Acid Reflux in Babies

Patient information: Acid reflux (gastroesophageal reflux) in babies (The Basics)
Written by the doctors and editors at UpToDate

What is acid reflux?
— Acid reflux (also called “gastroesophageal reflux” or just “reflux”) is when the acid that is normally in the stomach backs up into the esophagus (figure 1). The esophagus is the tube that carries food from the mouth to the stomach.

Healthy babies often have reflux, and spit up milk or formula after eating. This does not usually hurt them, and most babies grow out of it without treatment. But in some babies, the reflux is more serious. This is called “gastroesophageal reflux disease,” or GERD.

Figure 1.

Is my baby at risk of getting GERD?
— Some babies have a higher risk of getting GERD, including those who:

●Were born prematurely (3 or more weeks before the due date)
●Are around cigarette smoke
●Have certain health problems, such as Down syndrome, cerebral palsy, or other problems with the brain or spinal cord

How can I tell if my baby has acid reflux?
— If your baby spits up a lot, but seems otherwise happy and healthy, he or she probably has what is called “uncomplicated” reflux. This is very common. Burping your baby often, and keeping him or her upright and calm after feeding, might help with the spitting up.

If your baby has GERD, the symptoms might include:

●Refusing to eat
●Crying and arching the back, as if in pain
●Choking on spit-up
●Vomiting forcefully
●Not gaining weight normally

Should my baby see a doctor?
— If your baby spits up a lot and has any of the symptoms listed above, talk to his or her doctor. The doctor can do an exam, and might decide to do some tests to check whether your baby’s symptoms are caused by acid reflux or something else.

Uncomplicated reflux does not usually cause pain, and usually does not need treatment. If your baby cries a lot or is having trouble sleeping, his or her doctor can help decide if this is normal or caused by GERD or some other problem. All babies act fussy sometimes, and this does not necessarily mean anything is wrong.

Is there anything I can do to help my baby feel better?
— Yes. If your baby’s acid reflux is making him or her uncomfortable, you can try:

●Keeping the baby upright after eating – Your baby might spit up less often if you calmly hold him or her up on your shoulder for 20 to 30 minutes after a feeding, instead of putting him or her in a sitting or lying position. Putting the baby in an infant seat (such as a car seat) right after feeding does not help with reflux, and can actually make it worse. Also, don’t try to get your baby to eat when he or she doesn’t want to.

Always put your baby to sleep on his or her back (not the side or stomach), whether or not he or she has acid reflux.

●Quitting smoking – If you smoke, or if anyone in your house smokes, this can make your baby’s reflux worse and can cause other health problems for babies and children. Keep your baby away from cigarette smoke when you are out of the house, too.

●A milk-free and soy-free diet – Some babies have trouble digesting cow’s milk or products made with soy. Your baby’s doctor or nurse might suggest that you try removing milk and soy from the baby’s diet. If you breastfeed your baby, you can try removing all milk and soy from your diet, too. Then see if your baby’s acid reflux improves after a few weeks. If your baby drinks formula, there are special brands available that do not contain cow’s milk or soy. Most babies who have trouble with milk or soy outgrow the problem by the time they are 1 year old.

●Thickened feeds – Adding baby cereal to your baby’s bottle to make the milk thicker might help with acid reflux. Oat cereal is often a good choice. There are special thick formulas available, too. There are also special thickeners meant to be added to milk or formula, but these might not be safe for babies. Talk to your baby’s doctor or nurse about whether to try thickened feeds with your baby.

How is acid reflux treated?
— Most babies with acid reflux do not need medicine. Plus, medicines do not always make the reflux better. But if you have tried the ideas above, and your baby is still having trouble with reflux, your baby’s doctor or nurse might suggest trying medicine. There are lots of medicines available for adults with acid reflux, but not all of them can be used safely in babies.

If your baby’s reflux is serious, his or her doctor might recommend:

●Proton pump inhibitors – These medicines stop the stomach from making acid. Doctors sometimes recommend omeprazole (brand name: Prilosec) or lansoprazole (brand name: Prevacid) for babies. But they usually stop the medicine if it does not help within a few weeks.

●Other medicines – Other medicines that doctors sometimes suggest for reflux include ranitidine (brand name: Zantac) or famotidine (brand name: Pepcid). These medicines stop the stomach from making acid, but only work for a few weeks. Antacids are not very helpful for reflux because they are not as good at stopping the stomach from making acid. Besides, it is not safe to give more than a few doses of antacids to a baby.

Talk to your baby’s doctor before you give your baby any medicines for acid reflux.

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