- Reflux in Infants
- What causes reflux and GERD in infants?
- How common are reflux and GERD in infants?
- What are the symptoms of reflux and GERD in infants?
- How do doctors diagnose reflux and GERD in infants?
- What feeding changes can help treat my infant's reflux or GERD?
- What treatments might the doctor give for my infant's GERD?
- Signs of Acid Reflux in Babies
- Studies on Baby Acid Reflux
- Baby Acid Reflux Symptoms
- How Long Does Acid Reflux in Babies Last
- Is Acid reflux worse for babies at night?
- How is GERD / Acid Reflux Treated in Infants
- Reflux | La Leche League International
- Reflux in Babies and Toddlers
- Cause of GER in Infants
- Preventing GER
- Long-Term Prognosis for Infants with GER
- Pregnancy and birth: Reflux in babies
- How Parents Can Reduce Acid Reflux in Their Infants
- Acid Reflux (GERD) in Babies and Children
- I Think My Baby’s Got Reflux – La Leche League GB
- What are the signs to look out for?
- What might help?
- What causes reflux?
- Adding solids to “thicken feeds” has significant drawbacks
- Switching to formula may not be the answer
- If nothing seems to work
- Something positive?
Reflux in Infants
URL of this page: https://medlineplus.gov/refluxininfants.html
Also called: GER in Infants, GERD in infants, Pediatric Gastroesophageal Reflux
The esophagus is the tube that carries food from your mouth to your stomach. If your baby has reflux, his or her stomach contents come back up into the esophagus. Another name for reflux is gastroesophageal reflux (GER).
GERD stands for gastroesophageal reflux disease. It is a more serious and long-lasting type of reflux. Babies may have GERD if their symptoms prevent them from feeding or if the reflux lasts more than 12 to 14 months.
What causes reflux and GERD in infants?
There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your baby swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don't flow back into the esophagus.
In babies who have reflux, the lower esophageal sphincter muscle is not fully developed and lets the stomach contents back up the esophagus. This causes your baby to spit up (regurgitate). Once his or her sphincter muscle fully develops, your baby should no longer spit up.
In babies who have GERD, the sphincter muscle becomes weak or relaxes when it shouldn't.
How common are reflux and GERD in infants?
Reflux is very common in babies. About half all babies spit up many times a day in the first 3 months of their lives. They usually stop spitting up between the ages of 12 and 14 months.
GERD is also common in younger infants. Many 4-month-olds have it. But by their first birthday, only 10 percent of babies still have GERD.
What are the symptoms of reflux and GERD in infants?
In babies, the main symptom of reflux and GERD is spitting up. GERD may also cause symptoms such as
- Arching of the back, often during or right after eating
- Colic – crying that lasts for more than 3 hours a day with no medical cause
- Gagging or trouble swallowing
- Irritability, especially after eating
- Poor eating or refusing to eat
- Poor weight gain, or weight loss
- Wheezing or trouble breathing
- Forceful or frequent vomiting
NIH: National Institute of Diabetes and Digestive and Kidney Diseases
How do doctors diagnose reflux and GERD in infants?
In most cases, a doctor diagnoses reflux by reviewing your baby's symptoms and medical history. If the symptoms do not get better with feeding changes and anti-reflux medicines, your baby may need testing.
Several tests can help a doctor diagnose GERD. Sometimes doctors order more than one test to get a diagnosis. Common tests include
- Upper GI series, which looks at the shape of your baby's upper GI (gastrointestinal) tract. Your baby will drink or eat a contrast liquid called barium. The barium is mixed in with a bottle or other food. The health care professional will take several x-rays of your baby to track the barium as it goes through the esophagus and stomach.
- Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your baby's esophagus. A doctor or nurse places a thin flexible tube through your baby's nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your baby will wear this for 24 hours, most ly in the hospital.
- Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. The doctor runs the endoscope down your baby's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, the doctor may also take tissue samples (biopsy).
What feeding changes can help treat my infant's reflux or GERD?
Feeding changes may help your baby's reflux and GERD:
- Add rice cereal to your baby's bottle of formula or breastmilk. Check with the doctor about how much to add. If the mixture is too thick, you can change the nipple size or cut a little “x” in the nipple to make the opening larger.
- Burp your baby after every 1 to 2 ounces of formula. If you breastfeed, burp your baby after nursing from each breast.
- Avoid overfeeding; give your baby the amount of formula or breast milk recommended.
- Hold your baby upright for 30 minutes after feedings.
- If you use formula and your doctor thinks that your baby may be sensitive to milk protein, your doctor may suggest switching to a different type of formula. Do not change formulas without talking to the doctor.
What treatments might the doctor give for my infant's GERD?
If feeding changes do not help enough, the doctor may recommend medicines to treat GERD. The medicines work by lowering the amount of acid in your baby's stomach. The doctor will only suggest medicine if your baby still has regular GERD symptoms and
- You already tried some feeding changes
- Your baby has problems sleeping or feeding
- Your baby does not grow properly
The doctor will often prescribe a medicine on a trial basis and will explain any possible complications. You shouldn't give your baby any medicines unless the doctor tells you to.
Medicines for GERD in babies include
- H2 blockers, which decrease acid production
- Proton pump inhibitors (PPIs), which lower the amount of acid the stomach makes
If these don't help and your baby still has severe symptoms, then surgery might be an option. Pediatric gastroenterologists only use surgery to treat GERD in babies in rare cases. They may suggest surgery when babies have severe breathing problems or have a physical problem that causes GERD symptoms.
- Spitting up – self-care (Medical Encyclopedia) Also in Spanish
Signs of Acid Reflux in Babies
For many years, pediatricians have wondered if colic might actually be a burning pain caused by acid reflux in babies (when stomach acid squirts back up the wrong way also known as gastroesophageal reflux disease, or GERD). One book even trumpeted it as “the cause of all colic.” But hundreds of millions of dollars spent on baby antacid medicine (and big-pharma ad campaigns) have been wasted. It’s now proven that GERD rarely causes colic.
Studies on Baby Acid Reflux
Australian doctors examined 24 babies who were so irritable they had to be hospitalized (all under 3 months of age). Each was checked for acid reflux, but only one had it.
In fact, studies now show that even babies who do have severe reflux usually have no pain.
219 babies hospitalized because of severe reflux, 33% had excessive vomiting and 30% were failing to gain weight but few had just excessive crying.
A University of Pittsburgh study confirmed that acid reflux medicine makes no difference for most babies with colic. Doctors caring for 162 infants with marked crying after eating gave half the babies a powerful antacid; the rest got a placebo. What happened? Fifty percent of babies got better on the medicine…but 50% got better on the placebo, too.
In truth, all babies have reflux; we just call it by a different name: spitting up. There is a muscle at the bottom of the esophagus that keeps stomach juice from flowing back up to the mouth.
For the first 6 months it is pretty weak, so babies often burp up a smidge of their last meal…mixed with a bit of stomach acid. And, some barf huge amounts, with no crying at all. Doctors call them happy spitters and suggest just burping them better and not overfeeding.
For these families, the biggest problems caused by acid reflux in infants are milk stains on clothes and sofas.
Despite years of mounting evidence, 82% of pediatricians are still fooled into overprescribing acid suppression medicines. (Most of these medicines are not even FDA approved for infants under 1 year of age.) Frustrated doctors try to calm frustrated parents by giving out hundreds of thousands of antacid prescriptions every year.
Not only is this medicine unnecessary, it may be harmful! Stomach acid is an early line of defense against the bacteria your baby sucks off her fingers and lips and swallows every day.
Studies show that antacid drugs allow bad bacteria to grow in the stomach and may raise the risk for pneumonia and gastroenteritis.
And one type of antacid even had to be pulled from the market because it was found to cause sudden death.
When should you suspect that your baby has a reflux problem? (Gastroesophageal reflux disease, or GERD, is the name of the condition that involves frequent episodes of GER.) Only if you see these telltale signs:
- She vomits more than 5 times a day and more than an ounce each time.
- Her crying occurs with most meals—even early in the day.
- The crying jags don’t improve after 3 months of age. (Acid reflux doesn’t lessen until infants reach 4 to 6 months of age…well after colic is gone.)
- She has episodes of hoarseness or wheezing.
Baby Acid Reflux Symptoms
- Spitting up and vomiting
- Refuses to eat or swallow or has difficulty eating or swallowing
- Irritable during feeding
- Wet burps or hiccups
- Difficulty gaining weight
- Abnormal arching
- Frequent coughing or pneumonia
- Regular gagging or choking
- Difficulty sleeping
How Long Does Acid Reflux in Babies Last
Acid reflux in babies typically begin between weeks 2 and 4. Newborn acid reflux tends to peak around 4 months, and the symptoms finally subside around 7 months. Keep in mind that every baby is different and the acid reflux can last shorter or longer depending on your baby.
Is Acid reflux worse for babies at night?
When babies are suffering from acid reflux they prefer to be held upright. Fussy behavior from reflux can occur all day, rather than just at night. However, if acid reflux is uncomfortable it can cause restlessness in your baby and difficulty sleeping at night.
How is GERD / Acid Reflux Treated in Infants
GERD and acid reflux in infants can be treated in the following ways:
- Elevating the head of the baby’s bassinet
- Holding your baby upright for 30 minutes after feedings
- Change your baby’s feeding schedule for smaller amounts at more frequent periods
Note: So, even if your baby has improved on acid reflux medicine…ask your doctor about trying her off it for a few days, to see if the medicine is really necessary.
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Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.
Reflux | La Leche League International
A baby spitting up occasionally is usually looked at as “something babies do.” According to the late Dr. Gregory White, husband of the late LLL Founder, Mary White, “In a healthy baby, spitting up is a laundry problem, not a medical problem.”
A baby may spit up for lots of reasons:
- Baby is not be able to swallow quickly enough when milk ejects forcefully during a feeding, resulting in swallowing excess air.
- Mother has an oversupply of milk that can result in baby taking too much too fast for the stomach to handle. Either can result in additional air swallowed with the large volumes of milk. Read our post on oversupply.
- Less common reasons are:
- Immature muscle control
- Allergy to foods and/or dietary supplements mother may consume
If the spitting up is frequent and obviously uncomfortable for baby, it may be that your baby is experiencing gastroesophogeal reflux disease, or GERD.
- GERD occurs when the band of voluntary muscle fibers within the esophagus where it enters the stomach fails to keep the stomach contents in the stomach.
- Milk or food, along with acid from the stomach, backs up into the lower esophagus and irritates the tissues there.
- Adults recognize this feeling as heartburn. Read our post on GERD.
If your baby is overall a pleasant and healthy baby with good output and normal growth patterns, be assured that he will ly outgrow this stage by 6-12 months. In the meantime, here are some general tips to keeping spit up episodes to a minimum:
- Use positions for feeding that keep baby’s head higher than her tummy, such as a laid-back position or having baby diagonally across your chest in a cradle hold. Avoid positions that have baby bending at the waist, putting more pressure on her tummy. See Positioning.
- Keep baby upright for 15-20 minutes or so after feedings to allow for digestion to begin. This is a nice time to just lean back with baby on your chest to soothe, talk, sing, or hum to him or to just snuggle.
- Burp gently between sides and at the end of the feeding.
- Try shorter, frequent feedings, if baby is agreeable, to reduce the load in her tummy.
- Try nursing at one breast only each feeding to avoid two strong milk ejections and, therefore, reducing overfeeding and excess swallowing of air.
Occasionally, some older babies will start to spit up when they hadn’t typically been spitting up. If your baby doesn’t seem ill, other reasons might include:
- Something new to his diet – solids, adding or changing vitamins for you or baby, medications for either of you.
- Growth spurt – when babies start feeding more frequently with a growth spurt, they can be bringing in larger volumes of milk and/or more air.
- Teething – the discomfort of the gums may cause baby to be less efficient with her sucking and take in more air. Teething can also result in increased saliva production and swallowing, adding to the volume of fluid and air in her tummy. See Teething.
Reflux in Babies and Toddlers
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Gastroesophageal reflux, or GER, is a common condition affecting about half of young infants. It peaks between 3 and 4 months and usually resolves by 12 months of age. Babies that have GER regurgitate, or spit up, shortly after eating. This happens when stomach contents return up the esophagus and into and the mouth.
Cause of GER in Infants
The cause of GER is an immature digestive system. The muscle that separates the stomach from the esophagus can be underdeveloped in some babies, allowing undigested stomach content to rise up into the esophagus. This muscle matures between 6 and 12 months of age, so only about 10 percent of babies have GER after age 12 to 14 months.
In most cases, reflux is mild and normal. If you have a happy baby who is eating and growing normally, there’s no reason to be concerned. Severe GER, however, can indicate gastroesophageal reflux disease, or GERD, or gastrointestinal obstruction, which are rare but more serious conditions.
Speak with your pediatrician if your baby is not gaining weight, spits up large amounts, vomits forcefully (projectile vomiting), spits up fluid that is green or yellow or contains blood, repeatedly refuses food, has difficulty breathing after vomiting or shows signs of dehydration (such as having dry diapers or extreme fussiness).
Here are some tips to prevent reflux in your baby:
- Feed small, frequent meals.
- Get rid of excess gas by burping your baby more frequently not only after, but during feeding.
- Keep your baby upright at least 30 minutes after feeding. This may result in less reflux than when babies recline in an infant seat.
- Continue to breast-feed. For breast-feeding moms, a 2 to 4 week trial of avoiding milk and other dairy products as well as eggs may be worthwhile, because sometimes GER actually reflects symptoms of an infant’s food sensitivity. Restricting these or other foods in the diet of a breast-feeding mother is not recommended as a way to prevent food allergies in her baby. But if an allergy has developed, changing the mother’s diet can help.
- If you use infant formula, talk with your baby’s doctor about switching to a thickened formula or one with protein that is already broken down or “predigested.”
A small percentage of infants are unable to handle proteins found in milk or soy formulas. Consult with your pediatrician about alternative formulas. To pinpoint trigger foods, keep a journal of all foods eaten and symptoms experienced, and add only one new food at a time.
Registered dietitian nutritionist can help you analyze a food journal and instruct you on creating the best eating plan for your baby.
Long-Term Prognosis for Infants with GER
Most babies grow reflux as their gastrointestinal track matures. Check with the baby’s doctor to monitor weight and ensure your baby is staying hydrated and not experiencing an obstruction of the gastrointestinal tract.
However, if symptoms continue beyond the first year of age, especially if your toddler is showing signs of poor growth or problems with breathing, consult your baby’s health care provider. Babies who frequently spit up may be more ly to develop GERD as older children.
Pregnancy and birth: Reflux in babies
Created: July 3, 2008; Last Update: March 22, 2018; Next update: 2021.
Parents are often seen with a burp cloth on their shoulder when carrying their baby: It absorbs milk that the baby spits up. There's usually no need to worry if your baby regularly spits up milk or food.
Babies gain a lot of weight in their first year, so they also need a lot of food. That can sometimes be quite tough on their digestive system, which is why babies often spit up milk in the first few months of life. It is quite normal for about a spoonful of milk to come back up.
Reflux is only rarely a sign that your baby is not well. If they are unwell, then they will generally have other symptoms too, such as not growing as quickly as they should be.
Food travels to the stomach through the esophagus (food pipe). There's a ring of muscle at the bottom of the esophagus, called the esophageal sphincter. This ring makes sure that food stays in the stomach once it gets there. But this ring of muscle often doesn’t work properly in babies, and their stomach is still quite small too.
Reflux isn’t the same as vomiting. When we vomit, the diaphragm and the muscles in the esophagus contract, causing food to be actively forced back the stomach. People usually feel nauseous too. In reflux, on the other hand, food simply rises back up the esophagus and a small amount flows into the mouth. The medical term for this is “regurgitation.”
Lower sphincter muscle of the esophagus
A half to two thirds of all babies have reflux at least once a day until they are six months old. So there's no need to worry if your baby spits up often. It can be inconvenient sometimes, but as long as your baby doesn't have any other symptoms, it's perfectly normal. Babies don't spit up milk because they have been fed too much or because they don’t tolerate the milk.
Only 5 100 babies spit up food once they are ten to twelve months old. The rest of them simply grow it without any treatment. The age at which reflux stops can vary. Some babies still spit up food regularly even once they are older than one year.
If your baby is well-fed and is growing healthily, it is unly that reflux is caused by an underlying medical problem. Babies who spit up but don't show any other symptoms don't have to be examined. However, you should see a doctor if your baby
- spits up very frequently, isn't growing properly and isn’t gaining as much weight as should be expected at their age.
- is in pain – then they will cry a lot or frequently arch their back.
- coughs, wheezes or clears their throat frequently. This can be a sign that your baby’s esophagus is irritated by stomach acid.
- doesn’t only spit up after being fed, but also when they haven’t eaten anything.
- vomits: In other words, if the muscles in the stomach and intestines contract and larger amounts of food are spit up with greater force.
- has a fever and diarrhea: If babies lose too much fluid, they can quickly become dehydrated, which can be very dangerous.
Reflux is only rarely a sign of something more serious, for example in premature babies and toddlers with illnesses that slow down their development. Frequent reflux can then be a sign that the intestines haven’t formed properly. If that is the case, your baby will probably vomit regularly and have stomach cramps that you can see or feel. It is then important to see a doctor very quickly.
Frequent reflux might also be a sign of gastro-esophageal reflux disease (GERD). In GERD, the food that comes back up can damage the food pipe or lead to respiratory illnesses if it gets into the lungs.
- Gortner L, Meyer S, Sitzmann FC. Duale Reihe Pädiatrie. Stuttgart: Thieme; 2012.
- Mazur LJ, Smith HD. Gastroesophageal reflux in the infant. In: Moyer V, Elliott E (Ed). Evidence-based pediatrics and child health. London: Wiley; 2004.
- IQWiG health information is written with the aim of helpingpeople understand the advantages and disadvantages of the main treatment options and healthcare services.Because IQWiG is a German institute, some of the information provided here is specific to theGerman health care system. The suitability of any of the described options in an individualcase can be determined by talking to a doctor. We do not offer individual consultations.Our information is the results of good-quality studies. It is written by ateam ofhealth care professionals, scientists and editors, and reviewed by external experts. You canfind a detailed description of how our health information is produced and updated inour methods.
How Parents Can Reduce Acid Reflux in Their Infants
Sally Anscombe/Getty Images
Many babies have spitting up problems that don't require treatment. In these babies, referred to as “happy spitters,” symptoms usually disappear after six to eight months.
For some infants, however, symptoms are a sign of something more serious, such as gastroesophageal reflux disease (GERD), and they need medical attention.
Along with recommendations from your doctor, what can you do to ease your baby's symptoms whether she has harmless spitting or needs medical treatment for reflux?
Your pediatrician will be able to distinguish whether your baby's symptoms are normal “spitting up” or if she instead has a chronic medical condition which needs treatment. She will then be able to give you advice on the best treatment for your baby.
If your baby is experiencing reflux, the following tips may help to reduce her discomfort, and hopefully, spitting up.
Holding infants in an upright position both during feedings and for at least 30 minutes after feedings will help to reduce the amount of gastric reflux. While holding your baby, however, make sure her abdomen isn't compressed, which could worsen reflux.
Even though the prone (on the stomach) sleeping position was recommended for babies with reflux in the past, this is no longer recommended. In infants with GERD, the risk of SIDS generally outweighs the potential benefits of prone sleeping.
Having an infant sleep on her stomach is only considered in very unusual cases in which the risk of death from complications of GERD outweighs the potential increased risk of SIDS. Always place your baby to sleep on her back unless your pediatrician has told you otherwise.
Some physicians may recommend elevating the head of your baby's crib so that she is sleeping on an incline in order to allow gravity to help keep her stomach contents where they belong.
While studies have not looked specifically at babies sleeping at an incline in their cribs, studies of babies sleeping at an incline in a car seat find that this practice is associated with an increased risk of SIDS.
It is very important to talk with your infant's doctor before undertaking any changes in sleeping positions.
Feedings every two to three hours, while your infant is awake, will often reduce the occurrence of gastric reflux. Overfeeding can increase abdominal pressure, which can lead to gastric reflux. Using nipples with smaller holes may also help by reducing the amount of air the baby takes in and therefore, how distended her abdomen becomes (which, in turn, increases reflux).
If your child has begun solid foods (usually recommended after 4 months of age and not sooner) rice cereal may help to reduce the amount an infant will regurgitate. Start with one teaspoon of rice cereal to each ounce of formula. If your baby is breastfed, try pumping and then adding rice cereal to the breast milk.
Certain foods—such as caffeine, chocolate, and garlic—can promote reflux, so if you breastfeed your infant, you should consider cutting these foods your diet. Eliminating milk or eggs from their diet has also been helpful for some breastfeeding mothers.
Other factors may contribute to spitting up in babies who breastfeed. If you have strong let-down reflex, your baby may choke when latching on. If this occurs, some mothers pump for a moment before breastfeeding. If you are engorged when you begin feeding, your baby may have difficulty latching on and may swallow more air. Again, pumping for a short while before feedings may be helpful.
Just as adults can develop heartburn and reflux if they are feeling anxious, babies who are anxious or overstimulated may also spit up more. Make feeding time more enjoyable by eliminating loud noises and distractions and dimming the lights. wise, avoid vigorous activity and active play for up to 30 minutes after a feeding.
The way your infant is positioned in a car seat can cause regurgitation to increase. If your infant slouches over, it causes abdominal compression, increasing the risk of reflux. Using simple supports to keep your infant upright will prevent this.
Burping your infant several times during the feeding (after every ounce or two) will help minimize gastric pressure and the reflux it can cause. Waiting to burp your infant until after she has a full stomach can increase the chances of regurgitation.
Your doctor may recommend medications (such as Prilosec [omeprazole], which reduces stomach acid) if your baby has severe reflux symptoms such as choking and coughing.
Studies to date have shown little benefit on the whole with this practice, though it may be helpful for some babies.
Reducing stomach acid may also increase the risk of infection (since acid can kill off harmful bacteria) so these drugs should only be used with careful guidance from your physician.
On occasion, surgery (open Nissan fundoplication or ONF) may be needed for babies with severe reflux. If you are considering this procedure, make sure to talk to a pediatric surgeon who has performed many of these procedures and can tell you what you can expect with the surgery.
Avoid tight elastic around your baby's waist, and keep diapers loose. Also, don't give your infant caffeinated beverages, orange juice, or other citrus juices.
Reflux in babies can be very frustrating, and there is rarely one step alone which helps. In addition, every baby is different, and some of these tips may work better than others.
Fortunately, reflux often improves as a baby gets older, and for those in which it persists, there are a variety of treatment options.
Please remember that if you have any questions about your baby's health—no matter how seemingly small—it’s always a good idea to consult with your pediatrician.
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Additional Reading
- Chen, P., Soto-Ramirez, N., Zhang, H., and W. Karmaus. Association Between Infant Feeding Modes and Gastroesophageal Reflux: A Repeated Measurement Analysis of the Infant Feeding Practices Study II. Journal of Human Lactation. 2017. 33(2):267-277.
- Kliegman, Robert M., Bonita Stanton, St Geme III Joseph W., Nina Felice. Schor, Richard E. Behrman, and Waldo E. Nelson. Nelson Textbook of Pediatrics. 20th Edition. Philadelphia, PA: Elsevier, 2015. Print.
- Lightdale, J., Gremse, D., Section on Gastroenterology, Hepatology, and Nutrition. Gastroesophageal Reflux: Management Guidance for the Pediatrician. Pediatrics. 2013. 131(5):e1684-95.
Acid Reflux (GERD) in Babies and Children
It's common for infants to spit up after a meal. That little spit is called gastroesophogeal reflux or GER.
But frequent vomiting associated with discomfort and difficulty feeding or weight loss may be caused by something more serious known as GERD (gastroesophageal reflux disease).
Both GER and GERD can cause the upward movement of stomach content, including acid, into the esophagus and sometimes into or the mouth. Often times, that vomiting is repetitive. The differences between the two conditions are marked by the severity and by the lasting effects.
Older children also can have GERD.
Most of the time, reflux in babies is due to a poorly coordinated gastrointestinal tract.
Many infants with GERD are otherwise healthy; however, some infants can have problems affecting their nerves, brain, or muscles.
According to the National Digestive Diseases Information Clearinghouse, a child's immature digestive system is usually to blame and most infants grow the condition by the their first birthday.
In older children, the causes of GERD are often the same as those seen in adults. Also, an older child is at increased risk for GERD if he or she experienced it as a baby. Anything that causes the muscular valve between the stomach and esophagus (the lower esophageal sphincter, or LES) to relax, or anything that increases the pressure below the LES, can cause GERD.
Certain factors also may contribute to GERD, including obesity, overeating, eating spicy or fried foods, drinking caffeine, carbonation, and specific medications. There also appears to be an inherited component to GERD, as it is more common in some families than in others.
The most common symptoms of gastroesophageal reflux in infants and children are:
- Frequent or recurrent vomiting
- Frequent or persistent cough or wheezing
- Refusing to eat or difficulty eating (choking or gagging with feeding)
- Heartburn, gas, abdominal pain, or colicky behavior (frequent crying and fussiness) associated with feeding or immediately after
- Regurgitation and re-swallowing
- Complaining of a sour taste in their mouth, especially in the morning
Many other symptoms are sometimes blamed on GERD, but much of the time, we really aren't sure whether reflux actually causes them. Other problems seen in young children and infants that may be blamed on the condition include:
- Poor growth
- Breathing problems or wheezing
- Recurrent pneumonia
Yes. Most babies outgrow reflux by age 1, with less than 5% continuing to have symptoms as toddlers. However, GERD can also occur in older children. In either case, the problem is usually manageable.
Usually, the medical history as told by the parent is enough for the doctor to diagnose GERD, especially if the problem occurs regularly and causes discomfort. The growth chart and diet history are also helpful, but occasionally, further tests are recommended. They may include:
- Barium swallow or upper GI series. This is a special X-ray test that uses barium to highlight the esophagus, stomach, and upper part of the small intestine. This test may identify any obstructions or narrowing in these areas.
- pH probe. During the test, your child is asked to swallow a long, thin tube with a probe at the tip that will stay in the esophagus for 24 hours. The tip is positioned, usually at the lower part of the esophagus, and measures levels of stomach acids. It also helps determine if breathing problems are the result of GERD.
- Upper GI endoscopy. This is done using an endoscope (a thin, flexible, lighted tube and camera) that allows the doctor to look directly inside the esophagus, stomach, and upper part of the small intestine.
- Gastric emptying study. Some people with GERD have a slow emptying of the stomach that may be contributing to the reflux of acid. During this test, your child drinks milk or eats food mixed with a radioactive chemical. This chemical is followed through the gastrointestinal tract using a special camera.
There are a variety of lifestyle measures you can try for acid reflux in babies and older children:
- Elevate the head of the baby's crib or bassinet.
- Hold the baby upright for 30 minutes after a feeding.
- Thicken bottle feedings with cereal (do not do this without your doctor's approval).
- Feed your baby smaller amounts of food more often.
- Try solid food (with your doctor's approval).
For older children:
- Elevate the head of the child's bed.
- Keep the child upright for at least two hours after eating.
- Serve several small meals throughout the day, rather than three large meals.
- Make sure your child is not overeating.
- Limit foods and beverages that seem to worsen your child's reflux such as high fat, fried or spicy foods, carbonation, and caffeine.
- Encourage your child to get regular exercise.
If the reflux is severe or doesn't get better, your doctor may recommend medication.
Drugs to decrease stomach acid include:
Researchers aren't sure whether decreasing stomach acid lessens reflux in infants.
For the most part, drugs that decrease intestinal gas or neutralize stomach acid (antacids) are very safe. At high doses, antacids can cause some side effects, such as diarrhea. Chronic use of very high doses of Maalox or Mylanta may be associated with an increased risk of rickets (thinning of the bones).
Side effects from medications that inhibit the production of stomach acid are uncommon. A small number of children may develop some sleepiness when they take Zantac, Pepcid, Axid, or Tagamet.
Surgery isn't often needed to treat acid reflux in babies and kids. When it is necessary, a fundoplication is the most often performed surgery. During this procedure, the top part of the stomach is wrapped around the esophagus forming a cuff that contracts and closes off the esophagus whenever the stomach contracts — preventing reflux.
The procedure is usually effective, but it is not without risk. Discuss the potential risks and benefits of any operation with your child's doctor.
SOURCES: The National Institute of Diabetes and Digestive and Kidney Diseases. National Digestive Diseases Information Clearinghouse. American Association of Family Physicians.
© 2018 WebMD, LLC. All rights reserved.
I Think My Baby’s Got Reflux – La Leche League GB
In the early weeks, it is normal for a baby to “spit-up” and around half of all newborns do, at least once a day. As a baby’s digestive system matures, this usually decreases and for most mothers it is just a short-term inconvenience. 1
However, in some babies the valve between the stomach and oesophagus does not close properly. The stomach contents flow back into the oesophagus and can cause vomiting.
There are several reasons a baby may vomit and a doctor will need to rule out other causes, but one possible diagnosis is GERD (gastroesophageal reflux disease), also referred to as GOR (gastro-oesophageal reflux).
Not all reflux is noticeable and it doesn’t always make a baby uncomfortable, but when it’s severe it can be painful and cause distress to mother and baby.2
What are the signs to look out for?
- A baby may choke and cough, or seem to have a sore throat. Some babies have bad breath.
- A mother may notice back arching and head turning. The baby may stretch out flat as this reduces pain, instead of snuggling close to his mother.
- A baby may cry for long periods and be irritable during and after feeds. His cries may sound hoarse. This sometimes leads to a misdiagnosis of colic.
- A baby may seem to fight feeding or even refuse to feed. There may be poor weight gain.
What might help?
A few things may help lessen pain. Keeping the baby’s head higher than his bottom during feeding can be more comfortable for him/her.
Being at a 30 to 40 degree angle with the baby’s bottom in the mother’s lap and his torso supported on the mother’s crossed leg may be one way for the baby to feed more comfortably.
If the baby is feeding in a side-lying position then s/he may feed better on the left side; moving the baby over instead of turning him round if changing sides. It’s preferable to move the baby to a more upright position as soon as possible. 3
It can be useful to consider “head above bottom” at all times. A baby sling can be helpful for this purpose.
A baby with reflux may find it uncomfortable to lay down flat and might cry or spit up when laid in a cot. Some parents choose to keep their baby in their arms or a sling for naps.
Others find it helps to keep their baby upright for a period of time after feeds before they lay them down.
Changing the baby on his side may be preferable to avoid putting pressure on his stomach when lifting his legs. A lay-back bouncy seat can be useful.
Babies with reflux can find travelling in a car seat uncomfortable due to the pressure on their stomachs and some mothers choose to use the car less while it distresses the baby and instead use public transport while carrying the baby in a sling.
As the opening from the stomach to the oesophagus is usually on the right side, keeping the right side higher than the left may also help.
Short, frequent feeds ease the incidence and discomfort of reflux. 4 If a mother has a copious milk supply then feeding one side only at each feed may ease discomfort. However, it is worth looking at what seems to suit your baby.
What causes reflux?
There are several suggestions as to why reflux happens. It’s sometimes suggested that it’s caused by an immature sphincter muscle 5 and that this will strengthen as the baby grows.
Other studies have shown a link between reflux and allergies, or an intolerance to cows’ milk protein. 6 A mother could try to remove dairy products from her diet, in consultation with a medical professional, to see if that improves things.
One of the biggest causes can be fast-flowing milk or oversupply. If a baby seems to be choking or gasping because of a fast flow, there are several things to try. You can take him off the breast for a moment until the flow slows, or feed in a more upright position.
Making sure a baby has a deep latch and good tongue function can also make a difference. Tongue-tie can affect a baby’s sucking action and can lead to a baby swallowing too much air. You can find further suggestions here:
Adding solids to “thicken feeds” has significant drawbacks
It is sometimes suggested that babies with reflux will be helped by adding solids to their diet to thicken feeds.
In 2018, a study in the British Medical Journal reported that “Feed thickeners are commonly used for managing infants with GOR despite the lack of strong supporting evidence”.
7 As most existing studies assessing the efficacy of thickened feeds on reflux symptoms mainly include formula-fed infants, there is limited information available on the potential reduction of regurgitation in breastfed babies.8
Aside from the lack of strong evidence, this treatment has some significant drawbacks.
Introducing solid food too early replaces human milk, which is nutritionally ideal for babies, with a food of less nutritional value. It will also lower a mother’s milk supply.
Regurgitating solids can add to the baby’s distress and discomfort, and introducing solids too early might also trigger allergies in an already sensitive baby.
Switching to formula may not be the answer
Although it is sometimes suggested that breastfeeding mothers change to formula, this may well worsen symptoms. While both breastfed and formula fed babies can experience reflux, research has shown that formula fed infants have episodes of reflux more often than breastfed babies and they last longer.9
As one cause of reflux can be a delayed emptying of the stomach, the fact that human milk leaves the stomach twice as quickly as formula means that breastmilk lessens the possibility of reflux. 10
If nothing seems to work
If a baby continues to be distressed, then a doctor may refer you to a gastroenterologist who may prescribe medications which can help.
In his Guide to Breastfeeding, 11 Dr. Jack Newman, a member of La Leche League International’s Panel of Professional Advisors, explains how breastmilk is full of immune factors that interact with each other and protect the baby from bacteria, viruses and other micro-organisms.
They work by forming a protective layer on a baby’s mucous membranes which line the gut, respiratory tract and other areas. This stops micro-organisms from invading the body through these mucous membranes. Dr. Newman explains that a baby who spits up gets double protection, first when the milk goes down to the stomach, and again when he spits it up.
If you would further help and support look for your nearest LLL group or Leader.
You can find further information here:
Written by Anna Burbidge, LLLGB 2019
1 Nancy Mohrbacher, “Breastfeeding Answers Made Simple. A Pocket Guide for Helping Mothers”, (http://www.lllgbbooks.co.uk/store/p94/Breastfeeding_Answers_Made_Simple%3A_A_Pocket_Guide_for_Helping_Mothers.
2 La Leche League International, “The Womanly Art of Breastfeeding”, 8th Edition, 2010, p. 417. (http://www.lllgbbooks.co.uk/store/p91/The_Womanly_Art_of_Breastfeeding.html)3 Boekel, S.
“Gastro-esophageal reflux disease (GERD) and the breastfeeding baby”, ILCA Independent Study Module. Raleigh, North Carolina: International Lactation Consultant Association, 2000.
4 La Leche League International, “The Womanly Art of Breastfeeding”, 8th Edition, 2010, p. 417. (http://www.lllgbbooks.co.uk/store/p91/The_Womanly_Art_of_Breastfeeding.html)
6 Nancy Mohrbacher, “Breastfeeding Answers Made Simple”, 2010, pp. 517-520. (http://www.lllgbbooks.co.uk/store/p93/Breastfeeding_Answers_Made_Simple.
7 T’ng Chang Kwok, Shalini Ojha and Jon Dorling: “Feed thickeners in gastro-oesophageal reflux in infants”, BMJ Paediatrics Open 2018 (https://bmjpaedsopen.bmj.com/content/2/1/e000262)