Reflux in Babies and Toddlers

mom holding a baby

Reflux, or gastroesophageal reflux (GER), is a common condition affecting 40 to 65 percent of infants. It peaks between 1 and 4 months and usually resolves by 12 months of age. Babies that have GER regurgitate, or spit up, shortly after eating. This happens when stomach contents return up the esophagus and into and out of the mouth.

Cause of GER in Infants

The cause of GER is an immature digestive system. The muscle that separates the stomach from the esophagus can be underdeveloped in some babies, allowing undigested stomach content to rise up into the esophagus. This muscle matures between 6 and 12 months of age, so most babies grow out of GER by their first birthday with only 1 percent of toddlers having GER.

In most cases, reflux is mild and normal. If you have a happy baby who is eating and growing normally, there’s no reason to be concerned. Severe GER, however, can indicate gastroesophageal reflux disease (GERD) or gastrointestinal obstruction, which are rare but more serious conditions. Speak with your pediatrician if your baby is not gaining weight, spits up large amounts, vomits forcefully (projectile vomiting), spits up green or yellow fluid, repeatedly refuses food, or has difficulty breathing after vomiting.

Preventing GER

Here are some tips to prevent reflux in your baby:

  • Feed small, frequent meals.
  • Get rid of excess gas by burping your baby more frequently not only after, but during feeding.
  • Keep your baby upright at least 30 minutes after feeding.
  • Continue to breast-feed. “Research doesn’t show that a mother's diet causes reflux in the breast-fed baby, even though this is a common belief held by some,” says Melinda Johnson, MS, RD, spokesperson for the Academy of Nutrition and Dietetics.
  • If you use infant formula, switch to a thickened formula with the help of your pediatrician.

An estimated 5 percent of infants are unable to handle proteins found in milk or soy formulas. Consult with your pediatrician about alternative formulas. “Keep a journal of all foods eaten and symptoms experienced, and add only one new food at a time to pinpoint trigger foods,” says registered dietitian nutritionist Rachel Begun, MS, RDN.

A registered dietitian nutritionist can help you analyze a food journal and instruct you on creating the best eating plan for your baby.

Long-Term Prognosis for Infants with GER

Johnson assures parents that most babies grow out of reflux as their gastrointestinal track matures. “Check with the baby’s doctor to monitor weight and ensure your baby is staying hydrated and not experiencing an obstruction of the gastrointestinal tract,” she says.

However, if symptoms continue beyond the first year of age, especially if your toddler is showing signs of poor growth or problems with breathing, consult your pediatrician. Babies who frequently spit up may be more likely to develop GERD as older children.

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