“He brings up his milk and screams — I’m exhausted, please give him something”

Uncomplicated gastro-oesophageal reflux (posseting/regurgitation) is normal and very common in babies because the lower oesophageal sphincter is immature, affecting about 40% of infants, usually starting before 8 weeks and resolving in about 90% before 1 year (NICE NG1) — in a thriving, otherwise well baby it is a laundry problem, not a disease — but reassurance must follow proper assessment. Assess feeding (volume and frequency, since over-feeding is common and worsens reflux, plus technique, winding and breast vs bottle) and plot the weight on a growth chart (red-book or health-visitor weights), arranging an observed feed face to face because a video call cannot replace it, because much "reflux" improves with feeding adjustments alone. Exclude the red flags that mimic or complicate reflux: pyloric stenosis (forceful projectile vomiting, hunger after vomiting, weight loss/dehydration, typically 2–8 weeks and commoner in firstborn males — a surgical emergency); bile-stained green vomiting (urgent surgical obstruction); GORD with complications (faltering growth, marked feeding aversion, distressed back-arching/Sandifer’s, haematemesis, apnoea); cow’s-milk protein allergy (eczema, blood/mucus in stools, other atopy — consider maternal dairy exclusion if breastfeeding or a hydrolysed formula); and serious illness/dehydration. For uncomplicated reflux, first-line management is conservative and stepwise (NICE NG1): avoid over-feeding, offer smaller more frequent feeds with the same daily total and ensure good winding, then for formula-fed infants a thickened formula, and only if that fails stop the thickener and try an alginate for 1–2 weeks (breastfed infants: a breastfeeding assessment first, then an alginate trial) — never a thickener and an alginate together, and no positional management for sleeping infants (back to sleep) — while AVOIDING reflexive acid suppression, as PPIs/H2 blockers are not recommended for overt regurgitation alone (NG1 allows a 4-week trial only for unexplained feeding difficulty, distressed behaviour or faltering growth). Crucially, support the exhausted parent: validate how hard it is, acknowledge sleep deprivation, screen maternal mood for postnatal depression/anxiety (NICE CG192 questions), check support and signpost help — caring for the frazzled parent is caring for the baby. The hidden agenda is a plea born of exhaustion and helplessness as much as a request for medication; assess and reassure properly, give practical help, support her, and avoid both dismissal and unnecessary medicalisation.