Infant Acid Reflux: How to Resolve it For Your Baby?
Since you are reading this, I'm assuming you have a newborn that has been spitting up during or shortly after eating. This article will explain the causes of Infant Acid Reflux, whether to be concerned and what you should do to help manage this problem for your baby.
What you will learn About Infant Acid Reflux
- Will your baby outgrow Infant Acid Reflux?
- Risk Factors for Infant Acid Reflux.
- The causes of acid reflux in newborns.
- The symptoms of acid reflux in newborns.
- When to consult a doctor?
- How is Infant Acid Reflux diagnosed?
- What you can do to reduce the symptoms of Infant Acid Reflux?
- How is Infant Acid Reflux treated?
- Gastroesophageal Reflux (GER)
GER is the back flow of stomach contents (stomach acid, food, and fluids) back into the esophagus. Gastroesophageal refers to the stomach, the LES, and the esophagus; reflux means to flow back. Over 80% of babies have GER. It occurs most commonly during the first three months but may occur up to 18 months. This is perfectly normal and rarely indicates anything serious.
- Gastroesophageal Reflux Disease (GERD)
GERD is a more long-lasting (chronic) version of GER. GERD is more common in adults than in infants. So it's unlikely your baby has GERD.
- The Lower Esophageal Sphincter (LES)
The LES is a muscular valve located between the stomach and the esophagus. Its function is to allow food and liquid to enter the stomach and then stay shut to keep stomach contents in the stomach. In newborns, the LES may not be fully developed and will not close sufficiently to keep stomach contents from backing up into the baby's esophagus.
Most Babies Outgrow Infant Acid Reflux (GER)
As stated above, over 80% of infants spit up while feeding or shortly after. First of all, it is important to understand that this is perfectly normal and is rarely serious. In rare instances, infant acid reflux can indicate an underlying problem, like a food allergy, a blockage in the digestive system, a hiatal hernia, etc. Still, as stated, this is very rare. See the Causes of Infant Reflux below for more info.
GER Usually Goes Away
Infant Reflux will often go away once the baby's LES matures and their nervous system fully develops; usually, between 6 to 18 months of age, the symptoms will subside on their own. However, in 5% of babies, GER may continue as toddlers.
However, for the time being, watching your baby suffer from infant acid reflux can be a heart-wrenching experience. In addition, since babies can only communicate by crying, it is much more challenging to know that your baby has infant reflux.
Risk Factors for Infant Acid Reflux
The following conditions increase the risk of your child having infant acid reflux:
- One or more parents have a history of GERD
- Premature birth – this makes it even more likely that the LES and nervous system are not fully developed
- Congenital food pipe disorders, e.g., a hiatal hernia
- Obesity – overweight babies will have more back pressure on their LES, allowing stomach contents to back up into the esophagus
Causes of Infant Acid Reflux
The Main Causes Of Infant Acid Reflux Are:
- Underdeveloped LES – The babies' lower esophageal sphincter (LES) is not yet fully developed and, therefore, not strong enough to keep their stomach contents from backing up into their esophagus. The slightest bloating can cause the stomach contents to regurgitate into the throat.
- Neurodevelopmental Disorders – Infant acid reflux can also be caused by a poorly coordinated gastrointestinal tract, resulting in the LES being too relaxed.
- Premature Birth – the LES and the nervous system is not yet fully developed due to being born prematurely.
- Overfeeding – can cause excess stomach bloating, adding pressure to an underdeveloped LES, allowing stomach contents to flow back into the esophagus, and causing discomfort to your baby.
- Food intolerance or food allergies Food intolerances can cause stomach bloating, similar to overfeeding, e.g., lactose intolerance.
- Lying the baby down too soon after feeding – keep your baby upright for about 30 to 45 minutes after feeding; gravity helps the LES keep the stomach contents from backing up into the baby's esophagus.
- Improper Positioning of the baby during feeding – keep baby more upright – let gravity help the LES work better.
- Obese Baby – excess belly fat can exert additional pressure on the stomach's contents, increasing the internal pressure on the LES.
- Congenital GERD – if there is a parental history of acid reflux disease or GERD, the child may inherit this problem.
- Congenital Pyloric Stenosis – This is the narrowing of the valve between the stomach and the small intestine. This narrowing may prevent or limit the stomach contents from emptying into the small intestine. This is four times more common in male babies. Babies with this condition usually want to eat again soon after vomiting. Before vomiting, you may observe wave-like contractions across your baby's abdomen caused by the stomach muscles trying to force the stomach contents through the narrowed pylorus.
- Eosinophilic Esophagitis (EOE) – An allergic inflammatory condition that involves a specific type of white blood cell called eosinophil that builds up and injures the lining of the esophagus. Symptoms include difficulty swallowing, vomiting, upper abdominal pain, and heartburn.
Symptoms of Infant Acid Reflux
The most common symptoms of Infant Acid Reflux are:
- A persistent cough, breathing problems, or wheezing
- Frequent spitting up or regurgitation while feeding or shortly after
- Choking or gagging while feeding
- Colicky behavior (frequent crying and fussiness)
- Poor growth, poor weight gain, or weight loss
- Baby tries to avoid feeding by back arching
- The Baby's stool may contain blood
When to see a doctor
Take your baby to the doctor if your baby:
- Isn't gaining weight
- Is projectile vomiting
- The spit-up contains a green or yellow fluid
- The spit-up contains blood or a dark material the color of coffee grounds
- Refuses to eat and has difficulty eating or swallowing
- There is blood in their stool
- Has difficulty breathing, chronic cough and/or wheezing
- Is still spitting up after six months
Some of these symptoms may indicate serious but treatable conditions.
Consult your doctor to determine if they are significant.
How Is GERD Diagnosed in Infants and Children?
Usually, the baby's medical history is enough for the doctor to diagnose GERD, primarily if the problem occurs regularly and causes discomfort. The growth chart and diet history are also helpful, but occasionally, further tests are recommended.
They may include:
This can detect food being blocked from entering the small intestines (pyloric stenosis).
- Blood and Urine Tests
These tests can aid in identifying possible causes of recurring vomiting and reduced weight gain.
- Barium Swallow
This X-ray test uses barium to highlight the esophagus, stomach, and upper part of the small intestine. In addition, this test may identify any obstructions or narrows in these areas.
- Gastric Emptying Study
Some people with GERD have slow emptying of the stomach, which may contribute to acid reflux. During this test, your child drinks milk or eats food mixed with a radioactive chemical. This chemical is followed through the gastrointestinal tract using a special camera.
- pH Probe
During the test, your child is asked to swallow a long, thin tube with a probe at the tip that will stay in the esophagus for 24 hours. The tip is positioned, usually at the lower part of the esophagus, and measures levels of stomach acids. It also helps determine if breathing problems are the result of GERD.
- Upper GI Endoscopy
An upper GI series is not usually recommended for infants and children. This is because the results do not provide the physiological function of the esophagus. But in some cases where other diagnoses have been ambiguous, your doctor may recommend an upper GI endoscopy. This is done using an endoscope (a thin, flexible, lighted tube and camera) that allows the doctor to look directly inside the esophagus, stomach, and upper part of the small intestine. In addition, tissue samples may be taken. This is usually done under local anesthesia.
What Can You Do to Reduce Your Infant's Acid Reflux Symptoms?
Feeding Your Baby
Until your baby is six months old, it is best if the baby is fed breast milk exclusively. It is essential to be aware that what you consume can affect the baby through your breast milk.
If your breastfed baby exhibits signs of acid reflux, you should avoid ingesting these foods:
- Caffeine relaxes the LES, allowing the stomach contents to back up into the baby's esophagus easily. Caffeinated foods are tea, coffee, soft drinks, energy drinks, and chocolate.
- Carbonated Drinks – the bubbles in carbonated drinks can cause stomach bloating. The bloating puts additional pressure on the LES. In addition, if the drink contains caffeine, the LES is relaxed by the caffeine, making the combination even worse.
- Spicy Foods – spices in these foods irritate the LES, causing it to swell, making it more difficult to close completely, allowing the baby's stomach contents to back up into the esophagus.
- Citrus Fruits and drinks – citrus fruits and citrus fruit juices also irritate the LES, making it difficult to fully close. Avoid oranges, lemons, and their juices.
- Foods That Contain Preservatives – eating foods that contain a lot of preservatives cannot be effectively digested by the immature LES and gastrointestinal tract. Depending on the preservative, it can cause bloating, LES irritation, or LES relaxation. Best to avoid highly processed foods while you are breastfeeding.
- Alcohol – Avoid all alcohol while breastfeeding. The alcohol irritates the baby's gastrointestinal tract and causes the LES to relax.
- Foods that cause gas – Certain foods can cause bloating and excess gas. These foods can also cause bloating in the baby, which increases the pressure on the LES, resulting in acid reflux. Foods to avoid are broccoli, Brussels sprouts, cabbage, cauliflower, kidney beans, and black beans.
- Fried Foods – these may contain unhealthy fats that can interfere with proper digestion, causing bloating.
Burping Your Baby
When burping the baby, try and sit him or her on your lap and burp them. Do not put them on your shoulder and pat their back. Your shoulder will press up against your tummy and place pressure on the stomach. This will cause acids to rise. It's simple things like these that many parents should be aware of and will go a long way towards easing their baby's suffering.
- Always place your baby on their back to sleep. Never on their stomach or their sides.
- Only place them on a firm mattress.
- Remove thick blankets, pillows, loose objects, or plush toys from their sleeping area.
Infant acid reflux is treatable. First, experiment to find the lifestyle change that gets your child's acid reflux under control. In most cases, minor adjustments are all that are needed. However, suppose the suggested changes like proper burping, sleeping position changes, smaller, more frequent meals, and consideration of changes in what you eat do not help your baby's symptoms. In that case, it is essential to consult your baby's physician.
- Schwartz, Steven M. "Pediatric Gastroesophageal Reflux." Medscape, Nov 17, 2017, medicine.medscape.com/article/930029-overview
- Stanford Children's Hospital. "Gastroesophageal Reflux Disease (GERD)/Heartburn in Children"
- Mayo Clinic. "Pyloric Stenosis." Jan 6, 2018
- Mayo Clinic. "Eosinophilic esophagitis." Dec 9, 2017
- Gastroesophageal reflux in children: an updated review June 17, 2019
The information contained here does not constitute medical advice and is not meant to diagnose, treat, prevent, or cure disease. Please contact your doctor. The information provided is for informational purposes only and are solely the views of the author.
There is a whole lot missing here, and frankly, Mayo Clinic and WebMD, where your references are from, know nothing about infant GERD, nor GERD in general. You should always site sources from actual studies instead of posts by businesses.
Hi Doughtie, thanks for your comment. I agree this isn’t an all-encompassing article. The purpose of this article is to give the reader an idea of what is the cause, symptoms, and most common diagnoses and treatments. For more information, and treatment, the child’s pediatrician should be consulted. I’ve removed the WebMD reference but kept the Mayo Clinic reference.