Gastroesophageal Reflux

Gastroesophageal reflux (also known simply as “reflux” or “GER”) is very common in babies. For most babies, it does not cause any problems and gradually resolves between 6-12 months of age. When it causes problems (like pain or poor feeding), it is called “gastroesophageal reflux disease” (or “GERD”).

What is Reflux?

Reflux (also called “spit-up”) happens when milk from your baby’s stomach comes back up into the throat or mouth. This is very common — at least 40% of babies spit up every day. Reflux usually starts in the first few weeks of life, worsens between 2-4 months of age, and typically goes away on its own by 12 months of age.

Reflux is normal and has benefits! Scientists who study human milk believe that spitting up transports many of the germ-fighting factors in breastmilk to the nose, throat, sinuses, eustachian tubes (tunnels that lead to the inner ear), and lungs, keeping those parts of the body healthy by preventing infections. For example, we know that breastfed babies have a lower risk of ear infections and pneumonia.

Babies with normal reflux are often called “happy spitters” — they spit up and are otherwise comfortable, feed well, and gain weight normally. This type of reflux does not need medicine, testing, or any treatments.

GERD, or gastroesophageal reflux disease, is when reflux causes infants to not feel well, with symptoms such as pain or nausea with feeding. These babies may show signs of feeding refusal such as pushing away, arching their backs, or crying when offered to breast or bottle feed. With advanced symptoms, they may have trouble gaining weight. This type of reflux requires the help of the baby’s physician or other healthcare provider for evaluation and treatment.

Tips to Help Reduce Spit-up When Breastfeeding

• Feed smaller amounts more often. Try shorter, more frequent nursing or bottle feeding sessions rather than longer, less frequent ones. Overfilling the stomach can make reflux worse.
• Burp your baby frequently. Pause to burp your baby during and after each feeding. This helps release trapped air.
• Keep your baby upright after feeding. Hold your baby upright against your chest and shoulder for 10-20 minutes after nursing. Avoid placing your baby in a car seat or bouncer right after feeding, as the semi-reclined position can make reflux worse.
• Check your latch and positioning. A good latch helps your baby swallow less air. If you are having trouble with latch or positioning, ask your baby’s health provider or a lactation consultant for help.
• Use paced bottle–feeding techniques. Paced bottle feeding refers to offering the bottle in a manner that allows babies to set the tempo of their feeding, and it helps to prevent over-feeding.

Could It Be Something in My Diet?

This is a common concern of parents when babies spit up frequently.

Sometimes proteins from foods in a breastfeeding parent’s diet — especially cow’s milk (dairy) — can pass into breast milk and trigger spitting up. Other foods have not been shown to do this. If your baby’s reflux is severe or not improving, your baby’s physician or other healthcare provider may suggest removing dairy products (milk, cheese, yogurt, butter) or other foods from your diet for 2 to 4 weeks to see if symptoms improve.

Most babies with reflux do not need medication. Reflux medications (such as acid blockers) do not stop spit-up — they only reduce the acid in the stomach and treat the pain associated with spitting up. These medications are not recommended for “happy spitters” (healthy babies who are simply spitting up but not bothered by it).

If your baby has more serious symptoms (like refusal to eat, excessive fussiness, pain related to feeding, or poor weight gain), your baby’s physician or other healthcare provider might recommend a short trial of medication. Never give your baby any over-the-counter reflux or antacid medication without talking to a health provider first.