Regurgitation (also known as reflux, posseting and spitting up) of feeds in infants is very common, affecting at least 40 per cent of infants, with some having up to six episodes each day. Regurgitation usually starts before the baby is eight weeks old, becomes less frequent with time and, in 90 per cent of cases, resolves by the age of 12 months.

The first step in managing regurgitation is to reassure the parent, as it can be distressing for them to see their baby regurgitating feeds. In most cases no further action is required and the issue will resolve with time, but there are some steps parents can take if they are worried or their baby is distressed.

In breastfed babies it might be useful to have a feeding assessment with a trained breastfeeding advisor. If this does not improve the situation, they should be referred to their GP or health visitor.* It’s important to encourage continued breastfeeding wherever possible as it is best for baby.

In formula fed babies, after discussion with the pharmacist, a stepwise approach can be followed:

• If the volume of milk at each feed is excessive for the weight of the baby, advise reducing the amount of feed; the recommended feed volume found on the formula packaging can be used as a guide
• Recommend trialling smaller, more frequent feeds (while maintaining an appropriate total daily amount of milk)
• Suggest a 14 day trial of thickened formula (for example, containing rice starch, corn starch, locust bean gum or carob bean gum).

If the baby is still showing signs of distress, they should be referred to a Health Visitor or GP.

Colic is when a baby cries a lot but there's no obvious cause. It's a common problem, affecting about 20 per cent of babies.⁶

It can start when a baby is a few weeks old and usually stops by the time they are six months old. A baby may have colic if they cry for more than three hours a day, 3 days a week for at least a week.

They may cry more in the afternoon and evening. Other signs of colic include:

• It’s hard to settle or soothe the baby
• They clench their fists
• They go red in the face
• They bring their knees up to their tummy or arch their back
• Their tummy rumbles or they are very windy.

It is not known exactly what causes colic, but it may be caused by a developing GI system and gut microbiome or the baby not being able to digest milk proteins properly.

There is no cure for colic, but you can advise parents on ways they can soothe their baby:

• Hold or cuddle the baby when they're crying a lot
• Gently rock the baby over the shoulder
• Gently rock the baby in their Moses basket or crib, or push them in their pram
• Bathe your baby in a warm bath
• Have some gentle white noise like the radio or TV in the background to distract them.

Breastfed babies should continue to be fed as normal. Parents of formula fed babies might wish to try specialist anti-colic bottles and teats. They could also consider, under the advice of a healthcare professional, a 14 day trial of a formula milk formulated to help colic.

Constipation in babies is less common than regurgitation and colic, affecting about 15 per cent of babies. Symptoms of constipation include passing less than two stools per week or passing hard or large stools.⁷ It is less common in exclusively breastfed babies.

You can advise parents to try gently moving their baby’s legs in a bicycling motion, or carefully and gently massage their tummy to help stimulate their bowels. Warm baths can also encourage bowel movements.

If the baby is formula fed, check that the bottles are being made up correctly as per the instructions on the container. If dehydration is a possible issue, then feeds can be supplemented with bottles of boiled cooled water. If the baby has moved onto solids, fibre can be increased by offering more fruit and vegetables.

If symptoms persist or are recurrent, you should refer customers to the pharmacist.