All babies spit up from time to time, especially after they've been fed. But if spitting up — also known as reflux — happens increasingly often to your little one, it can be an indication of a problem called Gastroesophageal Reflux Disease or GERD for short.

Although you may have thought only adults have acid reflux, babies can have it, too, and in this article we'll explain why this happens.

Read on to find out how to recognize the signs and symptoms of reflux and GERD in babies, and what you can do about it, as well as when it's important to see your baby's healthcare provider.

What Is Acid Reflux and Gastroesophageal Reflux Disease (GERD) in Babies?

Reflux happens when the content of your baby's stomach backs up into her esophagus (the tube that transports foods and liquids from the throat to the stomach). This is because the sphincter (the muscle that locks off the esophagus from the stomach) is either too relaxed or is too weak to hold the liquid or food in your little one's tummy and can't stop it from travelling back up toward her throat.

Almost all babies have reflux from time to time, since the sphincter is still maturing. Spitting or vomiting is quite common in about half of all infants under 6 months old, and happens in about 5 percent of babies once they reach 12 months of age.

Your baby will most likely grow out of reflux once she's between about 1 and 2 years old. If the reflux doesn't go away within this time or gets worse, it could indicate there's a problem that may need medical attention.

When reflux becomes chronic, that is, it starts happening all the time, it's referred to as GERD. This condition is something your baby's healthcare provider can diagnose.

What Are the Symptoms of Reflux and GERD?

If you're seeing any of the following symptoms in your baby before or after she's eaten, she may have reflux (or GERD if the symptoms are happening very frequently):

  • Frequent vomiting or regurgitating

  • Periods of coughing, choking, or wheezing, especially if the reflux gets into the windpipe

  • Wet burps or hiccups

  • Irritability or crying after eating

  • Difficulty swallowing

  • Refusing to eat or eating only small amounts

  • Arched back

  • Being underweight or not gaining weight

  • Continuing to spit up after the first birthday.

These symptoms may get worse if, after eating, your baby is placed lying down or seated in a car seat.

How to Prevent Reflux

Here are seven ideas you can try to prevent reflux in your baby, and that may also help prevent it from turning into GERD:

  1. Avoid overfeeding your baby

  2. Feed your baby smaller amounts more frequently

  3. Burp your baby more frequently, both during and after each meal

  4. After a feeding, limit play and activities such as like tummy time where your baby lies down for longer periods

  5. After a feeding, place your baby in an upright position for at least 30 minutes

  6. With your healthcare provider's approval, thicken your baby's breast milk or formula with up to 1 tablespoon of oatmeal

  7. If you're giving formula, you might consider changing formulas.

acid reflux in babies

When to See Your Healthcare Provider

If your baby is still experiencing reflux even after you've implemented the prevention strategies listed above, have her checked by her healthcare provider. In some cases, your provider may refer you to a pediatric gastroenterologist. If your baby is diagnosed with GERD, your provider may prescribe medicine or may suggest some dietary changes, such as switching formulas, to see if your baby's condition is due to an allergy.

Besides thickening your breast milk or formula as mentioned above, your baby's healthcare provider may suggest switching to a protein hydrolysate formula (a type of formula that is hypoallergenic) to see if symptoms improve in one to two weeks. If it turns out your baby has an allergy to the proteins found in a milk - or soy-based formula, switching formulas may be the best resolution in preventing and keeping the reflux from returning.

Testing for Reflux and GERD

If your baby is struggling to gain weight properly or is in extreme discomfort because of the reflux, the healthcare provider may prescribe medicine. Or your baby's provider may decide to run tests to rule out other problems.

Tests to diagnose the reflux as GERD may include a barium swallow, which is when your baby or young child would need to swallow a solution, and then get X-rays; or an upper endoscopy, which is when a physician uses a tiny fiber optic camera to look inside your baby's esophagus and/or stomach.

FREQUENTLY ASKED QUESTIONS

  • If you see any of the following symptoms in your baby before or after he’s eaten, he may have reflux or GERD:
    • Vomiting or regurgitating
    • Periods of coughing, choking, or wheezing, especially if the reflux gets into the windpipe
    • Wet burps or hiccups
    • Irritability or crying after eating
    • Difficulty swallowing
    • Refusing to eat or taking in only small amounts
    • Arched back
    • Underweight or cannot gain weight
    • Spitting up that continues after his first birthday.
  • You can help prevent your baby from experiencing reflux by
    • avoiding overfeeding him
    • feeding him smaller amounts more frequently
    • burping him more frequently, both during and after each meal
    • limiting his activities, like tummy time, once he’s been fed
    • placing him in an upright position for at least 30 minutes after a feeding
    • thickening his milk or formula with up to 1 tablespoon of oatmeal (with your healthcare provider’s approval)
    • changing his formula, if he’s formula fed.
  • If your baby’s healthcare provider thinks your baby’s formula may be causing reflux or GERD, the provider may suggest switching to a protein hydrolysate formula. This is a type of formula that is hypoallergenic. If your baby has an allergy to the proteins found in a milk- or soy-based formula, this switch may help. It may take one to two weeks for your baby’s reflux symptoms to improve after making this switch.

Know that most bouts of reflux will clear on their own in time, but if this condition does develop into GERD, it can be treated successfully by your healthcare provider. If you think your baby's reflux is getting worse, reach out to his healthcare provider for guidance. It's a good idea to be proactive so that you can help prevent the reflux from getting worse and turning into GERD.

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