Reflux in Babies - Symptoms and Treatments

As a registered nurse and mom to four kids, I have seen my fair share of reflux in babies, but what is it exactly? Here's an explanation of reflux, GER, and GERD and how they are treated.

Newborn reflux, or gastroesophageal reflux (GER) is when a baby regurgitates or spits up milk. It is very common and something that many parents have to deal with. Besides being messy, it is usually harmless. If your baby has complications like extreme irritability, trouble eating, or trouble gaining weight, it may be gastroesophageal reflux disease (GERD).

Key takeaways

Reflux (spitting up) in newborns and infants is common and isn’t usually painful or problematic.
Babies who seem to be in pain, have eating problems, or have other complications with reflux may have GERD. Speak to your baby’s doctor if you think they have GERD.
Reflux and GERD in infants can usually be treated at home by keeping them upright after feeds, giving them smaller and more frequent feeds, burping well, and keeping them from secondhand smoke exposure.
Acid-reducing medication isn’t usually recommended but might be prescribed if other methods aren’t helping.
Reflux in babies improves with age and is usually gone around 9-12 months.

What is acid reflux in newborns and babies?

Newborn reflux, or gastroesophageal reflux (GER), is very common. It is when the contents of the stomach come up into the esophagus. This often happens for newborns for a few reasons.

For one, the ring of muscles between the stomach and the esophagus — called the lower esophageal sphincter (LES) — is immature in babies and is often open when it isn’t supposed to be, allowing stomach contents to move upward.

In addition to this, a baby’s diet consists of only liquid milk, which moves easily. Young babies also spend a lot of time lying down, so gravity isn’t holding their food down.

Spit up, while messy, usually isn’t painful for babies and isn’t alone a cause for concern. GER isn’t something that needs to be treated.

However, if the spit-up is accompanied by complications that affect your baby, they may have gastroesophageal reflux disease (GERD), which might need treatment.

Newborn reflux symptoms

How does a baby with reflux behave? Infant reflux symptoms include spitting up or regurgitating milk after feeding. If the baby has reflux alone, but it isn’t GERD, they will seem mostly content even when they spit. If they have GERD there will probably be other symptoms along with the spit-up.

Signs of GERD in infants include:

Frequent and intense spit up
Intense or projectile vomiting
Crying when spitting up
Blood or greenish color in spit up
Arching back and moving neck as if in pain, especially after eating
Irritability, specifically after eating
Fussy eating or refusing to eat
Hard or swollen belly
Gagging or choking with spit up
Coughing, wheezing, or breathing troubles
Poor weight gain
Less wet and dirty diapers

If your baby shows any of these signs, talk with their pediatrician about if it could be GERD. There are things other than GERD that could cause some of these symptoms in infants.

Your baby's doctor may want to rule out other problems. They will ask questions about your baby’s symptoms and eating habits and look at their growth. They might want to perform some tests to confirm they have GERD.

Natural remedies for acid reflux in babies

Some ways you can help your baby’s reflux naturally at home are:

Feed them in an upright position.
Keep them upright for about 20-30 minutes after eating.
Burp them when they take natural breaks from eating. Burp them well and often.
Ensure your baby has a proper latch on the breast or bottle to prevent them from swallowing an excess of air, which can cause spit-up and gas pains. A lactation consultant can help you with this if you aren't sure.
Give your baby smaller and more frequent feedings to avoid overfilling their stomach.
Do not smoke around your baby and prevent their exposure to any secondhand smoke.

Your baby’s doctor may suggest you try thickening your baby’s feeds with baby cereal. Only do this under your doctor’s recommendation. It may also be suggested to you to try eliminating dairy from your diet if your baby is breastfed or trying a different formula if formula fed. (Here's a post on how to transition between formulas without rocking the boat too much.)

Infant reflux medicine

Medication isn't typically recommended for babies with uncomplicated reflux. While the medication decreases the amount of acid produced in their stomach, it doesn’t prevent reflux or spitting up. Medication won’t help a “happy spitter” and probably won’t help a baby who is mildly or moderately agitated when they spit.

However, your baby’s doctor might recommend trying medication if they are extremely irritable, have an inflamed esophagus, aren’t eating well, or are losing weight — especially if other home treatments haven’t worked.

The medication your baby might be prescribed would be an H2 blocker such as famotidine (Pepcid) or a PPI (proton pump inhibitor) — such as omeprazole (Prilosec) or lansoprazole (Prevacid). These medications reduce stomach acid to make reflux less painful.

If their medication isn’t working after a few weeks, the doctor will likely have you stop giving it. Oftentimes babies are only on medication for a few months before weaning off of it since reflux symptoms typically improve with age.

What can trigger reflux in babies?

Reflux can be exacerbated by a baby eating too much food in one sitting and overfilling their belly. Lying down immediately after eating or having pressure on their belly right after eating can also cause them to spit up.

Swallowing a lot of air can cause gas pains and spit up. This can cause the baby to be very fussy along with spitting up. Burping periodically during a feed and immediately after will help relieve air and reduce gas and spit-up.

A bad feeding latch could cause your baby to swallow air while eating, which can lead to fussiness and symptoms of infant reflux. Being sure your baby is latching well to the breast or bottle can help. If you aren’t sure about your baby’s latch, consult with their doctor or with a lactation consultant.

If your baby is consistently struggling to latch and seems to be swallowing a lot of air, it might be a good idea to also consult with a pediatric dentist to check for a tongue or lip tie. Tongue ties and lip ties can prevent a good latch and lead to a baby swallowing air while eating. (Wondering if your baby has a lip or tongue tie? Here's some info on what to look for.)

Does a pacifier help with reflux?

It’s possible that sucking on a pacifier can cause an infant to swallow air, which could cause gas and therefore exacerbate symptoms of reflux. The same is true for a bottle nipple that is too small.

However, babies also swallow air while crying, especially if they are screaming or crying intensely. If a pacifier can calm a fussy baby, it may also prevent them from swallowing air while intensely crying.

A pacifier is also a better comfort method than the breast for a baby with reflux. If your baby is hungry, be sure to feed them. But if your baby seems to just want to suck for comfort, a pacifier is a better option to avoid overfilling their stomach and causing discomfort and reflux.

Does warm or cold milk help with acid reflux in babies?

For reflux, the temperature of milk doesn’t matter, and there is no harm in giving a baby cold milk if they like it. Always be sure when preparing a bottle that the milk isn’t too hot. Always check the temperature of the bottle by swirling it to mix the milk, then test a little on your wrist.

How should a baby with reflux sleep?

It is always important to lie your baby down to sleep on their back, on a flat and firm surface, with no surrounding blankets or pillows. (Jump to the reflux section in the safe sleep post from an infant safe sleep expert.)

Will gripe water help with reflux?

Some parents use over-the-counter gripe water to treat their infant’s reflux, although there is no evidence that this helps. Gripe water typically has fennel and ginger in it, which are both thought to aid digestion.

Should I breastfeed if my baby has reflux?

Yes, you should breastfeed your baby if you choose, even if they have reflux. There is no need to stop breastfeeding a baby with reflux or GERD

Foods to eat or avoid when breastfeeding a baby with acid reflux

Unless the doctor suspects a cow’s milk allergy, it usually isn’t necessary for a breastfeeding mom to change her diet. In that case, the doctor might have you eliminate dairy to see if that improves symptoms.

It is true, however, that some foods can change the taste of breastmilk and might contribute to irritability and fussiness. If you suspect a certain food is making your baby’s reflux or fussiness worse, you can try cutting it out of your diet for a week or so to see if it helps.

How long does infant reflux last?

Infant reflux usually occurs around 2 or 3 weeks old as a newborn. Reflux usually peaks in babies around 4 months.

The good news is that after 6 months —when babies are likely to have more developed digestive systems and be able to sit up, as well as having solid foods introduced into their diet —their symptoms often start improving and resolve by 9 to 12 months old.

Again, if you suspect your baby has GERD, or you have other concerns related to their reflux, talk to their doctor. You can usually treat reflux and GERD with natural methods at home, but the doctor can facilitate medical treatment as needed.

Take heart in knowing that spit-up is normal, doesn’t usually negatively affect your baby, and will improve as they grow.