Reflux in Infants

What is reflux (GER) and GERD?

Gastroesophageal reflux (GER), often called reflux or spitting up, happens when food or milk comes back up from your baby's stomach into the esophagus. The esophagus is the tube that carries food from your mouth to your stomach. Reflux is very common in healthy babies. It usually starts to get better by 6 months of age and goes away by 12 months. Reflux that continues after 18 months is unusual.

Gastroesophageal reflux disease (GERD) is a more serious and long-lasting type of reflux. It can cause feeding problems, discomfort, or other symptoms that affect your baby's growth or sleep. Babies may have GERD if symptoms prevent them from feeding well or last longer 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, this muscle is not fully developed and lets the stomach contents back up the esophagus. This causes your baby to spit up (regurgitate). As your baby grows and the 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. This allows stomach contents to come up more often or cause irritation.

How common are reflux and GERD in infants?

Reflux is very common in babies and usually goes away on its own. Most babies spit up several times a day during their first 3 months. They usually stop spitting up between the ages of 12 and 14 months.

GERD is less common. Babies may show symptoms, but they decrease with growth, with only a small number of babies affected by 12 months.

Babies are more likely to have reflux or GERD if they:

• Were born too early (premature)
• Have lung problems, such as cystic fibrosis
• Have conditions that affect the nervous system, such as cerebral palsy
• Have a hiatal hernia (when part of the stomach pushes up into the chest)
• Have had surgery on the esophagus

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
• Coughing
• Gagging or trouble swallowing
• Irritability or crying, especially after eating
• Poor eating or refusing to eat
• Not gaining enough weight or losing weight
• Wheezing or trouble breathing
• Forceful or frequent vomiting

Other conditions can cause similar symptoms. Contact your baby's health care provider if your baby has symptoms, especially if your baby isn't gaining weight.

How are reflux and GERD diagnosed in infants?

In most cases, your provider diagnoses reflux by reviewing your baby's symptoms and medical history. Testing is only needed if symptoms don't get better with feeding changes or medicines, or if there are other health concerns.

Several tests can help your provider diagnose GERD. Sometimes more than one test may be ordered 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 chalky-tasting liquid called barium. The barium is mixed in with a bottle or other food. Several x-rays are taken to track the barium as it goes through your baby's esophagus and stomach.
• Esophageal pH or impedance monitoring, which measures the amount of acid or liquid in your baby's esophagus. A thin flexible tube is placed 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 likely 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. An endoscope is inserted down your baby's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, tissue samples (biopsy) may be taken.

What feeding changes can help treat my infant's reflux or GERD?

Simple feeding changes may help reduce your baby's reflux:

• Add rice cereal to your baby's bottle of formula or breastmilk. Check with your provider 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 provider thinks that your baby may be sensitive to milk protein, they may suggest switching to a different type of formula. Do not change formulas without talking to your provider.

What are the treatments for my infant's GERD?

If feeding changes do not help enough, your provider may recommend medicines to reduce stomach acid. Medicines aren't usually needed, and are only suggested if your baby still has regular GERD symptoms and:

• You have already tried some feeding changes
• Your baby has problems sleeping or feeding
• Your baby does not grow or gain weight properly

Acid-blocking medicines may be given for a short time to see if they help. You shouldn't give your baby any medicines unless your provider tells you to.

If medicines don't help and your baby still has severe symptoms, your provider might talk to you about surgery. Surgery is rarely needed for babies with GERD. It may be considered only if reflux causes serious breathing problems or if your baby isn't gaining enough weight.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Questions for your care team

General prompts to help prepare for your appointment.

• How does this information apply to my situation?
• Which symptoms or results need evaluation?
• Which tests are useful, and what can they tell us?
• What care options, benefits, and risks should we discuss?
• When should I seek urgent help, and whom should I call?
• When is follow-up, and how will we know whether the plan is working?