All newborns spit up. The muscles that keep liquid in their little tummies aren’t fully developed at birth, so it’s totally normal to have a bit of a reversal of fortune at each feeding; and that shouldn’t affect sleep. But when your happy spitter becomes an unhappy spitter and your sleep strategies aren’t working, it may be time to explore the possibility that your little one is suffering from reflux.

There are two types of reflux. GER (gastroesophageal reflux) is the reflux you’ve probably heard your mama friends talk about. These are the happy spitter babies—the constant changing of outfits is the most annoying part of this and the best treatment is time. GERD (gastroesophageal reflux disease), on the other hand, is a chronic condition that often needs intervention to prevent damage to babies’ esophagi and mouths.

Aside from not gaining enough weight, being fussy after most feedings and having forceful spit-up episodes, babies with GERD have a lot of trouble sleeping. That’s because the safest sleep position—lying on their back—can cause painful stomach acid to enter baby’s throat and mouth. But since back is still best, even for GER and GERD babies, you’ll need to find other ways to minimize their discomfort while sleeping.

Here are five tips to help your little GERD baby sleep better at night:

1. Hold baby upright for 15-30 minutes after each feeding and burp them several times before putting them down.

You don’t have to sit with baby—upright can be in a carrier. Just don’t make it too tight, as you don’t want to press on baby’s tummy too much, especially if you’re on shirt #5 for the day! You can also walk around while wearing baby.

2. Small but frequent feedings.

I know it seems like that’s all you do right now but the less liquid at a time in your baby’s belly, the easier they can digest it. The more digested, the less spit-up! Check with your doctor about how much your baby should be eating in a day and ask his or her advice about how to divide that amount up into smaller portions.

3. If you’re bottle feeding, take a look at the nipple size.

If the nipple hole is too small for baby and they have to work really hard to get the milk, they’re taking in a lot of air and that can cause gas pain and result in more spitting up. Ask your doctor what nipple size he or she recommends for your baby’s age, given your concerns.

4. If you’re planning on doing any sleep training, find some good solutions for controlling the reflux by talking to your doctor.

If your baby is prescribed medication, you should see a difference in 24-48 hours. You can sleep train even if your baby has reflux. There are several, gentle ways to help them (and you) sleep better even while waiting for this stage to pass. Before you start exploring different sleep training methods, get the okay from your doctor.

5. Do not elevate their crib or bassinet. At all. Ever.

Wedges, putting blankets under their heads, having them sleep in a swing or Rock n’ Play are all big sleep no-nos. It is so tempting to do one of these for a baby who seems uncomfortable but the risk of something happening is too great. The AAP does not endorse any kind of wedge or other positioners for sleeping.

So many newborns struggle with reflux and, as with a lot of new baby things, the best remedy is time. But if you’re worried about the frequency, amount and other symptoms that relate to your baby’s spitting up, talk to your doctor about your concerns. Don’t be afraid to mention your concerns more than once—reflux can be stubborn. And if you get sent home with a prescription to try, grab the giant size detergent while you’re at the store too.

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