Reflux in babies happens when food or milk flows back into the mouth after being swallowed. This can lead to spit-ups, irritability, excessive crying, or restless sleep, and in more serious cases, feeding problems, pneumonia, or apnea. It is especially common during the first year of life.
Most babies experience reflux because their gastrointestinal tract is still developing. It is also more likely in babies who were born prematurely, have obesity, or have conditions like cerebral palsy or cow’s milk protein allergy. While reflux is not always a sign of illness, other symptoms beyond spit-ups or vomiting should be evaluated by a pediatrician.
Treatment often focuses on simple adjustments, like reducing feeding volume or using special formulas. In some cases, pediatricians may recommend medication or, more rarely, surgery when symptoms are severe or persistent.
Signs and symptoms
The main symptoms of reflux in babies include:
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Spit-ups
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Vomiting
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Irritability
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Excessive crying
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Restless sleep
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Feeding difficulties
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Choking
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Frequent coughing
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Hoarseness
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Difficulty gaining weight
Reflux is common in babies younger than 1 year and usually does not cause symptoms beyond spit-ups and the occasional vomiting episode, especially after breastfeeding or meals.
If additional symptoms appear, or if spit-ups and vomiting continue past 1 year of age, it is important to see a pediatrician or pediatric gastroenterologist for diagnosis and treatment guidance.
Confirming a diagnosis
A pediatrician typically confirms reflux by reviewing the baby’s symptoms, medical history, and any complications.
In some cases, the doctor may order tests such as an abdominal ultrasound or a CT scan to rule out other conditions, like intestinal obstruction or hydrocephalus, that can cause similar symptoms.
Main causes
Reflux in babies is common and mainly occurs because the digestive system is still developing. After feeding, milk can easily flow back toward the mouth, leading to a spit-up.
Reflux is also more likely in babies born prematurely, those with obesity, asthma, allergies, cerebral palsy, genetic syndromes like Down syndrome, or a family history of gastroesophageal reflux.
Treatment options
Reflux in babies typically improves on its own between 6 months and 1 year of age without specific treatment.
However, depending on the severity and cause, doctors may recommend special formulas, such as anti-regurgitation or hydrolyzed formulas. In more persistent cases, medications may be considered. Surgery is generally reserved for severe cases that do not respond to other treatments.
Medication for reflux in babies
Medications sometimes used for reflux in babies include antacids, such as famotidine or omeprazole, and prokinetic medications, such as metoclopramide.
Famotidine is FDA-approved for treating reflux in infants. Omeprazole is approved for children 1 year and older but may be used off-label in younger infants when recommended by a pediatric gastroenterologist. Metoclopramide is FDA-approved for certain gastrointestinal conditions but is not specifically approved to treat reflux in infants, and its use for this purpose is off-label and uncommon due to the risk of neurological side effects.
These medications are rarely needed and should only be used under the guidance of a pediatrician or pediatric gastroenterologist.
Home treatment for reflux in babies
Home care for reflux can involve steps such as:
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Avoid giving a bottle or breastfeeding when the baby is not hungry
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Avoid rocking the baby after meals
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Avoid dressing the baby in tight clothing around the belly
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Offer the bottle more slowly
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Do not smoke near the baby
It also helps to keep the baby upright for about 30 minutes after feeding and to always place the baby on their back to sleep.
Possible complications
In more serious cases, reflux can cause aspiration pneumonia if stomach contents enter the lungs, esophagitis from frequent acid exposure, or apnea.
Feeding difficulties can also lead to anemia, malnutrition, or delayed development.