Reflux in infants and babies

Related links:

• Our services: how we care for children with heartburn and reflux issues

Related tests and treatments:

• Upper GI series
• Endoscopy
• 24-hour pH-impedance probe
• Esophageal manometry
• Gastric emptying study

What is reflux?

The muscle at the bottom of our esophagus — known as the lower esophageal sphincter — normally relaxes to let food and drink down into our stomach and then closes. When that muscle relaxes too much, stomach acid, food or drinks can back up into the esophagus, a process called gastroesophageal reflux.

Everyone experiences reflux from time to time — it is especially common in infants.

Reflux sometimes causes heartburn, which is a burning sensation felt behind the breastbone when stomach acid moves into the esophagus. Chronic heartburn and reflux can be a sign of gastroesophageal reflux disease or another GI condition, but everyone experiences these symptoms from time to time. Occasional heartburn and reflux are not harmful, and the best treatment is usually to avoid things that trigger symptoms.

What causes reflux in infants?

Reflux is very common in babies because the esophageal sphincter is still weak, which is why babies frequently spit up. Sometimes environmental factors like positioning or exposure to second-hand smoke can trigger reflux. Severe constipation can also cause reflux symptoms if a child has a lot of stool backup that could slow the emptying of the stomach.

What are the symptoms of infant reflux?

Babies with reflux may be especially irritable and cry a lot during and after mealtimes. Older children may complain of:

• Refusal to eat
• Fussiness around mealtimes
• Frequent or forceful vomiting
• Frequent cough
• Poor appetite or feeling full early
• Poor weight gain
• Large amounts of spit-up or vomiting

Who is at risk of developing this condition?

Almost all infants will experience some amount of reflux during the first year of life.  Infants born premature are at increased risk of reflux as are babies with some heart or lung diseases.  If you are concerned, you should work with your child’s health team to see if your child’s symptoms would benefit from seeing a GI specialist.

Why are is infant reflux a concern?

If reflux is a severe enough problem, it can lead to poor growth, weight loss, poor nutrition, worsening of symptoms with time or failure to learn the feeding skills needed to eat normal solids.  Sometimes symptoms of reflux can be a sign of swallowing problems that can put children at risk of damage to the lungs.

How is infant reflux diagnosed/evaluated?

What is the treatment for infant reflux?

Treatment isn’t always necessary with infants. Babies with reflux might cry because they are scared of spitting up or are bothered by regurgitated liquid coming out of their nose, but that doesn’t necessarily mean they need medication. Reflux medications come with possible side effects — including headaches, constipation and increased risk of pneumonia and intestinal infections — and it is often generally safest to wait for babies to outgrow the problem. However, some simple changes in feeding routines can reduce reflux symptoms in infants:

• After feedings, place your infant on his or her stomach with the upper body elevated at least 30 degrees or hold your baby in a sitting position in your lap for 30 minutes while under supervision.
• If bottle-feeding, keep the nipple filled with milk so your infant does not swallow too much air while eating. Try different nipples to find one that allows your baby’s mouth to make a good seal during feeding.
• Burp your baby several times during bottle-feeding or breastfeeding. Your child may reflux more often when burping with a full stomach.
• Adding rice cereal to feeding may be beneficial for some infants.
• Changing your baby’s formula or avoiding milk or soy if you are re a breastfeeding mother can help if a food sensitivity is causing the reflux.

Some infants with reflux will not be able to gain weight due to frequent vomiting or refusing to eat. If that’s the case, your child’s doctor may recommend:

• Adding rice cereal to baby formula
• Increasing calories by adding a prescribed supplement to formula or breast milk
• Changing your baby’s formula or avoiding milk or soy if you are a breastfeeding mother
• Nasogastric tube feedings: Formula or breast milk is given through a tube that is placed in the nose, guided through the esophagus and into the stomach. Tube feedings can be given in addition to or in place of regular feedings.

What happens after treatment?

If the symptoms continue, then your child may need to be checked to see if there is another medical problem causing the reflux.

When should you contact a physician?

Talk to your pediatrician if your child is experiencing reflux symptoms every day or frequently.

What is the long-term outlook for infant reflux?

Most babies successfully outgrow reflux by 12-18months of age with many improving between 6-12months old.