Understanding reflux in babies

Reflux is the movement of the contents of the stomach all the way back up into the esophagus, the tube that connects the mouth and stomach. In some cases, the contents come out through the mouth or, more rarely, through the nose.

Alejandro Llanos Chea, M.D., a pediatric gastroenterologist at Children's Health℠, provides details on reflux in babies – including what's normal and when you should take your baby to the pediatrician

Is acid reflux normal in babies?

"Reflux can be normal in babies," explains Dr. Llanos Chea. "Reflux happens in babies because they have a shorter esophagus and smaller stomachs." There's a door between the esophagus and the stomach that's known as the lower esophageal sphincter. Normally that remains closed once food goes into the stomach. In babies, that sphincter tends to open up after they eat.

Causes of reflux in babies

Normal reflux in babies can be caused by the following:

• Baby's small anatomy, such as a small stomach and short esophagus
• Being overfed
• Changing position, such as lying down right after feeding
• Not burping enough after a feed

Signs and symptoms of gastroesophageal reflux disease (GERD) in babies

Many babies have reflux for their first months of life. This reflux passes on its own and does not require treatment. If the reflux lasts longer and the baby has more severe symptoms, this is when the baby may have GERD and may need intervention.

Symptoms of GERD are different for each baby. "When reflux occurs with other troublesome symptoms, or it continues beyond the age of 12 to 18 months, that's when we call it gastroesophageal reflux disease," says Dr. Llanos Chea.

Some common signs and symptoms of GERD in babies may include:

• Frequent, intense vomiting
• Crying or arching the back while feeding, suggesting pain
• Inadequate weight gain
• Refusing to eat
• Distended, full looking belly
• Vomit that is red in color

In rare cases, babies may have respiratory symptoms – such as coughing or wheezing – related to reflux. In most cases, however, respiratory issues are not related to reflux.

If your baby is showing any of the signs of GERD, there's a possibility that they have an underlying health condition that's causing the symptoms. Speak with your pediatrician about whether they recommend additional testing or specialty care.

Tips for treating reflux in babies

It's important to realize that, in most cases, reflux in babies is not acid. Therefore, the treatment for reflux in babies typically focuses on reducing the reflux itself and not necessarily on reducing acid. Dr. Llanos offers tips to help reduce reflux in babies:

1. Lifestyle modifications

The first course of treatment for reflux in babies is typically lifestyle modification. These modifications include:

• Continuing to breastfeed if you're breastfeeding your baby
• Burping baby sufficiently after feeding
• Keeping baby in an upright position for 15 to 20 minutes after feeding
• Reducing feed amounts by feeding your baby smaller amounts more often
• Trying a smaller nipple size if your baby is bottle-fed

2. Cow's milk protein elimination

Another option your baby's pediatrician may suggest is eliminating cow's milk protein from your baby's diet. "If your baby drinks formula, this means trialing a hypoallergenic formula that doesn't contain intact cow's milk protein" explains Dr. Llanos Chea. "If your baby is breastfed, mom will need to eliminate all cow's milk and milk products from her diet."

3. Thickening feeds

If lifestyle modifications aren't enough to control your baby's reflux symptoms, the next treatment course is typically trying to thicken their feeds. Doing so may:

• Decrease reflux symptoms
• Decrease regurgitation
• Increase baby's weight gain

If your baby drinks formula, you can try an anti-reflux formula that already includes a thickener. There are also commercially available thickeners that you can purchase separately and then add to your baby's formula or breastmilk. Other options for thickening feeds include rice cereal or baby oatmeal.

4. Referral to pediatric gastrointestinal (GI) doctor

If your baby doesn't improve using lifestyle modifications or with thickened feeds, your pediatrician will likely refer your baby to a pediatric GI doctor. From there, the GI doctor will typically perform testing to determine if your baby has an underlying health condition that could be causing the reflux symptoms.

When to see a doctor for reflux in babies

"Although reflux can be distressing for babies and parents, it's important to realize that the condition will pass, and most babies with reflux will not have any long-lasting effects," says Dr. Llanos Chea. If your baby exhibits any of the concerning reflux symptoms, make an appointment with your pediatrician.