What to Do if Your Baby Has Reflux or GERD

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. Read on to find out how to recognize the signs and symptoms of reflux and GERD in babies, what you can do about it, and 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 the esophagus (the tube that transports food and liquid 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 too weak to hold the liquid or food in your little one’s tummy and can't stop it from traveling back up toward their 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 they're 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—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 they eat, they 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 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 cereal (see note below)

7. If you're feeding your baby formula, you might consider changing formulas.

Note: It’s sometimes difficult to thicken breast milk due to the natural enzymes it contains, so follow your healthcare provider's advice on how best to do this. Also, be aware that oatmeal cereal is preferred over rice cereal because of the concern about the presence of arsenic in rice cereal.

When to See Your Healthcare Provider

If your baby is still experiencing reflux even after you've implemented the prevention strategies listed above, have your little one checked by their healthcare provider. In some cases, the provider may refer you to a pediatric gastroenterologist. If your baby is diagnosed with GERD, their provider may prescribe medicine or 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’s 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. Alternatively, 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 receive an upper endoscopy, which is when a physician uses a tiny fiber optic camera to look inside your baby’s esophagus and/or stomach. If your baby continues to have poor weight gain or worsening problems with feeding, or doesn’t respond to medical management, your healthcare provider may order additional tests or recommend that your baby be seen by a pediatric gastroenterologist.

The Bottom Line

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 child's healthcare provider. If you think your baby's reflux is getting worse, reach out to their 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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