Gastroesophageal Reflux in Infants

On this page:

• What is gastroesophageal reflux (GER)?
• What are the symptoms of GER?
• How is GER diagnosed?
• What is the treatment for GER?
• Points to Remember
• Hope through Research
• For More Information

What is gastroesophageal reflux (GER)?

Gastroesophageal reflux (GER) occurs when stomach contents reflux, or back up, into the esophagus during or after a meal. The esophagus is the tube that connects the mouth to the stomach. A ring of muscle at the bottom of the esophagus opens and closes to allow food to enter the stomach. This ring of muscle is called the lower esophageal sphincter (LES). The LES normally opens to release gas after meals. With infants, when the LES opens, stomach contents often reflux into the esophagus and out the mouth, resulting in regurgitation, or spitting up, and vomiting. GER can also occur when babies cough, cry, or strain.

What are the symptoms of GER?

GER is common in healthy infants. More than half of all babies experience reflux in the first 3 months of life, but most stop spitting up between the ages of 12 to 24 months. Only a small number of infants have severe symptoms. An infant with GER may experience

• spitting up
• vomiting
• coughing
• irritability
• poor feeding
• blood in the stools

In a small number of babies, GER results in symptoms that cause concern. These symptoms include

• poor growth due to an inability to hold down enough food
• irritability or refusing to feed due to pain
• blood loss from acid burning the esophagus
• breathing problems

These problems can be caused by disorders other than GER. Your health care provider will need to determine whether GER is the cause of your child’s symptoms.

Digestive system noting the mouth, esophagus, lower esophageal sphincter (LES), stomach, and small intestine.

How is GER diagnosed?

An infant who is consistently spitting up or vomiting may have GER. The doctor or nurse will talk with you about your child’s symptoms and examine your child. Tests may be ordered to help determine whether your child’s symptoms are related to GER. Sometimes treatment is started without tests. If the infant is healthy, content, and growing well, often no tests or treatment are needed.

What is the treatment for GER?

The treatment for reflux depends on an infant’s symptoms and age. Some babies may not need treatment because GER often resolves by itself. Healthy babies may only need their feedings thickened with cereal and to be kept upright after eating. Overfeeding can aggravate reflux, so your health care provider may suggest different ways of handling feedings. For example, smaller quantities with more frequent feedings can help decrease the chances of regurgitation. If a food allergy is suspected, you may be asked to change the baby’s formula. Breastfeeding mothers may be asked to change their own diets for 1 to 2 weeks. If a child is not growing properly, higher-calorie food or tube feeding may be recommended.

When an infant is uncomfortable, has difficulty sleeping or eating, or does not grow, your health care provider may suggest a trial of medication to decrease the amount of acid in the stomach. Any potential complications related to the medication will be explained. However, most infants don’t need medication and outgrow reflux by 1 or 2 years of age.

^*If medication is needed, treatment will often start with a class of medications called H2-blockers, also called H2-receptor agonists. These drugs help keep acid from backing up into the esophagus. H2-blockers are often used to treat children with GER because they come in liquid form. H2-blockers include

• cimetidine (Tagamet)
• ranitidine (Zantac)
• famotidine (Pepcid)
• nizatidine (Axid)

A second class of medications often used to reduce stomach acid is proton-pump inhibitors (PPIs), which block the production of stomach acid. PPIs include

• esomeprazole (Nexium)
• omeprazole (Prilosec)
• lansoprazole (Prevacid)
• rabeprazole (Aciphex)
• pantoprazole (Protonix)

* The authors of this fact sheet do not specifically endorse the use of drugs for children that have not been tested in children (“off label” use). Such a determination can only be made under the recommendation of the treating health care provider.

Specific Instructions for Infants with GER

• If you feed your baby with a bottle, add up to 1 tablespoon of rice cereal to 2 ounces of infant milk. You can add cereal to expressed milk if you are breastfeeding. If the mixture is too thick for your baby you can change the nipple size or cut a little “x” in the nipple.

• Burp your baby after he’s consumed 1 or 2 ounces of formula. For breast-fed infants, burp after feeding on each side.

• Do not overfeed. Talk with your infant’s doctor or nurse about the amount of formula or breast milk that your baby is consuming.

• When possible, hold your infant upright in your arms for 30 minutes after feedings.

• Infants with GER should usually sleep on their backs, as is suggested for all infants. Rarely, a physician may suggest alternative sleep positions.

Points to Remember

• GER occurs when stomach contents back up into the esophagus.
• GER is common in infants but most grow out of it.
• In infants, GER may cause spitting up, vomiting, coughing, poor feeding, or blood in the stools.
• Treatment depends on the infant’s symptoms and age and may include changes in eating and sleeping habits. Medication may also be an option. Only rarely and in severe cases is surgery required.

Hope through Research

The National Institute of Diabetes and Digestive and Kidney Diseases, through its Division of Digestive Diseases and Nutrition, supports basic and clinical research into gastrointestinal diseases. Researchers are studying the risk factors for developing GER and what causes the LES to open, with the aim of improving future treatment for GER. They are also studying the efficacy and safety of drug therapy for the treatment of GER in children and investigating the effectiveness of medications compared with surgery.

For More Information

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN)
P.O. Box 6
Flourtown, PA 19031
Phone: 215–233–0808
Fax: 215–233–3918
Email: naspghan@naspghan.org
Internet: www.NASPGHAN.org

NASPGHAN’s Children’s Digestive Health and Nutrition Foundation (CDHNF)
Internet: www.CDHNF.org

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.

National Digestive Diseases Information Clearinghouse

2 Information Way
Bethesda, MD 20892–3570
Phone: 1–800–891–5389
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: nddic@info.niddk.nih.gov
Internet: www.digestive.niddk.nih.gov

The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1980, the Clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.

Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This publication was reviewed by NASPGHAN.

This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.

NIH Publication No. 06–5419
August 2006