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For Patients & Families:
Gastroesophageal Reflux
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Samuel Nurko, MD, MPH
Anyone who has ever held a baby knows they often spit up when they eat. For most babies and their parents, this just leads to a lot of laundry. But for some, spitting up too much, too often can be a sign of gastroesophageal reflux disease, or GERD.

Reflux, which is when stomach contents leave the stomach and come back into the esophagus (the tube that connects the mouth to the stomach) or even the mouth, happens to just about everyone. When the acid that breaks food down in the stomach gets into the esophagus or mouth it can be painful, causing a child to cry or have trouble sleeping, and giving an adult heartburn. But while some amount of reflux is normal, GERD occurs when complications from reflux arise. Here are some signs and symptoms of GERD in babies:

  • Vomiting and/or spitting up regularly during or after feedings
  • Choking, gagging or coughing during or after feedings
  • Extreme fussiness in babies, especially after feedings
  • Arching the back during or after feedings
While it's not usually possible to stop a child from getting reflux, mild symptoms will almost always go away by the time a child is a year old. As long as your infant is comfortable and gaining appropriate weight, no major interventions are needed. If your child's symptoms are more severe, your health care giver may prescribe a medication that will decrease the acid in your child's stomach and decrease the painful symptoms of GERD. You also may be able to relieve your baby's reflux with some simple home measures:
  • Head up at a gentle angle - Place your baby in an infant seat at a gentle angle after feeding, hold her upright for a half hour, or lay her on her stomach while awake at a 30 to 45 percent incline with her head up. This will help prevent food from backing up into the esophogus. However, do not allow your infant to sleep on her stomach because it can increase the risk of Sudden Infant Death Syndrome. Also, sitting your baby up straight in an infant seat may actually put pressure on her stomach and make reflux worse.
  • Try smaller, more frequent feedings - Many children have an easier time keeping down small meals. But when you cut back on the size of the meals, you'll have to increase their frequency so your baby gets enough to eat.
  • Thicken the milk or formula - Adding up to a tablespoon of rice cereal to 2 ounces of milk or formula will thicken it which makes the liquid less likely to slosh up out of the stomach into the esophagus.
  • Burp early and often - Too much gas or air in the stomach can increase reflux for infants. So if you're bottle feeding, find a nipple that allows your baby's mouth to make a good seal during feeding and keep the nipple filled with milk so your infant doesn't swallow too much air. Burping your baby after 1 or 2 ounces of formula or milk, (the equivalent of feeding on each side for breast-fed infants) also can help prevent a build up of gas in the stomach.
When to Call the Doctor
Call the doctor immediately if:
  • your infant spits up blood or green or yellow liquid
  • your infant appears to be having trouble breathing
Call the doctor today if:
  • your infant vomits forcefully after every feeding or the amount of vomit increases
  • your child is not able to hold any fluids down
Talk with the doctor at your child's next checkup if:
  • your infant spits up and/or vomits often and doesn't seem to be gaining weight
  • your infant consistently fusses after feedings, especially when lying on her back
  • your infant continues to spit up or vomit after the age of one
Testing for Reflux
Testing for reflux is usually done by doctors only when symptoms are not relieved with routine treatment or when complications occur. Your gastroenterologist may decide to do x-rays, or endoscopic procedures. For those children with more persistent and difficult symptoms, other tests may be necessary.

Until recently, standard reflux tests that measure acid level in the esophagus, have not been able to diagnose non-acid reflux. This type of reflux occurs when non-acidic substances, such as bile, come back up out of the stomach into the esophagus. A new technique called multilumen intraluminal impedance was recently developed to determine if your child has non-acid reflux.

Source: Children's Hospital Boston physicians Alan Leichtner, MD, and Sam Nurko, MD, are both experts on gastroesophageal reflux in children.

Please keep in mind that the text provided is for informational purposes only and is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health professional before starting any new treatment or making any changes to existing treatment.

Children's Hospital Boston©, 2005. This page may be reproduced for educational purposes. Reprint permission is required for all other uses.

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