It is very common for babies to spit up and have reflux after feeding. If your baby is experiencing reflux, there are a few simple things you can do to help relieve your baby’s discomfort.

When a baby is first born, their stomach is about the same size as their fist. Given such a limited amount of space, it is likely that your baby will have some trouble when it comes to keeping all of their food down. Infant reflux is normal for most babies to experience, especially as newborns. However, there are a few serious symptoms that you should keep an eye out for when it comes to infant reflux. Here's everything you should know about reflux--how to know if your baby has it and ways to help treat it.

What is infant reflux?

Infant reflux usually will happen shortly after your baby is finished feeding. Because your baby's stomach is so small and they have not yet fully developed the muscles in their esophagus, they will usually spit up some of the food that they just finished eating. Reflux is very common for babies to experience and will likely happen multiple times a day.  As long as your baby is healthy, growing steadily, and seems content, their reflux should be no cause for concern. 

Infant reflux is sometimes also called gastroesophageal reflux (GER) and the condition is rarely serious. As your baby grows, they will begin to experience reflux less frequently. Your baby should stop having reflux after the age of 18 months. If they are still experiencing reflux, you should talk to your doctor.

In rare situations, reflux can cause more serious symptoms like a failure to gain weight or difficulty breathing. These symptoms can be related to a more serious medical problem like a food allergy or gastroesophageal reflux disease (GERD). 

Learn more from Boston Children’s Hospital about reflux in babies and children:

What are the symptoms of infant reflux?

Infant reflux is your baby spitting up the contents of their stomach, usually shortly after eating. It is very unlikely that your baby's stomach contents could have enough acid to irritate their throat enough to cause any medical problems. 

Other than spit-up, there are a few symptoms that you should be aware of that could signal a more serious medical condition. If your baby is experiencing these symptoms, see your doctor.

See a doctor if your baby… 

• Isn't gaining weight

• Consistently spits up forcefully

• Spits up green or yellow fluid

• 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

What causes infant reflux?

As you know, your baby's body is going through huge stages of growth and development. In infants, the muscle between the esophagus and stomach (also known as the lower esophageal sphincter, (LES)) has not fully developed. Because the muscle has not fully matured, stomach contents are able to easily come back up. With time, the LES muscle will open up only when your baby swallows and remains tightly closed at all other times. This will help keep your baby's stomach contents where they belong. Your baby should stop experiencing reflux by at least 18 months old. 

There are some factors that cause infant reflux that are common in babies but can often not be avoided. These factors include: 

• Lying flat most of the time

• Consuming an almost completely liquid diet

• Being born prematurely

There are a few occasions that infant reflux can be caused by a more serious underlying medical condition.

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

• Food intolerance. A protein in cow's milk is the most common trigger but this can be caused by various foods. 

• 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.

What is GERD?

If your baby's reflux symptoms are severe or causing pain, this might be a sign that they have gastroesophageal reflux disease, or GERD. Additionally, if the symptoms have not stopped past 12 to 14 months old, this is also a sign that your baby likely has GERD. The most common symptoms of GERD include failure to gain weight, trouble sleeping, frequent vomiting, and respiratory problems like recurring pneumonia or wheezing. Some babies with GERD may also display symptoms of colic (unexplained crying for more than three hours a day, more than three days per week). If you think your baby has GERD, talk to your doctor about next step recommendations.

How to treat influx?

The good news is that your baby's reflux will usually go away on its own. This is because your baby's esophagus muscles are maturing and their stomach size is growing. However, there are a few things that you can do in the meantime to help alleviate any symptoms for the comfort of both you and your baby.

• Breastfeed, if possible. If your baby has reflux, breastfeeding is the best option to consider. Breast milk digests twice as fast as formula so you are less likely to experience reflux with breast milk. However, if breastfeeding isn't possible, you should talk to your doctor about which formula would be best for your baby. Sometimes, switching your baby to a speciality formula (like a hypoallergenic or dairy-free option) can help relieve symptoms.

• Keep baby upright after feeding. To avoid food traveling upward into the esophagus, keep your baby upright during and shortly after feedings. You should continue to keep your baby upright for at least 20 minutes after the feeding.

• Give frequent but small feedings. With such a small stomach, it might be easier for your baby to have more frequent but smaller feedings. This could help decrease the reflux because there is less to come back up. Sometimes, babies that have reflux naturally prefer to eat this way. But others might get fussy if they are not used to this new schedule. After a few days, your baby should readjust to their new schedule so it is worth trying to stick to it.

• Change their formula. If your baby is on regular formula, your baby’s reflux might be a symptom of an intolerance to the cow’s milk protein. If you think that your baby might have a dairy intolerance, talk to your doctor about switching to a dairy-free formula and see if the influx still happens. 

• Angle the bottle. Hold the bottle at an angle that fills the entire nipple with milk to help reduce the amount of air the baby swallows.

• Burp often. While feeding your baby, you might want to stop every 2 to 3 ounces to burp your baby. Burping will help release the gas and relieve symptoms of reflux.

• Avoid tight diapers and clothing. Tight diapers and clothes can put added pressure on your baby's stomach. Keep your baby in looser clothes or more comfortable diapers to avoid causing any discomfort.

• Delay playtime after meals. Right after you finish feeding your baby, avoid bouncing or moving them around too much. All of the movement will only increase the chance of them having reflux.

• Change your diet. There are some foods, such as dairy products or gas-inducing veggies like cabbage and broccoli, that might increase your baby's reflux. Try eliminating these foods from your diet if you are breastfeeding and see if symptoms improve.

• Check nipple size. You might be using a bottle nipple that is too small or too big. The wrong nipple size can cause your baby to swallow too much air and increase influx responses.

• Thicken your baby’s milk. Doctors recommend trying to thicken your baby's formula with rice cereal to help make it easier to digest. Adding the rice cereal will also slow your baby's rate of intake. Before trying this method, talk to your doctor because adding the rice cereal does add extra calories.

Medical Treatment for Acid Reflux

Your baby's reflux should be treatable with the natural remedies listed above and go away as they get older. However, if you notice that your baby's reflux is not getting better, or getting worse, you should talk to your doctor. They may prescribe your baby a medication to help relieve the symptoms. Doctors typically only prescribe medication if the baby is not growing normally, has trouble breathing, or seems to be in pain. 

Most of the common medicines given to baby's for infant reflux are very safe and effective but you should talk to your doctor to learn more about the potential side effects. Children likely outgrow reflux before their first birthday so your baby will not be on medication for very long.

What is silent reflux?

There is another type of reflux that you should be aware of as well. It is called silent reflux, also referred to as laryngopharyngeal reflux (LPR). This is when the contents of a baby’s stomach flows backward into the voice box, the back of the throat, and the nasal passages. This type of reflux doesn’t always cause outward symptoms, which is why it’s described as ‘silent.’

This is a more serious type of reflux and has slightly different symptoms than the typical infant reflux.

• Breathing problems

• Gagging

• Chronic coughing

• Difficulty feeding

• Spitting up

• Poor weight gain or loss of weight

Is Gripe Water safe?

One popular method of treating infant reflux is "gripe water," and you might be tempted to try it to help ease the symptoms of reflux for your baby. However, there's no scientific evidence that gripe water is effective in treating reflux.

Ingredients vary depending on the manufacturer, but many versions of gripe water include fennel, ginger, peppermint, lemon balm, chamomile, and sodium bicarbonate. 

Talk to your baby’s doctor if you are interested in trying a natural remedy, such as gripe water, to treat your child’s reflux. It is important to choose both safe and proven remedies when trying to help manage your baby’s reflux.

Infant Reflux Takeaway

Luckily, infant reflux is a very common and treatable condition. With a few lifestyle changes, you should be able to control your baby's reflux until they eventually grow out of it.

For many parents, small adjustments to your baby's routine is all they need to do to make your baby more comfortable when feeding. Most cases of influx go away with time and age. 

Always talk to your doctor about any concerns you have regarding your baby's influx so that they can more accurately assess the problem and help find the best solutions for treating your baby's reflux. 

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These statements have not been evaluated by the Food and Drug Administration. Products are not intended to diagnose, treat, cure or prevent any disease.