Infant acid reflux

More than half of all babies experience infant acid reflux during the first three months after birth, according to the National Digestive Diseases Information Clearinghouse. Although infant acid reflux is most likely after a feeding, it can happen anytime your baby coughs, cries or strains. And it’s probably tougher on you than on your baby. Even when soaked in spit up, most babies who have infant acid reflux are healthy and content. Infant acid reflux typically resolves on its own by ages 12 to 18 months. In the meantime, changes in feeding technique — such as smaller, more frequent feedings, changing position or interrupting feedings to burp — can help keep reflux under control. In a few cases, medication or other treatments may be recommended.

Signs of infant acid reflux may include:

  • Spitting up
  • Irritability during or after feedings
  • Poor feedings

Normal infant acid reflux doesn’t interfere with a baby’s growth or well-being. Contact your baby’s doctor if your baby:

  • Isn’t gaining weight
  • Spits up forcefully, causing stomach contents to shoot out of his or her mouth
  • Spits up more than a tablespoon or two at a time
  • Spits up green or brown fluid
  • Resists feedings
  • Is irritable after feedings but improves when held upright
  • Has fewer wet diapers than normal or appears lethargic
  • Has other signs of illness, such as fever, diarrhea or difficulty breathing

Some of these signs may indicate more serious conditions, such as gastroesophageal reflux disease (GERD) or pyloric stenosis. GERD is a severe version of reflux that can cause pain, vomiting and poor weight gain. Pyloric stenosis is a rare condition in which a narrowed valve between the stomach and the small intestine prevents stomach contents from emptying into the small intestine.

Normally, the ring of muscle between the esophagus and the stomach (lower esophageal sphincter) relaxes and opens only when you swallow. Otherwise, it’s tightly closed — keeping stomach contents where they belong. Until this muscle matures, stomach contents may occasionally flow up the esophagus and out of your baby’s mouth. Sometimes air bubbles in the esophagus may push liquid out of your baby’s mouth. In other cases, your baby may simply drink too much, too fast.

Most cases of infant acid reflux clear up on their own without causing problems for the baby. Rarely, infant acid reflux can lead to poor growth or breathing problems. Some research indicates that babies who have frequent episodes of infant acid reflux may be more likely to develop gastroesophageal reflux disease during later childhood.

Treatment is typically limited to simple changes in feeding technique — such as smaller, more frequent feedings, interrupting feedings to burp or holding your baby upright during feedings. If you’re breast-feeding, your baby’s doctor may suggest that you avoid cow’s milk or certain other foods. If you feed your baby formula, sometimes switching brands helps.

For babies who have severe infant acid reflux or GERD, more aggressive treatment may be recommended.

Medication. If your baby is uncomfortable, the doctor may prescribe infant doses of medications commonly used to treat heartburn in adults. Choices may include H-2 blockers, such as cimetidine (Tagamet) or ranitidine (Zantac), or proton pump inhibitors, such as omeprazole (Prilosec) or lansoprazole (Prevacid). It’s important to note that otherwise healthy children taking these medications may face an increased risk of certain intestinal and respiratory infections.

Alternative feeding methods. If your baby isn’t growing well, higher calorie feedings or a feeding tube may be recommended.
Surgery. Rarely, the muscle that relaxes to let food into the stomach (the lower esophageal sphincter) must be surgically tightened so that less acid is likely to flow back into the esophagus. The procedure, known as fundoplication, is usually reserved for the few babies who have reflux severe enough to interfere with breathing or prevent growth. Although surgery can reduce GERD symptoms, the complications are potentially serious — including persistent gagging during feedings.

To minimize the mess, consider these tips:

Keep it calm. Make each feeding peaceful and relaxed. Feed your baby before he or she becomes frantic.
Sit up. Feed your baby in an upright position. Follow each feeding with 15 to 30 minutes in a sitting position. Try a front pack, backpack or infant seat. Gravity can help stomach contents stay where they belong. Be careful not to jostle or jiggle your baby while the food is settling.
Try smaller, more frequent feedings. Feed your baby an ounce (about 30 milliliters) less than usual or limit nursing sessions to just one breast.
Take time to burp. Frequent burps during and after each feeding can keep air from building up in your baby’s stomach. Sit your baby upright, supporting his or her head with your hand. Avoid burping your baby over your shoulder, which may put pressure on your baby’s abdomen.
Check the nipple. If you’re using a bottle, make sure the hole in the nipple is the right size. If it’s too large, the milk will flow too fast. If it’s too small, your baby may get frustrated and gulp air. A nipple that’s the right size will allow a few drops of milk to fall out when you hold the bottle upside down.
Thicken the formula or breast milk. If your baby’s doctor approves, add a small amount of rice cereal to your baby’s formula or expressed breast milk. You may need to enlarge the hole in the nipple to make sure your baby can drink the thickened liquid.
Raise the head of the crib. To reduce the risk of sudden infant death syndrome, it’s important to place your baby to sleep on his or her back. This position can aggravate reflux, however. It may help to slightly elevate the head of your baby’s crib.

Remember, infant acid reflux is usually little cause for concern. Keep plenty of burp cloths handy as you ride it out.