Patient education: Spitting up and GERD in babies (The Basics)

When is spitting up a problem? — Healthy babies often spit up milk or formula after eating. Most babies grow out of it without treatment.

Sometimes, people use the term "acid reflux" for spitting up. Acid reflux is when the acid that is normally in the stomach backs up into the esophagus (figure 1). The esophagus is the tube that carries food from the mouth to the stomach. But baby spit-up does not always contain stomach acid.

If your baby spits up a lot, but seems otherwise happy and healthy, they probably have what is called "uncomplicated reflux." This is normal and very common. But in some babies, reflux can lead to problems. When this happens, doctors call it "gastroesophageal reflux disease" ("GERD").

Is my baby at risk of getting GERD? — Some babies have a higher risk of getting GERD, including those who:

●Were born prematurely (3 or more weeks before the due date)

●Are around cigarette smoke

●Have certain health problems, such as Down syndrome, cerebral palsy, or other problems with the brain or spinal cord

What are the symptoms of GERD? — Spitting up a lot does not mean that your baby has GERD. All babies cry and act fussy sometimes, and this does not always mean that something is wrong.

In babies who do have GERD, symptoms might include:

●Refusing to eat

●Crying and arching the back, as if in pain

●Choking on spit-up

●Vomiting forcefully

●Not gaining weight normally

Should my baby see a doctor or nurse? — If your baby spits up a lot and has any of the symptoms listed above, talk to a doctor or nurse. They can do an exam. They might also do tests to check whether your baby's symptoms are caused by acid reflux or something else.

Uncomplicated reflux does not usually cause pain, and usually does not need treatment. If your baby cries a lot or is having trouble sleeping, their doctor or nurse can help decide if this is normal or caused by GERD or some other problem.

Is there anything I can do to help my baby feel better? — Yes. If your baby spits up a lot or seems uncomfortable, you can try:

●Keeping the baby upright after eating – Your baby might spit up less often if you calmly hold them up on your shoulder for 20 to 30 minutes after a feeding. Burping your baby often can help, too. Putting the baby in an infant seat (such as a car seat) right after feeding does not help with reflux, and can actually make it worse. Also, don't try to force your baby to eat when they don't want to.

Always put your baby to sleep on their back, not their side or belly. This is the safest position for sleep, whether or not your baby spits up a lot.

●Quitting smoking – If you smoke, or if anyone in your house smokes, this can make your baby's reflux worse and can cause other health problems for babies and children. You can get help to quit smoking (call 1-800-QUIT-NOW or 1-800-784-8669). Keep your baby away from cigarette smoke when you are out of the house, too.

●A milk-free and soy-free diet – Some babies have trouble digesting cow's milk or products made with soy. Your baby's doctor or nurse might suggest that you try removing milk and soy from the baby's diet. If you breastfeed your baby, you can try removing all milk and soy from your diet, too. Then, see if your baby's reflux improves after a few weeks. If your baby drinks formula, there are special brands available that do not contain cow's milk or soy. Most babies who have trouble with milk or soy outgrow the problem by the time they are 1 year old.

●Thickened feeds – Adding baby cereal to your baby's bottle to make the milk thicker might help with reflux. Oat cereal is often a good choice. There are special thick formulas available, too. Talk to your baby's doctor or nurse about whether to try thickened feeds.

There are also special powder thickeners meant to be added to milk or formula. But these might not be safe for babies, especially if they were born early (premature).

How is GERD treated? — Most babies who spit up a lot do not need medicine. Plus, medicines do not always make the reflux better. But if you have tried the ideas above, and your baby is still having symptoms like acting irritable or not eating enough, your baby's doctor or nurse might suggest trying medicine. There are lots of medicines available for adults with acid reflux, but not all of them can be used safely in babies.

If your baby has GERD, a doctor might recommend:

●Proton pump inhibitors – These medicines stop the stomach from making acid. Doctors sometimes recommend omeprazole (brand name: Prilosec), lansoprazole (brand name: Prevacid), or similar medicines for babies. But they usually stop the medicine if it does not help within a few weeks.

●Other medicines – Another medicine that doctors sometimes suggest is famotidine (brand name: Pepcid). This medicine stops the stomach from making acid, but only works for a few weeks. Antacids are not very helpful, because they are not as good at stopping the stomach from making acid. Besides, it is not safe to give more than a few doses of antacids to a baby.

Talk to your baby's doctor or nurse before you give your baby any medicines for acid reflux.

More on this topic

Patient education: Acid reflux and GERD in children and teens (The Basics)
Patient education: Acid reflux and GERD in adults (The Basics)
Patient education: Esophagitis (The Basics)

Patient education: Acid reflux (gastroesophageal reflux) in babies (Beyond the Basics)
Patient education: Gastroesophageal reflux disease in children and adolescents (Beyond the Basics)
Patient education: Gastroesophageal reflux disease in adults (Beyond the Basics)