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. Our pediatric pros explain how families can help babies with reflux work through it.
At A Glance
Reflux in babies is normal, and in many cases, it improves naturally with time.
The vast majority of babies with reflux are “happy spitters” without pain or discomfort.
A small percentage of babies have gastroesophageal reflux disease, which is associated with irritation and pain.
There are different ways to help with reflux. Consult your doctor to create a plan.
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.
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. 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. 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 include:
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.
Keep baby upright. Help baby sit upright for 30 minutes after feeding. Lying baby on their left side or offering the pacifier can also help.
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. 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.
Try paced feeds. Pause baby every 4-5 minutes, sit them up and offer a pacifier. Then return to feeding baby. Short breaks can help the belly handle the milk.
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. 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 can worsen reflux.
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.
Frequently Asked Questions
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)
Written By
R. Ruiz, MD, FAAP, CLC. Pediatric Gastroenterologist
V. Kalami, MNSP, RD, CSP. Pediatric Dietitian/Nutritionist
K. Grenawitzke, OTD, OTR/L, SCFES, IBCLC. Pediatric Feeding/Swallowing Specialist
K. Rappaport, OTR/L, MS, SCFES, IBCLC. Pediatric Feeding/Swallowing Specialist
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