Gastroesophageal reflux in infants
Gastroesophageal reflux occurs when stomach contents leak backward from the stomach into the esophagus. This causes "spitting up" in infants.
Reflux - infants
When a person eats, food passes from the throat to the stomach through the esophagus. The esophagus is called the food pipe or swallowing tube.
A ring of muscle fibers prevents food at the top of the stomach from moving up into the esophagus. These muscle fibers are called the lower esophageal sphincter, or LES. If this muscle does not close well, food can leak back into the esophagus. This is called gastroesophageal reflux.
A small amount of gastroesophageal reflux is normal in young infants. However, ongoing reflux with frequent vomiting can irritate the esophagus and make the infant fussy. Severe reflux that causes weight loss or breathing problems is not normal.
Symptoms may include:
- Cough, especially after eating
- Excessive crying as if in pain
- Excessive vomiting during the first few weeks of life; worse after eating
- Extremely forceful vomiting
- Not feeding well
- Refusing to eat
- Slow growth
- Weight loss
- Wheezing or other breathing problems
Exams and Tests
The health care provider can often diagnose the problem by asking about the infant's symptoms and doing a physical exam.
Infants who have severe symptoms or are not growing well may need more testing to find the best treatment.
Tests that may be done include:
- Esophageal pH monitoring of stomach contents entering the esophagus
- X-ray of the esophagus
- X-ray of the upper gastrointestinal system after the baby has been given a special liquid, called contrast, to drink
Often, no feeding changes are needed for infants who spit up but are growing well and seem otherwise content.
Your provider may suggest simple changes to help the symptoms such as:
- Burp the baby after drinking 1 to 2 ounces of formula, or after feeding on each side if breastfeeding.
- Add 1 tablespoon of rice cereal to 2 ounces of formula, milk, or expressed breast milk. If needed, change the nipple size or cut a small x in the nipple.
- Hold the baby upright for 20 to 30 minutes after feeding.
- Raise the head of the crib. However, your infant should still sleep on the back, unless your provider suggests otherwise.
When the infant begins to eat solid food, feeding thickened foods may help.
Medicines can be used to reduce acid or increase the movement of the intestines.
Most infants outgrow this condition. Rarely, reflux continues into childhood and causes esophageal damage.
Complications may include:
- Aspiration pneumonia caused by stomach contents passing into the lungs
- Irritation and swelling of the esophagus
- Scarring and narrowing of the esophagus
When to Contact a Medical Professional
Call your provider if your baby:
- Is vomiting forcefully and often.
- Has other symptoms of reflux.
- Has problems breathing after vomiting.
- Is refusing food and losing or not gaining weight.
- Is crying often.
Hibs AM. Gastroesophageal reflux and gastroesophageal reflux disease in the neonate. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 10th ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 91.
Khan S, Orenstein S. Gastroesophageal reflux disease. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 323.
Reviewed By:Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency
or for the diagnosis or treatment of any medical condition. A licensed medical professional
should be consulted for diagnosis and treatment of any and all medical conditions. Call 911
for all medical emergencies. Links to other sites are provided for information only -- they
do not constitute endorsements of those other sites. © 1997-A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.
Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.