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Reflux and regurgitation

Managing the symptoms of reflux and regurgitation can be challenging. We’ve gathered the latest guidelines and expert opinions to support healthcare professionals to make the correct diagnosis and help to reduce concern among parents. Click on each of the tabs below to learn more about infant reflux and regurgitation and to download resources.


Reflux and regurgitation are considered normal physiological processes that occur several times a day in healthy infants. They are caused by the valve at the top of the stomach having a weak action. Food and stomach acid can move back into the oesophagus.1


  • Regurgitation
  • Excessive crying / irritability during/after feeding
  • Regular coughing
  • Arching of neck and back during or after feeding
  • Poor sleep habits typically with frequent waking

Diagnosis and management

Reflux and regurgitation image 1


First step treatment in breastfed infants with Gastroesophageal Reflux Disease (GERD)3

2018 ESPGHAN guidelines recommend:

  • Avoid overfeeding
  • Use thickened feeds, e.g. Cow & Gate Instant Carobel
  • Continue breastfeeding

Suitability of Cow & Gate Instant Carobel:

  • Indicated for the dietary management of infantile vomiting and posseting, habitual or recurrent vomiting (e.g. gastro-oesophageal reflux) and rumination
  • Suitable for both breast and bottlefed infants – no need to switch chosen milk feed*
  • Unique flexibility – viscosity can be altered to desired requirements and can be used to thicken both cold and hand-hot liquids
  • Suitable for milk & lactose free, gluten free and vegetarian diets
  • Suitable for full term infants, children and adults
  1. Lightdale J et al., Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics 2013; 131 (5):e1684-e1695
  2. Vandenplas J et al. J Pediatr Gastroenterol Nutr 2009;49:498-547
  3. 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 (2018), Journal of Pediatric Gastroenterology and Nutrition, 66; 3, 516-554.

Breastfeeding is best for infants. Instant Carobel is a food for special medical purposes for the dietary management of habitual and recurrent vomiting, and rumination. It should only be used under medical supervision, after full consideration of the feeding options available including breastfeeding. Suitable for full term infants, children and adults. It is not suitable for use as the sole source of nutrition. For enteral use only.

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