During hot weather, some babies who are formula fed can be given a little extra cooled, boiled water, between formula feeds. However, it shouldn't take up a large part of the intake, as it will impact nutrition. Also, it should be given separately and not added to formula to make it more dilute, as this impacts on the osmolality and tolerance of the milk.

Breastfed babies do not require extra water, as the breastmilk will adapt.

There is no real evidence that anti-colic preparations work (e.g. simeticone/lactase/gripe water etc.). Some recent studies have shown potential benefit of a certain probiotics (L. reuteri) in breastfed babies, but it does not feature in guidelines yet.

Gaviscon can cause constipation, so as with all medications, it's a balance of pros and cons. If it has not had an impact on the reflux symptoms after a couple of weeks, it could be stopped. Asking parents to keep a symptom diary can be beneficial.

As mentioned live, this is a very good point. It is important to ensure babies are not overfed. Calculating 150-180ml/kg/day and figuring out what volumes that is can be beneficial. Furthermore, showing a healthy growth chart can also reassure to cut down a little! Pacing feeds can be helpful too.

There's no strict criteria if a medicine is working. However, the reflux should improve once the baby is weaning and is on more solids. I would suggest aiming to wean or trialling off once has started weaning and aim to be off by 12 months.

I'm not sure what this question is getting at. Do anticolic preps cause reflux? There's little evidence they work so I would generally not advise anti-colic meds in the first place.

A trial of a couple of weeks seems reasonable to me. It's something that should kick in quite quickly!

There seems to be reports that they can, although I presume it's highly variable for different people!

I find parents do sometimes report a baby prefers one formula over another, but I'm not sure of the scientific basis behind this. It's unlikely to do harm though!

There's no evidence gripe water is of benefit. I have never seen a paediatrician advise its use.

Rocker chairs/bouncers, even car seats, are not the safest place for babies. They don't adhere to full safe sleeping advice: https://www.lullabytrust.org.uk/safer-sleep-advice/

Loud noises should try to be avoided where possible.

When I answered this live, I said I wasn't aware that there was specific data related to this, but I was wrong. This study showed a significant minority of families with food insecurity concerns diluted formula: https://pubmed.ncbi.nlm.nih.gov/22114199/

https://www.babycentre.co.uk/a551926/your-babys-poo-whats-normal-and-whats-not

I personally have never used, or seen used, Carobel for reflux. It does feature in some guidelines but not something I have experience of.

As mentioned in the talk, sometimes one has to just ask these difficult questions. Safeguarding concerns are never an easy thing to navigate, but we have a duty to enquire if concerns are there.

I believe related to the reduction in the barrier defence of stomach acid.

It is not something I have experience of using and in my practice, I've only ever seen it used for swallowing difficulties. I note it does feature in some guidelines, but not something I've encountered.

The evidence hasn't shown this. There is some evidence of benefit in breastfed babies.

A night feed is generally needed/recommended in younger babies. By around 4-5 months some babies may sleep through the night.