Infant reflux

Understanding acid reflux.

Acid reflux happens when the contents of the stomach back up into the esophagus.The esophagus is the tube that carries food from the throat to the stomach. At the bottom of the esophagus — where it joins the stomach — is a ring of muscle that normally opens when you swallow. This ring of muscle is known as the lower esophageal sphincter (LES).

When the LES doesn’t close completely, stomach contents and digestive juices can come back up into the esophagus.

Rarely, infant reflux can be accompanied by worrisome symptoms, such as failure to thrive or weight loss. These can indicate a medical problem, such as an allergy, a blockage in the digestive system or gastroesophageal reflux disease (GERD).

Signs and symptoms of reflux.

Your baby may not show any signs of reflux or they may show the following signs:

_ Spitting up milk during or after feeds.

_ Refusing feeds, gagging or choking.

_ Persistent hiccups or coughing.

_ Excessive crying or crying while feeding.

_ Frequent ear infections.

You do not need to be concerned about reflux if your baby is feeding well, happy and gaining weight as normal.

When to see a doctor.

See your baby’s doctor if your baby:

▪️ Isn’t gaining weight.

▪️ Consistently spits up forcefully, causing stomach contents to shoot out of his or her mouth (projectile vomiting).

▪️ Spits up green or yellow fluid.

▪️ Spits up blood or a material that looks like coffee grounds.

▪️ Refuses food.

▪️ Has blood in his or her stool.

▪️ Has difficulty breathing or a chronic cough.

▪️ Begins spitting up at age 6 months or older.

▪️ Is unusually irritable after eating. Some of these signs can indicate possibly serious but treatable conditions, such as GERD or a blockage in the digestive tract.


In infants, the ring of muscle between the esophagus and the stomach — the lower esophageal sphincter (LES) — is not yet fully mature. That allows stomach contents to flow back up. Eventually, the LES will open only when your baby swallows and will remain tightly closed at other times, keeping stomach contents where they belong.

The factors that contribute to infant reflux are common in babies and often can’t be avoided. These factors include:

1. Lying flat most of the time.

2. Consuming an almost completely liquid diet.

3. Being born prematurely. Occasionally, infant reflux can be caused by more-serious conditions, such as:

▪️ GERD. The reflux has enough acid to irritate and damage the lining of the esophagus.

▪️ Pyloric stenosis. A valve between the stomach and the small intestine is narrowed, preventing stomach contents from emptying into the small intestine.

▪️ Food intolerance. A protein in cow’s milk is the most common trigger.

▪️ Eosinophilic esophagitis. A certain type of white blood cell (eosinophil) builds up and injures the lining of the esophagus.

▪️ Sandifer syndrome. This causes abnormal tilting and rotation of the head and movements that resemble seizures. It’s a rarely seen consequence of GERD.


Infant reflux usually resolves without causing problems for your baby.

If your baby has a more-serious condition such as GERD, he or she might grow poorly. Some research indicates that babies who have frequent episodes of spitting up might be more likely to develop GERD during later childhood.


Your doctor will start with a physical exam and questions about your baby’s symptoms. If your baby is healthy, growing as expected and seems content, then testing usually isn’t needed. In some cases, however, your doctor might recommend:

▪️ Ultrasound. This imaging test can detect pyloric stenosis.

▪️ Lab tests. Blood and urine tests can help identify or rule out possible causes of recurring vomiting and poor weight gain.

▪️ Esophageal pH monitoring. To measure the acidity in your baby’s esophagus, the doctor will insert a thin tube through the baby’s nose or mouth and into the esophagus. The tube is attached to a device that monitors acidity. Your baby might need to stay in the hospital while being monitored.

▪️ X-rays. These images can detect abnormalities in the digestive tract, such as an obstruction. Your baby may be given a contrast liquid (barium) from a bottle before the test.

▪️ Upper endoscopy. A special tube equipped with a camera lens and light (endoscope) is passed through your baby’s mouth and into the esophagus, stomach and first part of the small intestine. Tissue samples may be taken for analysis. For infants and children, endoscopy is usually done under general anesthesia.

Lifestyle and home remedies.

_ How and when to feed your baby.

▪️ Give more frequent feedings.

Your baby may be more likely to have reflux and to spit up when their stomach is too full. Increasing the frequency of feedings while decreasing the amount at each feed will likely help.

Breastfed babies may benefit from a change in the breastfeeding parent’s diet. Some studies have shown that babies can benefit when the breastfeeding parent restricts their intake of milk and eggs, though more research is needed. Formula-fed infants may be helped by a change in formula.

Avoid making any dietary or formula changes without discussing with your child’s doctor first.

A less-full stomach puts less pressure on the lower esophageal sphincter (LES). The LES is the ring of muscle that prevents food from going back into the esophagus from the stomach.

Pressure on this muscle causes it to lose effectiveness, allowing stomach contents to rise into the throat. LES strength takes time to develop over the first year, so many infants naturally spit up often.

Feeding on demand, or whenever your baby appears to be hungry, may also be helpful.

▪️ Feed them upright.

If you can, feed baby upright and keep them in that position for about 30 minutes after. This can aid in preventing acids from creeping up.

▪️ Avoid sleep positioners.

Don’t be tempted to try a sleep positioner while feeding or sleeping. These are padded risers that can keep your baby’s head and body in one position.

▪️ Check bottle and nipple size.

If you bottle feed, keep the nipple filled with milk throughout feedings to avoid air gulping. Try a variety of nipples, avoiding those with larger holes that can cause milk to flow too fast.

▪️ Thicken breast milk or formula.

With your pediatrician’s approval, adding a small amount of infant rice cereal to formula or breast milk may be an option to lessen spitting up.

Thickening the food is thought to help stop stomach contents from sloshing up into the esophagus. This option has not been shown to decrease other reflux symptoms. Check with your doctor before trying this option.

▪️ Burp them more often.

Whether you bottle-feed or breastfeed, make sure to frequently burp your baby. Burping your infant during a feeding may help with reflux symptoms.

Burp bottle-fed infants after every 1 to 2 ounces (or more frequently if they eat less). Burp breastfed babies any time they pull off the nipple.

_ Your infant’s sleeping position.

Always put baby to sleep on their back on a firm mattress. Make sure the crib or sleeping area is free of thick blankets, pillows, loose objects, or plush toys.

Studies have shown an increased risk of SIDS in all sleeping positions except for on the back. This applies to all babies, even those with GER and GERD.

Babies who sleep at an incline in a car seat or carrier have been shown to have more reflux as well as an increased risk of SIDS.Consider scheduling a bit of time between sleeping and eating instead of changing positions.

_ Schedule time between sleeping and eating.

Because acid reflux occurs after meals, don’t put your infant to bed immediately after a feeding. Instead, burp them and wait 30 minutes before lying your baby down for a nap or for the evening. This will help make sure their system digested the meal.

Similar to acid reflux in adults, acid reflux in infants can be made worse by their position, especially after eating. Because very young infants can’t sit up by themselves, make sure your infant remains upright for 30 minutes after eating. This will help aid digestion before your child sleeps.

Reference :

Infant reflux/

Infant reflux/

Treating Acid Reflux in Infants/

Reflux in babies/

GERD in Infants: How Can I Help My Baby Sleep?/

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