Gastroesophageal Reflux (GER) in Babies

Also called: Gastroesophageal Reflux Disease, GERD, Reflux, Spitting Up

What Is Gastroesophageal Reflux (GER)?

Gastroesophageal reflux (GER), or reflux, is when food and acid from the stomach go back up into the esophagus and sometimes out the mouth or nose.

It’s normal for babies to have gastroesophageal (gass-troh-eh-soff-eh-JEE-el) reflux and some spitting up. Most reflux gets better over time and most babies outgrow it by the time they are 1 year old.

What Are the Signs & Symptoms of Gastroesophageal Reflux?

When babies have reflux, they spit up. Often, this happens after a feeding. Reflux differs from vomiting because vomiting is forceful. Reflux is spitting up that usually isn’t forceful. Sometimes it happens when a baby burps after feeds and liquid comes out of the mouth or nose or both. Babies with reflux usually aren’t fussy or uncomfortable.

What Causes Gastroesophageal Reflux?

A ring of muscle (the lower esophageal sphincter) separates the esophagus from the stomach. Reflux symptoms happen if this ring relaxes at the wrong time or doesn't close as it should. This lets stomach contents flow backward into the esophagus, into the back of the throat, and sometimes out the mouth or nose.

What Is Gastroesophageal Reflux Disease (GERD)?

Reflux that happens a lot; causes problems like poor growth, vomiting, or damage to the esophagus; or lasts past a baby’s first birthday is called GERD (gastroesophageal reflux disease).

Signs of GERD in babies include:

• irritability or inconsolable crying after eating
• choking or wheezing
• spitting up that continues after the baby is 1 year old
• refusing to eat or eating only small amounts
• not gaining weight

GERD can make it hard for babies to get proper nutrition. If your baby isn't gaining weight as expected or is losing weight, talk with your doctor right away.

How Is Gastroesophageal Reflux Diagnosed?

Doctors usually diagnose reflux by hearing about the symptoms and doing an exam and checking a baby’s weight. If your baby has GER symptoms, try to keep track of your baby’s feedings. If you breastfeed your baby, keep a journal of foods you eat too. This can help the doctor figure out what's going on.

For typical reflux symptoms, medical tests usually aren’t needed. 

How Is Gastroesophageal Reflux Treated?

Some simple feeding changes can help most babies with reflux spit up less:

• Avoid overfeeding your baby. Give smaller feedings more often to help prevent reflux. Talk to the doctor about how much and how often to feed your baby.
• Feed your baby in a calm, quiet place without distractions. 
• Burp your baby before and after feeding.
• Feed your baby slowly. Try burping your baby after each ounce.
• Hold your baby upright while feeding and for 15–30 minutes after. Even sitting (such as in an infant seat) after feeding can make reflux worse.
• If you’re breastfeeding, talk to your doctor before changing your baby’s diet or your diet.

Don’t let anyone smoke around your baby. Tobacco smoke can make reflux worse.

Breastfed infants with reflux should continue to breastfeed. Sometimes doctors might recommend that formula-fed babies get formula that’s thickened with infant cereal or be switched to a formula that helps reduce reflux. Talk with your doctor before making any changes to your baby’s formula.

Medicines like antacids don’t help babies with reflux who are happy and growing well. Antacids can only decrease the acid in the stomach and would not stop the reflux from happening. Doctors sometimes try antacids for babies with GERD who are very irritable or not gaining weight. If these don’t help, the doctor may want the baby to go to a pediatric gastroenterologist (GI).

When Should I Call the Doctor?

Call the doctor if your baby has reflux and:

• doesn’t seem to be growing as expected
• cries a lot more than usual
• won't eat, or cries and arches away from the bottle or breast during feedings
• coughs, chokes, wheezes, or has trouble breathing
• has forceful vomiting more than a few times in a 24-hour period
• has blood in the poop
• still has problems with reflux after age 1

Go to the ER right away if your baby throws up blood or bile (a green or yellow liquid).

What Else Should I Know?

It can be a challenge if your baby has reflux, but remember that in time the spitting up will get better.