Reflux and GERD in Babies: Spitting Up, Warning Signs and Treatment

Gastroesophageal reflux (GER) — usually just called reflux, or spitting up — happens when food or milk comes back up from a baby's stomach into the esophagus, the tube that carries food from the mouth to the stomach. It is very common in healthy babies.

Gastroesophageal reflux disease (GERD) is a more serious, longer-lasting form. It can cause feeding problems, discomfort, or symptoms that affect a baby's growth or sleep.

Why it happens

A ring of muscle called the lower esophageal sphincter works as a valve between the esophagus and the stomach. It relaxes when a baby swallows, letting food through, and otherwise stays closed so the stomach's contents stay put.

• With reflux, the muscle isn't fully developed yet, so stomach contents slip back up and the baby spits up (regurgitates). As the muscle matures, the spitting up should stop.
• With GERD, the muscle is weak or relaxes at the wrong times, so stomach contents come up more often or cause irritation.

How common it is, and how long it lasts

Most babies spit up several times a day during their first 3 months. Reflux usually starts improving by 6 months of age, and reflux that continues after 18 months is unusual. GERD is less common; its symptoms ease as babies grow, and only a small number are still affected at 12 months. A baby may have GERD if symptoms keep them from feeding well or last longer than 12 to 14 months.

Reflux and GERD are more likely in babies who:

• were born early (premature);
• have lung problems such as cystic fibrosis;
• have conditions affecting the nervous system, such as cerebral palsy;
• have a hiatal hernia, where part of the stomach pushes up into the chest;
• have had surgery on the esophagus.

Symptoms

The main symptom of both is spitting up. GERD may also cause:

• arching of the back, often during or just 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. Call your baby's health care provider about any of these — especially if your baby isn't gaining weight.

Diagnosis

Usually a provider diagnoses reflux from the baby's symptoms and medical history alone. Tests are needed only if symptoms don't improve with feeding changes or medicine, or if there are other concerns. One or more of these may be used:

• Upper GI series: the baby drinks or eats barium, a chalky-tasting liquid mixed into a bottle or food, and x-rays follow it through the esophagus and stomach to show the shape of the upper digestive tract.
• Esophageal pH or impedance monitoring: a thin, flexible tube passed through the nose measures when and how much acid or liquid comes up into the esophagus, recorded on a monitor over 24 hours, usually in the hospital.
• Upper endoscopy and biopsy: a long, flexible tube with a light and camera looks at the esophagus, stomach and first part of the small intestine, and small tissue samples may be taken.

Feeding changes that can help

• Thicken feeds with rice cereal added to formula or breast milk — ask your provider how much. If it's too thick, use a different nipple size or cut a small "x" in the nipple.
• Burp often: after every 1 to 2 ounces of formula, or after each breast.
• Don't overfeed — give the recommended amount.
• Hold your baby upright for 30 minutes after feeding.
• Ask before switching formula. If your provider suspects a milk-protein sensitivity, they may suggest a different type.

Medicine and surgery

Most babies don't need medicine. A provider may suggest acid-reducing medicine — sometimes for a short time, to see whether it helps — only if GERD symptoms continue despite feeding changes and the baby has trouble sleeping or feeding or isn't growing or gaining weight properly. Never give your baby medicine unless your provider says to.

Surgery is rarely needed. It may be considered only when reflux causes serious breathing problems or the baby isn't gaining enough weight, and other treatments haven't helped.

Sources

Based on "Reflux in Infants," MedlinePlus, U.S. National Library of Medicine, drawing on the National Institute of Diabetes and Digestive and Kidney Diseases (NIH); a work of the United States government in the public domain. The source says reflux usually goes away by 12 months in one place and that babies usually stop spitting up between 12 and 14 months in another, so this page gives neither as the typical end.