Acid Reflux in Newborns & Young Babies
Reflux impacts 1 in 2 babies in the United States. While it typically resolves itself between 12 to 18 months of age, reflux in newborns can be stressful for both you and baby.
Key Points
Reflux is common in babies and usually improves naturally with time
Reflux peaks around 4 to 5 months of age and typically disappears by 12 to 18 months as baby grows and develops.
The vast majority of babies with reflux are “happy spitters” without pain or discomfort
When reflux causes complications like feeding refusal, difficulty gaining weight, or significant discomfort, it may be considered acid reflux or gastroesophageal reflux disease (GERD). If your baby seems to be in pain around feeds or is struggling to grow, contact their medical provider.
There are many strategies that can help ease symptoms of reflux
From feed pacing and positioning to formula changes and dietary adjustments, there are a number of ways to reduce reflux symptoms. Because every baby is different, work with your doctor to figure out which approach makes the most sense for your child.
What is reflux?
Reflux (also called gastroesophageal reflux) happens when contents in the tummy backwash into the food tube, also known as the esophagus. Reflux usually causes babies to spit up or even vomit, among other symptoms. Reflux is usually harmless, and it is very common in young babies. It typically peaks around 4 to 5 months of age, and slowly improves through the first year of life, resolving itself between 12 and 18 months of age.[1]
Occasionally, reflux leads to discomfort or pain, also known as GERD (gastroesophageal reflux disease) which is a cause of concern. If this is the case for your baby, work with your doctor to create a plan that addresses the child’s needs.
What are reflux symptoms in babies?
Most babies with reflux tend to be “happy spitters” who do not experience any discomfort or pain, and in these cases, intervention isn’t usually needed.[1] If a baby cries, forcefully vomits, or arches their back while experiencing reflux, talk to your doctor. Some babies with painful reflux have difficulty with feeding and growing, and nutritional or medical strategies may be needed.
What causes reflux in babies?
Reflux usually happens when a baby’s muscles are not fully developed near the connection of the food tube and the stomach. These muscles act like a door between the food tube and the stomach, and when the body is not eating, they stay shut. For babies with reflux, the door is often open when it shouldn’t be because the muscles are still growing strong. Additionally, in babies, the angle in which the food tube connects to the stomach is large, which can make it easier for stomach contents to reflux into the food tube. As babies grow and develop, this angle becomes smaller and their muscles stronger, and reflux tends to resolve itself, typically disappearing by 12 to 18 months of age.
How to help baby with reflux?
Different factors can worsen reflux in babies, including constipation, overfeeding, slow digestion, positioning during and after feeding, diet (of baby or breastfeeding parent), cow’s milk protein allergy, and in some cases, anatomical abnormalities.[2] There are ways to address these contributing factors to help alleviate reflux in babies, though each child has different circumstances and needs. Consult your doctor to ensure you are taking the appropriate steps for your child.
Common Strategies to Help Babies with Reflux | Description |
|---|---|
Consider the diaper and waistband | The diaper should be snug but not so tight that it’s applying pressure on the abdomen, which can lead to reflux.[1] |
Keep baby upright | Help baby sit upright for 30 minutes after feeding. Lying on their left side can also help. Offering the pacifier after feeding can also help.[3] [4] [5] |
Observe the latch | If baby swallows lots of air while sucking, reflux can occur. Work with a lactation consultant or feeding professional to assess baby’s latch. |
Avoid overfeeding | Too much breast milk or formula can worsen reflux.[1] [6] Follow your baby’s cues for when they are full, and let them set the pace of how much to drink. |
Break for burps | While feeding, take frequent breaks to burp baby, which can help reduce reflux by decreasing the likelihood of big burps when the stomach is full.[1] |
Try pacing the feed | Short breaks can help the belly handle the milk. You can do this with paced bottle feeding or when breastfeeding, pause baby every 4 to 5 minutes, and let sit up in your lap with a pacifier for a few minutes, then return to feeding baby. |
Smaller, frequent feeds | Offer a little less breast milk or formula at each feeding, and increase the frequency. This way, the belly is a little less full (and less likely to spit up). |
Resolve constipation | When constipation happens, it can create a back-up in the tummy that leads to reflux.[2] For details, check out our infant constipation guide. |
Focus on tummy time | As baby’s core strength grows, reflux symptoms often decrease as muscles become more capable of keeping tummy contents where they belong. Just be sure to avoid placing baby on tummy immediately after feeds, which can cause reflux. |
Be careful of smoke | Avoid exposure to tobacco smoke, which worsen reflux.[1] |
Try a new formula | Ask your doctor or dietitian about formulas for babies with reflux. |
Talk to your doctor about diet | In some cases, cow’s milk, soy, and other foods may need to be removed from a breastfeeding parent’s diet.[2] |
When to seek help
Contact your doctor if you observe any of the following symptoms:
baby is regularly struggling to drink or refusing food
baby is arching or crying during or after nursing or bottle feedings
baby is not gaining weight
baby has bloody or green/yellow vomit
baby is inconsolable when crying
baby has trouble breathing
baby is frequently coughing on their spit up, breastmilk, or formula
baby is having projectile vomiting during or after eating
baby will only eat when falling asleep or sleeping (dream feeding)
Frequently Asked Questions
Silent reflux is the presence of reflux without overt or outward symptoms. Sometimes babies with silent reflux will have trouble gaining weight, have difficulty feeding, or are challenging to soothe, but do not show the typical signs of reflux described above.
A small percentage of babies have gastroesophageal reflux disease (GERD). GERD happens when reflux causes complications such as pain and discomfort around feeding, feeding refusal, difficulty gaining weight, and more. That said, it can be difficult to diagnose, so if your baby is showing signs of GERD, consult baby’s doctor.
Signs baby may have GERD:
Crying during feeds
Forceful or projectile vomiting
Arching the back as if in pain after a feed
Refusing to eat
Spitting up blood
Coughing while feeding
Difficulty gaining weight
Baby begins showing signs of reflux after 6 months of age
Formulas that are easier for babies to process and digest can help reduce reflux symptoms, including formulas with whey and casein as the primary proteins. Talk to your baby’s medical provider about formulas labeled as “hypoallergenic” or "hydrolyzed," which may help. Your baby’s doctor or dietitian, should be able to help you choose one that works for your baby’s needs.
No specific diet has been proven to fix reflux in all breastfed babies. Some common foods in a breastfeeding parent’s diet—especially cow's milk and soy—are thought to make reflux worse for some babies, but every baby is different. When dealing with a baby with reflux, figuring out which foods to cut and which to keep in a breastfeeding parent’s diet is different for every family. Before removing anything from your diet, talk to your doctor and, if possible, a lactation consultant. The goal is to help baby feel better without cutting out more than you need to.
It may, but talk to your doctor first. Thickening bottle feeds with rice cereal used to be a common intervention to address reflux, but due to concern of arsenic in rice, major medical institutions now recommend the use of infant oatmeal, among other alternatives. Your baby’s medical provider should be able to guide you on this.
No. While some doctors may suggest an early introduction of solids as a remedy for reflux, there is no research to support this claim. In fact, some studies suggest that starting solids can actually worsen it. Starting solids before baby is developmentally ready can increase the risk of choking and lead to baby refusing solid foods. It also may decrease a baby’s interest in drinking breast milk or formula, which needs to be their primary source of nutrition at this age.
Learn what to expect with reflux and starting solids once baby is developmentally ready.
Dream feeding is a technique where a caregiver offers baby a breast or bottle feeding while baby is in a light sleep state, allowing them to remain asleep but also fill their belly. The parent gently rouses the baby and offers a feeding in an attempt to help the baby learn to sleep longer stretches.
Dream feeding may also be used by some parents when baby has reflux as a way to feed a baby who refuses to eat when they are awake. In particular, babies who have acid reflux may find that eating leads to pain, and over time they may refuse the breast or bottle, or may eat only very small amounts at each meal to avoid the feeling of pain from acid reflux when the belly gets filled. In this situation, the caregiver is relying on baby’s sucking reflexes (which can be quite strong when baby is in a light sleep state) to override their daytime refusal. When this happens, dream feedings can be a way for a family to help baby eat more over a 24-hour period while attempting to avoid the baby waking up every few hours throughout the night.
While dream feedings can be a way to help a baby with acid reflux eat enough to grow in the short-term, they are considered a quick fix, not a sustainable path forward. If you need to rely on dream feeds to help your baby eat enough to grow, we suggest getting further support with managing baby’s reflux from your baby’s medical provider.
