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Gastroesophageal Reflux in Babies

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Updated July 08, 2014

Hispanic father holding baby boy on his shoulder
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Gastroesophageal Reflux (GER) is a medical term doctors use to describe a condition where food and stomach acid flow back up (reflux) into the esophagus. A ring of muscles at the bottom of the esophagus called the lower esophageal sphincter (LES) opens and closes to allow food to enter the stomach. The LES opens to release gas after meals.

More than gas may escape, however. The LES may also allow stomach contents to flow back into the esophagus and out the mouth. Parents often see the result as spitting up, though vomiting may also occur. GER can occur at times other than during or shortly after a feeding. Reflux can occur when babies cough, cry, or strain also.

GER is common in infants and has its own name -- spitting up. Reflux occurs during the first three months of age in more than half of all infants. Many babies don't require treatment. Referred to as "happy spitters," their symptoms usually disappear between 12 and 18 months of age. However, for a small number of babies, symptoms of reflux are severe, and medical evaluation and treatment is needed.


Symptoms of Acid Reflux in Infants

Common infant GER symptoms are:
  • Frequent spitting up or vomiting
  • Irritability when feeding
  • Refusing food or eating only small amounts
  • Sudden or constant crying
  • Arching the back while feeding
  • "Wet" burps
  • Frequent hiccups
  • Frequent coughing
  • Poor sleep habits with frequent waking
  • Bad breath

A small number of infants will experience the following less common symptoms:

  • Difficulty swallowing
  • Frequent sore throat
  • Weight loss or poor weight gain
  • Respiratory problems (such as asthma, pneumonia, bronchitis, wheezing)
  • Frequent ear or sinus infections
  • Excessive drooling
  • Hoarse voice
  • Spells of not breathing


Diagnosing Acid Reflux in Infants

If your baby is healthy and growing well, the doctor may make a diagnosis of reflux on a parent's description of symptoms and feeding history, and a physical exam alone. However, your baby's doctor may order tests if he or she suspects a more serious condition, such as GERD. In these cases, diagnostic tests may include:
  • Lab tests. This can consist of various blood and urine tests to identify or rule out possible causes of recurring vomiting and poor weight gain.

  • Esophageal pH monitoring. This test will measure the acidity in your baby's esophagus.

  • Upper endoscopy. A tube with a camera lens and light is inserted through your baby's mouth and into esophagus and stomach. The doctor may use this procedure to see if there is a narrowing (stricture) or inflammation (esophagitis) in the esophagus.


Treating Acid Reflux in Infants

Treatment of infant reflux depends on the severity of the problem. Your baby's doctor may decide no treatment is needed, that the reflux will disappear on it's own as your baby grows older. For most babies, reflux will resolve itself during the first year of life. If your baby is otherwise healthy, is happy, and is growing, the doctor may recommend a few lifestyle changes for your baby in order to ease the reflux problem.

If the reflux is more serious, or if your baby has been diagnosed with GERD, the doctor may prescribe a prescription medication or over-the-counter remedy to help treat the reflux. These remedies include:

  • Antacids - These neutralize stomach acid. These include Tums, Mylanta, and Maalox.

  • Acid Suppressers - These suppress acid production in the stomach. These include Tagamet, Pepcid, Zantac. and Axid.

  • Acid Blockers - These completely block acid production in the stomach. Prilosec and Prevacid have been approved for children over certain ages.
It is very important to discuss treatment options with your baby's doctor before beginning any treatment method, especially before using any over-the-counter remedy.


Points to Remember About Acid Reflux in Infants

  • GER occurs when stomach contents back up (reflux) into the esophagus.

  • GER is common in infants, especially during the first three months of age, but for most babies, it will disappear as they grow older.

  • Treatment will depend on your baby's symptoms and age. Treatment can include lifestyle changes, prescription or over the counter remedies, or a combination of these.

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Sources:

"Gastroesophageal Reflux in Infants." NIH Publication No. 06–5419 August 2006. National Digestive Diseases Information Clearinghouse (NDDIC). 08 Jan 2007

Heartburn, Hiatal Hernia, and Gastroesophageal Reflux Disease (GERD). NIH Publication No. 03–0882 June 2003. National Digestive Diseases Information Clearinghouse. Accessed on 08 Jan 2007

Marsha Kay, M.D., Vasundhara Tolia, M.D.. "COMMON GASTROINTESTINAL PROBLEMS IN PEDIATRIC PATIENTS." The American College of Gastroenterology. 08 Jan 2007

Brian Pace, MA, Richard M. Glass, MD. "Gastroesophageal Reflux in Children." JAMA, July 19, 2000---Vol 284, No. 3. The Journal of the American Medical Association. 8 Jan 2007

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