 months; another says reflux continuing after 18 months is unusual, which implies 18 months is still inside the range of ordinary. This page does not average them or pick one.
Published answer
Source
In their words
6 to 8 months
IFFGD / About Kids GI
“For most babies, spitting up improves and typically resolves by 6 to 8 months of age.”
starts to get better by 6 months
MedlinePlus (NIDDK)
“It usually starts to get better by 6 months of age and goes away by 12 months.”
by 12 months
RCH Clinical Practice Guideline
“resolves by 1 year of age in the majority of cases”
by 12 months
Mayo Clinic
“Most babies stop spitting up by age 12 months.”
by 12 months
AAFP / AFP 2025
“usually resolve by 1 year”
12 to 14 months
MedlinePlus (NIDDK)
“They usually stop spitting up between the ages of 12 and 14 months.”
1 to 2 years
IFFGD / About Kids GI
“Reflux usually resolves within 1 to 2 years after birth.”
continues after 18 months is unusual
MedlinePlus (NIDDK)
“Reflux that continues after 18 months is unusual.”
The envelope runs from 6 months to 24 months. The earliest published “typically resolving” claim is 6 months, the latest published outer boundary is 1–2 years, and MedlinePlus separately says reflux continuing after 18 months is unusual. Across that whole span a baby can be spitting up with every one of these sources still describing it as ordinarily self-limiting — and, at the early end of it, inside a published red flag. The checker below places your baby on this envelope and names which of these answers your baby has passed.
Every published answer that applies, with its source
Where does your baby sit on the published envelope?
Enter the date of birth, when the spit-up started, and the time of the last feed. The checker places your baby on the envelope of published resolution answers, computes the end of the published upright hold from your actual feed time, reports which published red flags you have ticked with the source for each, and tells you when the onset date itself falls inside a published red-flag band. It never tells you your baby is fine.
5. Tick anything on the published red-flag lists
Only the ones that apply to your baby today. Nothing here is scored or counted for you — the result names what you ticked.
The advice that collides with safe sleep
Upright for 20 or 30 minutes, then flat on the back.
“Keep your baby upright after a feed” and “put your baby to sleep on the back” sound like they conflict. They do not, once you split the clock — and the sources are unusually blunt about the half that parents try to extend. Read the prohibition below with the timings above it, because it is the same sources saying both.
Published hold
Source
In their words
20–30 minutes
RCH Clinical Practice Guideline
“Holding the infant in a head elevated position for 20-30 minutes after feeding may reduce GOR”
20 minutes
RCH Kids Health Info (parent fact sheet)
“Try keeping them upright for about 20 minutes after their feed.”
30 minutes
Mayo Clinic
“Keep your baby upright for 30 minutes after each feeding. Don't do active play or use an infant swing right after feeding.”
30 minutes
MedlinePlus (NIDDK)
“Hold your baby upright for 30 minutes after feedings.”
The published hold is an awake, supervised hold. Nothing on this page tells you to incline anything at sleep. RCH’s guideline, having just endorsed 20–30 minutes of head-elevated holding after a feed, adds immediately: “Do not recommend prone/side sleeping or inclining the sleep surface due to the risk of SIDS”. Mayo: “Even if your baby spits up, put your baby to sleep on the back. This is to lower the risk of sudden infant death syndrome, also called SIDS. Don’t put your baby to sleep on the stomach to try to keep the baby from spitting up.” The 2025 AAFP review states the position for the field: “Current guidelines do not recommend the use of positional therapy (eg, head elevation, left lateral positioning) for infants with reflux due to conflicts with safe sleep recommendations for supine positioning.” Two published hold times differ by ten minutes; on this point there is no disagreement at all.
Two answers from one hospital
Is the crying the reflux?
If you are reading this at 3am with a screaming baby, this is the question. One institution publishes both answers, in two documents aimed at two audiences, and they do not say the same thing.
The clinical guideline
“does not cause crying and irritability in healthy infants. Infant crying peaks at 6-8 weeks, and co-incidentally some babies with simple GOR may also be unsettled”
GOR is not the cause of the crying. The crying has its own timeline, peaking at 6-8 weeks, and RCH calls the overlap a coincidence.
Source: RCH Clinical Practice Guideline
The parent fact sheet, from the same hospital
“There are many possible reasons for colic, and reflux is one potential cause.”
Asked by parents whether reflux could be the cause of colic, the same hospital's parent fact sheet answers that reflux is one potential cause.
Source: RCH Kids Health Info parent fact sheet
This page reports the disagreement rather than resolving it. The practical reading: reflux being an unlikely cause of ordinary crying is not the same as crying being nothing. The same guideline that plays down reflux as a cause lists “excessive irritability” as a red flag to reconsider the diagnosis in its own right. Crying is a reason to look for something, whichever of these two positions you land on.
What the sources say, in the order they say it
The published escalation order has a step most pages skip.
This is not a treatment recommendation. It is the order the published guidelines put things in, and the reason it is worth reading is that the guidelines put a formula change before acid suppression while most parent-facing pages start with the medicine. No medicine, brand or dose appears anywhere on this page.
Step
What the published guidance says
1
Most of it needs no treatment at all
RCH CPG: “Gastro-oesophageal reflux (GOR) is common in healthy, thriving infants and does not require investigation or treatment”. RCH Kids Health Info, to parents: “For most babies, you don’t have to do anything about reflux and regurgitation.” IFFGD: “As long as your baby is growing, has a good amount of wet diapers every day and spit up is not green or red, there is no damage or concern if your baby spits up a lot.”
Decision owner: the source, not this page
2
Feeding changes, and the published ones are modest
RCH CPG: thickened feeds “may reduce frequency of vomiting” in bottle-fed babies, but “the benefit of thickening feeds is only modest, and the burden of expressing and bottle feeding is significant”. It also warns: “breast milk should not be thickened with cereal-based thickeners”. On burping and volumes, Mayo suggests smaller amounts more often, while RCH says to “consider a trial of smaller, more frequent feeds”. RCH is explicit that “GOR alone is not an indication to change formula or stop breast feeding”.
Decision owner: your care team decides
3
A cow’s-milk-protein question, before acid suppression
The 2018 NASPGHAN-ESPGHAN guideline “adds a recommendation for change of formula to a protein hydrolysate or amino acid based formula before acid suppression in infants”. RCH: “Consider cow milk protein allergy in infants with GORD symptoms”, with a “2-4 week trial of strict cow milk protein elimination”. This is the part a parent-facing page usually skips: the guideline puts the formula question BEFORE the medicine question.
Decision owner: your care team decides
4
Acid suppression, and what the sources say about it
AAP, in Pediatrics: acid suppressants “reduce gastric acidity but are not effective against GER”. RCH CPG: “Do not use acid suppressant therapy as a diagnostic trial for irritable infants” and “There is no evidence to support empiric use of PPI as a diagnostic trial for irritable infants”. Where a trial is used at all, RCH describes it as a “2-4 week trial” with a review of ongoing need, and the 2018 guideline frames the whole document around “reducing acid suppression whenever possible”. RCH also lists what it says the evidence shows about risk: “increased risk of community acquired pneumonia, gastroenteritis, future fractures and micronutrient deficiencies”.
Decision owner: your care team decides
5
This page gives no medicine, no brand and no dose
Every line above is a restatement of a published position. Nothing here is a recommendation to give or withhold anything, and there is no dose anywhere on this page. The published guidance is explicit that these are decisions for the clinician who has seen your baby.
Decision owner: nobody on this page
RCH describes what it says the evidence shows about the medicine’s risks, and AAP measured how often it is used anyway. RCH: PPI therapy “may lead to increased risk of community acquired pneumonia, gastroenteritis, future fractures and micronutrient deficiencies”. AAP, in Pediatrics: “nearly 7% of all infants and 2% of infants without one of the exclusion criteria were prescribed an acid suppressant”, concluding that “acid suppressant overuse remains a persistent problem”. Both are reported here because both are published. Neither is a reason for you to start or stop anything — that is the clinician who has seen your baby.
“Silent reflux”
It is not a diagnosis the sources recognise.
RCH parent fact sheet
“Some people believe that an unsettled baby who does not vomit or posset may suffer from 'silent reflux'. However, this is not a medical diagnosis. The term is very controversial as there is no scientific evidence to support this.”
RCH clinical practice guideline
“There is insufficient evidence to support the diagnosis or management of "silent reflux"”
So if your baby is unsettled and not spitting up, the thing to do is still take it to your care team — RCH lists excessive irritability as a red flag, and the “making you worried for any other reason” route is published on its own. What you should not do is carry a diagnosis the sources do not make into a treatment decision.
The stain is not the volume
Why a teaspoon can look like the whole feed.
What you are looking at
“Keep in mind that when you see how much your baby has spit up based on the size of a spit-up stain, it's easy to think there's more than there is. Babies most often spit up only one or two mouthfuls of breast milk or formula.”
Source: Mayo Clinic
Why it looks like that
“Adults do not notice when they have an episode of gastroesophageal reflux. They may reflux over an ounce of gastric contents, but that ounce never makes it up to the throat. That's because the adult esophagus holds about an ounce and a half of fluid. In contrast, the infant esophagus holds only less than one-tenth of that amount. As little as a teaspoon of reflux may cause a bit of spit up in the infant's mouth.”
Source: IFFGD / About Kids GI
The published way to tell whether enough is going in is not the bib. It is diaper output and growth: the AFP 2025 review and HealthyChildren both use wet-diaper counts, and RCH’s red flag for this is “weight loss or faltering growth”. There is a diaper output checker on this site for the published counts by day of life, and a feed count and gap checker for how many feeds and how long between them.
Printable
A spitting-up log your care team can actually use.
The published red flags turn on things you can only answer from a record: how forceful it was, what colour it was, the age it started, and whether growth is affected. This log has a column for the upright hold so the timing question is answered by the sheet rather than by memory.
Spitting-up log — bring this to the appointment
The published lists separate ordinary spit-up from vomiting by force and by colour, so record both every time. Never record a dose given without a clinician’s instruction behind it.
Date / time
Feed time
Upright until
Amount (rough)
Force: oozing / shooting
Colour
Wet diapers today
Mood & feeding
Question for the care team
Baby’s date of birth: ______________ · Age when the spit-up started: ____________ · Care team / after-hours number: ____________________ · Weight, if known: __________
Questions dads actually ask
The honest answers.
How long does reflux last?
The published answers span 6 months to 18 months, and they come from sources that agree about almost everything else. IFFGD says spit-up “typically resolves by 6 to 8 months of age” and, on the same page, that reflux “usually resolves within 1 to 2 years after birth”. MedlinePlus says it “starts to get better by 6 months of age” and that babies “usually stop spitting up between the ages of 12 and 14 months”. Mayo says “most babies stop spitting up by age 12 months”. The checker above lists every published answer with its source and shows you where your baby sits on that envelope, rather than picking the tidiest one.
My baby is 7 months old and still spitting up. Is that a problem?
This is exactly the seam this page exists to name, and the sources genuinely point in two directions at that age. IFFGD says 6 to 8 months is when spit-up typically resolves. Mayo lists “begins spitting up at age 6 months or older” as a reason to contact your baby's healthcare professional, and RCH lists “onset of vomiting… >6 months of age” as a red flag to reconsider the diagnosis — while also listing “vomiting increasing or persisting beyond 12-18 months” as a separate red flag. So the same age band holds a “typically resolving” answer and a “new onset is a red flag” answer. The distinction that matters is onset versus persistence: a baby who has always spat up and is now improving is a different case from a baby who started at 6 months. Both are worth raising with your care team.
Is the crying the reflux?
The same hospital publishes two answers. RCH's clinical practice guideline says GOR “does not cause crying and irritability in healthy infants”, adding that infant crying peaks at 6-8 weeks and that some babies with simple GOR “may also be unsettled” coincidentally. RCH's own parent fact sheet, asked whether reflux could be the cause of colic, answers: “There are many possible reasons for colic, and reflux is one potential cause.” This page reports both instead of resolving them. If “excessive irritability” is the reason you are reading this, note that RCH lists it as a red flag in its own right.
The spit-up looks like so much. How can a teaspoon be that big?
Mayo: “when you see how much your baby has spit up based on the size of a spit-up stain, it's easy to think there's more than there is. Babies most often spit up only one or two mouthfuls.” IFFGD gives the mechanism: an adult may reflux over an ounce without noticing, because the adult oesophagus holds about an ounce and a half, while “the infant esophagus holds only less than one-tenth of that amount. As little as a teaspoon of reflux may cause a bit of spit up in the infant's mouth.” The stain is not the volume. The published way to measure whether enough is going in is diaper output and growth, not the size of the mark.
Do I need to keep him upright for 20 minutes or 30?
Both are published. RCH's parent fact sheet says “about 20 minutes after their feed”; RCH's clinical practice guideline says “a head elevated position for 20-30 minutes after feeding may reduce GOR”; Mayo says “30 minutes after each feeding”; MedlinePlus says “30 minutes after feedings”. The two answers differ by ten minutes and no source explains the gap. Where they agree completely is the absolute part: this is an awake, supervised hold, and the same sources prohibit the obvious extension of their own advice — see the section on sleep position.
Can I raise the head of the crib, or let him sleep on his side?
No, and the sources are unusually direct about it because it is the one place parents try to extend useful advice into dangerous territory. RCH's guideline, having just endorsed upright holding for 20-30 minutes after a feed, adds: “Do not recommend prone/side sleeping or inclining the sleep surface due to the risk of SIDS”. Mayo: “Even if your baby spits up, put your baby to sleep on the back. This is to lower the risk of sudden infant death syndrome, also called SIDS. Don't put your baby to sleep on the stomach to try to keep the baby from spitting up.” The 2025 AAFP review states the position for the whole field: “Current guidelines do not recommend the use of positional therapy (eg, head elevation, left lateral positioning) for infants with reflux due to conflicts with safe sleep recommendations for supine positioning.”
Is it silent reflux?
“Silent reflux” is not a diagnosis the sources recognise. RCH's parent fact sheet: “Some people believe that an unsettled baby who does not vomit or posset may suffer from 'silent reflux'. However, this is not a medical diagnosis. The term is very controversial as there is no scientific evidence to support this.” RCH's guideline puts it more briefly: “There is insufficient evidence to support the diagnosis or management of 'silent reflux'”. An unsettled baby who is not spitting up is a real problem worth raising — it is simply not this diagnosis.
Does medicine fix it?
For ordinary reflux, the sources say no, and they say it plainly. AAP, in Pediatrics: acid suppressants “reduce gastric acidity but are not effective against GER”. IFFGD: “studies have conclusively shown that acid suppressing medications like H2 inhibitors (famotidine) or proton pump inhibitors (lansoprazole, pantoprazole, omeprazole, esomeprazole) do not help infants with this issue”. RCH's guideline: “Do not use acid suppressant therapy as a diagnostic trial for irritable infants”. The 2018 NASPGHAN-ESPGHAN guideline puts a formula change to a protein hydrolysate or amino acid formula BEFORE acid suppression. And AAP measured how often it happens anyway: “nearly 7% of all infants and 2% of infants without one of the exclusion criteria were prescribed an acid suppressant”. This page gives no medicine, no brand and no dose.
Could it be a milk allergy instead?
Your care team is the only one who can work that out, and the sources say why it is hard: RCH's guideline states that a subset of infants with non-IgE mediated cow milk protein allergy “can present with symptoms of persistent regurgitation, vomiting and irritability indistinguishable from GORD”. RCH therefore says to “Consider cow milk protein allergy in infants with GORD symptoms”, and describes the trial as “a 2-4 week trial of strict cow milk protein elimination” with a referral arranged. IFFGD adds that a milk protein enterocolitis is “a common cause of severe reflux in infants”. Indistinguishable is the source's own word.
Does burping or tummy time help?
The sources treat these as comfort measures, not treatments, and one of them is explicitly honest about tummy time. RCH's parent fact sheet supports upright holding in between feeds and tummy time “only… if your baby is awake and if you or another adult is with them”, then adds: “However, having tummy time will not reduce the age at which the reflux will get better.” Mayo suggests burping during and after feeds to keep air from building up. IFFGD notes that for most babies the whole thing improves with time regardless.
Sources
Where every figure on this page comes from.
Every number above is a restatement of one of these. Where a source says something this page states, the words are quoted; where the sources disagree, both are shown.