Gastroesophageal Reflux (GER), or reflux, is the passive, backward flow of stomach contents into the esophagus. This occurs because the lower esophageal sphincter, the muscular ring between the esophagus and the stomach, is still immature in infants. The liquid-only diet and the amount of time babies spend lying flat contribute to the frequency of this occurrence. While reflux is extremely common in early life, it is important to understand whether your baby’s symptoms represent a normal developmental phase or a condition requiring medical attention.
Reflux Versus Normal Spitting Up
The difference between normal infant reflux and a more concerning condition is defined by the presence of discomfort and complications. Physiological reflux, or “happy spitting,” is routine for about half of all babies in the first three months of life. These infants frequently bring up small amounts of milk without apparent pain or distress. This kind of reflux is not considered a disease and typically resolves as the baby’s digestive system matures, often by 12 to 14 months of age.
Gastroesophageal Reflux Disease (GERD) is diagnosed when the backward flow causes complications or significant, bothersome symptoms. This suggests the reflux is causing pain or is severe enough to interfere with well-being. The key distinction is that GERD affects the baby’s health, growth, or quality of life.
Signs That Suggest Reflux
Parents can use a symptom checklist to assess if their baby’s frequent spitting up is more likely GERD. Signs are generally categorized into behavioral indicators of pain and physical manifestations of the reflux event. Observing a combination of these signs offers insight into the baby’s level of discomfort.
Behavioral Signs
Excessive fussiness or irritability, especially during or immediately following a feeding, is a common behavioral indicator. The baby may cry inconsolably or show signs of discomfort that are difficult to soothe. A particularly telling sign is arching the back, often pushing away from the breast or bottle during a feed, which is a reaction to the pain of rising stomach acid.
Babies with painful reflux may refuse to eat or only take small, frequent amounts to avoid the pain of a full stomach. Conversely, some infants may “cluster feed” or feed constantly, perhaps trying to soothe the burning sensation in their esophagus with milk. Frequent hiccups, coughing, or a hoarse cry may also indicate that stomach contents are reaching the throat area.
Physical Signs
Frequent regurgitation is a clear physical sign, but not all reflux is visible; this is often called “silent reflux.” In these cases, stomach contents come up into the esophagus but are swallowed back down, causing the baby to gulp or swallow repeatedly after a burp or feed. Wet burps, which include a small amount of liquid coming up, are also a frequent occurrence.
Poor weight gain, sometimes called failure to thrive, is a serious physical concern resulting from not keeping enough nutrition down or refusing to eat due to discomfort. Other physical signs include noisy breathing, wheezing, or a recurrent cough unrelated to a cold or illness. These respiratory symptoms occur when stomach contents are inhaled into the airways.
Immediate Comfort Measures
Several non-medical adjustments to environment and feeding technique can immediately help alleviate mild reflux symptoms. Keeping the baby upright during feeds is highly recommended to help the milk settle. An upright or semi-upright position ensures the baby’s head is above the stomach, which minimizes the return flow.
After feeding, hold your baby upright for at least 20 to 30 minutes, avoiding jostling or pressure on the abdomen. Small, more frequent feedings prevent the stomach from becoming overly full, reducing pressure on the lower esophageal sphincter. Burping your baby frequently throughout the feeding, rather than only at the end, helps release trapped air that can force milk back up.
If breastfeeding, consult your pediatrician about whether eliminating common dietary triggers, such as cow’s milk protein, from your own diet may be beneficial. For formula-fed infants, a doctor may suggest a trial of a specialized formula or thickening the formula with rice starch or a commercial thickener. Never make major dietary changes or thicken feeds without first discussing it with a healthcare professional.
When to Consult a Pediatrician
While most reflux resolves naturally, certain “red flag” symptoms indicate a need for prompt medical evaluation.
- Projectile vomiting, defined as forceful vomiting that travels a significant distance, is a serious sign that requires immediate medical attention.
- Vomit that is green or yellow, known as bilious vomiting, or contains blood, whether red or coffee-ground-like, also warrants an urgent call to the doctor.
- If your baby’s refusal to feed or difficulty feeding is severe enough to cause weight loss or a significant failure to gain weight, this is a clear indication for professional help.
- Signs of dehydration, such as reduced urination, lethargy, or a sunken soft spot (fontanelle), are also urgent concerns.
- Any instance of choking, gagging, or breathing difficulties that seem linked to feeding should be evaluated quickly to rule out respiratory complications.